Postoperative Intractable Headache Resolving after Occipital Nerve Block

We present the case of a 59-year-oldman who had an unusual severe and debilitating postoperative headache and its challenging management. The patient had undergone a routine general anesthetic through his permanent tracheal stoma for this 30 minutes procedure of direct laryngoscopy and esophagoscopy with esophageal dilation. Upon arrival at recovery room, patient complained of a severe, debilitating headache not responding to aggressive pharmacologic treatment, which resolved utilizing a novel treatment. Performing an occipital nerve block in the recovery room provided rapid and complete resolution of this condition, thus avoiding further escalation of additional medication with potential unnecessary side effects and further workup and consultations. We also offer a discussion of this condition and its treatment. Herein, we review current literature from the fields of anesthesiology, neurology and otolaryngology. This case emphasizes the impact of patient positioning regardless of duration of the procedure. It stresses on the need for awareness among anesthesia providers of the patient's preexisting neck pathology and its possible contribution to severe postoperative headaches, resistant to pharmacologic treatment. We discuss the role of the occipital nerve block as a simple therapeutic modality for resolution of this debilitating morbidity in the postoperative period.