Greater Occipital Nerve Blockade in Veterans With Post-concussion Headache: Sub-study 2

Anesthetic greater occipital nerve (GON) blockade is a simple, inexpensive, and safe procedure that has demonstrable headache pain suppressing effects. In this study, Veterans with post-traumatic headache will be randomized to receive 0.0%, 0.05%, or 0.5% bupivacaine in bilateral GON blocks and the lasting (i.e., transitional) effects on headache frequency measured in a headache diary.

Inclusion Criteria: * United States Military Veterans within VA Connecticut Healthcare System1. * Head injury with headaches that have continued to occur for at least three months after the head injury * At least two headache days per week * Review of the medical record does not reveal another source for headache Exclusion Criteria: * Skull defect * Other contraindication to bupivacaine * Allergy or adverse reaction (e.g., rash, cardiac effects) to amide anesthetics, such as lidocaine * Instruction from clinician to avoid amide anesthetics, such as lidocaine * Pregnant or lack of adequate birth control * Clinical review of the patient's case reveals red flag signs or symptoms (e.g., side-locked pain, unilateral numbness/weakness during headache, rapid ascension to peak pain, syncope during attacks) that warrant further work-up (e.g., MRI, arterial imaging). * Absence of imaging warranted by the standard of clinical care for the head injury with headaches.