Hi,
And so it sounds as if your daughter has been diagnosed with
occipital neuralgia and now possibly supraorbital neuralgia which is a form of
trigeminal neuralgia.
The steroid block she is to receive is most likely for diagnostic and not therapeutic purposes since if she obtains the relief it will be very brief but will pretty much clinch the diagnosis.
If your daughter's headaches (especially the supraorbital problem) are due to the trauma of the head or face then, these are some of the most difficult types of headaches to treat.
In our Headache Clinic in Cleveland, OH I typically like to first identify a cause to the headache (since nobody is REALLY born with these problems). Once the cause has been found then, treatment directed at that cause will offer the most long term relief. Absent of that everything else is going to be mostly trial and error.
In the case of neuralgias many medications and classes are available such as antiepileptics (Tegretol,
Phenytoin, Depakote), calcium channel blockers (verapamil,
diltiazem, mexiletine), and then, there is
indomethacin which might work in this type of headache if it is part of a hemicranial syndromic presentation but if it is strictly a supraorbital neuralgia then, this may not be as good an answer as other remedies.
If she is on Neurontin with some relief then, ask about either high dose Neurontin, longer acting Neurontin (Trokendis), or if her insurance allows coverage with Lyrica or
Duloxetine then, I might try those as well. I would also not rule out the use of Botox injections as preventative and high dose melatonin (with cautions and caveats).
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Dariush Saghafi,
Neurologist