BackTable / VI / Podcast / Episode #242

Image-Guided Headache Interventions

with Dr. Dan Nguyen

In this episode, guest host Dr. Jacob Fleming interviews Dr. Dan Nguyen about MSK and neurologic pain interventions, specifically how he evaluates and treats different types of headaches at his practice.

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Image-Guided Headache Interventions with Dr. Dan Nguyen on the BackTable VI Podcast)
Ep 242 Image-Guided Headache Interventions with Dr. Dan Nguyen
00:00 / 01:04

BackTable, LLC (Producer). (2022, September 12). Ep. 242 – Image-Guided Headache Interventions [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Dan Nguyen discusses Image-Guided Headache Interventions on the BackTable 242 Podcast

Dr. Dan Nguyen

Dr. Dan Nguyen is an interventional radiologist specializing in interventional pain management with Neuroradiology & Pain Solutions of Oklahoma.

Dr. Jacob Fleming discusses Image-Guided Headache Interventions on the BackTable 242 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Show Notes

Dr. Nguyen left academia and the East Coast 6 years ago, where he trained in neurointerventional radiology and pain intervention to open his own practice in Oklahoma City after visiting Dr. Beall. He now has a clinic where he sees musculoskeletal and neurologic pain patients. He enjoys the long term relationships he has built with many patients in his practice. He still does a degree of diagnostic work so as not to lose his skills.

Next, Dr. Nguyen discusses how he evaluates and treats headaches as a neurological pain interventionalist. Understanding the neuroanatomy of the face is key. He tries to understand the presentation of the patient’s headaches, whether it is located above the eyebrow, near the ear or at the jaw. He treats cervicogenic headache, trigeminal neuralgia and occipital neuralgia with a diagnostic block, radiofrequency ablation and neuromodulation. He also treats migrainous headaches. After determining whether the pain is musculogenic or neurogenic, he does a trigger point injection or a test injection of the nerve, followed by RFA and neuromodulation.

Dr. Nguyen tells us his approach to trigeminal neuralgia workup. There are three branches, and the Gasserian ganglion (trigeminal ganglion) lies deep to the foramen ovale. To approach it, he usually tries to target the most peripheral nerve branch. For V1, he evaluates the supraorbital, supratrochlear nerves, which you can see with ultrasound. For V2, he evaluates the infraorbital with ultrasound. The foramen rotundundum requires CT guidance to access. For V3 he evaluates the mental and alveolar nerves or the foramen ovale. He does diagnostic blocks, and if this provides relief to the patient they discuss radiofrequency ablation. He advises operators to take the longest path to the nerve to ensure the ablative needle is fully buried under the skin to avoid burns. He also discusses the rare outcome of anesthesia dolorosa which can cause facial numbness and pain after ablation of the Gasserian ganglion. He says that for most of his patients, they accept this potential risk due to the more likely possibility of relief from the excruciating pain they experience with trigeminal neuralgia.

Resources

Dr. Nguyen Twitter:
@neuroradiology

Narouze: Interventional Management of Head and Face Pain
https://link.springer.com/book/10.1007/978-1-4614-8951-1

American Society of Spine Radiology:
https://assrannualmeeting.org

American Society of Neuroradiology:
https://www.asnr.org/annualmeeting/

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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