214 - Stellate ganglion block for refractory Post COVID headaches

Case Diagnosis: We present a series of five patients with long COVID headaches treated with stellate ganglion blocks (SGB).

Case Description: 1. A 38-year-old female with headache that lasted for one year received right SGB and had a 50% relief of headache that lasted ten months until the most recent evaluation.
2. A 48-year-old male with headache lasting for six months received right SGB and achieved 80% relief of headache. The relief lasted for twelve months.
3. A 58-year-old female with headache for two years received right SGB and showed complete relief of her headache. The relief lasted for eight months.
4. A 61-year-old female who presented with headache for two years showed a 30% reduction in headache at eight months following right SGB.
5. A 48-year-old female presented with brain fog for nine months. She received a sequential right SGB followed by left SGB. Right SGB resulted in 50% reduction in brain fog; left SGB resulted in 80% reduction.



Discussions: Right SGB resulted in significant reductions in headaches, reporting sustained reduction in headaches from 50% to 100%. It has been speculated that errors in the crosstalk between the immune system and the autonomic nervous system cause these headaches. This miscommunication can lead to poor sympathetic nerve control and cerebral blood flow in long COVID patients. With SGB shown to increase extra-cranial blood flow, we can deduce a mechanism by which SGB relieve these headaches.



Conclusions: The efficacy of SGBs in relieving long COVID headaches suggests a potential treatment option for patients with refractory symptoms. This also provides additional insight on the potential mechanism of the pathogenesis of these headaches, potentially by increasing cerebral blood flow.