Diagnosis: Chronic migraine headaches.
Treatment: Pain Management (occipital nerve block,trigger point injections), Pre-service.
The insurer denied the Pain Management (occipital nerve block,trigger point injections), Pre-service.
The denial is upheld.

The patient is a female with chronic migraine headaches following a motor vehicle accident (MVA).

No, the occipital nerve block, trigger point injections are not medically necessary.

The patient is a female with migraine headaches, post-concussion syndrome, and depression who has undergone occipital nerve blocks (ONBs) and trigger point injections (TPIs). She previously underwent these injections in the past with reportedly "good results." However, there is no objective description of its effectiveness. The patient has had numerous injections at the same time. Based on the records, the patient underwent greater occipital nerve blocks (GONBs), auriculotemporal nerve blocks, and supraorbital nerve blocks at the same time. There is some marginal literature that supports the use of GONB in migraine headaches; however, coupled with the other two nerve blocks at the same time, it is impossible to determine which of these blocks were effective. Along with this, the patient also underwent trigger point injections to the neck and shoulder areas that also may cause headaches and neck pain. Given the fact that the literature is inconclusive for nerve blocks for migraine headaches, and that multiple nerve blocks and trigger point injections were performed at the time, without objective documentation of relief, the requested ONB and TPI (trigger point injections) are not medically necessary.