Traumatic Brain Injury: Stellate Ganglion Block May Provide Relief

Traumatic brain injury (TBI), including "mild injuries" like concussions, affects millions of people every year. Fortunately, many patients recover on their own, but an alarming number experience persistent complications, including post-traumatic headaches, sleep disturbances, cognitive impairment, depression, and post-traumatic stress disorder (PTSD). Given the limited effectiveness of traditional treatments, and the concern for progressive degeneration, the Stellate Ganglion Block (SGB) holds promise for providing valuable symptom relief.

Post-Traumatic Headaches (PTH) after TBI

Headaches and migraines after TBI are one of the most common complications after TBI. These headaches can start as early as a few days after injury and can persist for months to years, significantly impairing quality of life. It appears these TBI-related headaches are a result of neurovascular inflammation, central sensitization, and cortical spreading depression (CSD), which can fuel chronic headache disorders.

CSD is a harmful complication of traumatic brain injury, often resulting from loss of blood flow and direct neuronal damage. In CSD, vital chemicals responsible for proper neuron functioning become dysregulated. Neuroscientists refer to this as a collapse of electrochemical membrane gradients, which leads to loss of electrical signaling, excessive calcium loading in cells, cellular swelling, and dysregulated release of neurotransmitters. These complications of CSD cause "excitotoxic injury," meaning nerve injury occurring because of hyperactivated nerve activity.

Stellate Ganglion Block (SGB) for Post-Traumatic Headaches

Stellate ganglion is a bundle of nerves that controls your sympathetic nervous system, or "fight flight response." When the fight flight response is hyperactivated, such as after head trauma, the blood vessels spasm and restrict blood flow to the brain. Blocking the nerves in the stellate ganglion reverses this harmful spasm of brain blood vessels and can restore brain functioning.

SGB has shown success in treating migraines from multiple different causes, including post-TBI headaches. These rapid and impressive improvements in headache symptoms may be the result of SGB's anti-inflammatory effects, improvements in blood flow, reduction in stress levels, or restored melatonin activity.

Sleep Disturbances After TBI

Up to half of adults who survive a TBI develop chronic sleep disturbances—most often insomnia, fragmented sleep, hypersomnia, or sleep-disordered breathing. These problems can persist for years, worsening mood, cognition, and overall rehabilitation outcomes.

Stellate Ganglion Block for Sleep Disturbances

SGB restores melatonin rhythm and reduces stress, which are believed to mediate its positive effects on improving sleep. The stress hormone reduction effects of SGB are appreciable in patients after the stress of surgery.

Additionally, nightmares can negatively affect patients after TBI. SGB has been shown to greatly reduce the frequency of nightmares in many patients with PTSD, especially those suffering from TBI.

PTSD Following TBI

Up to 36% of patients develop PTSD following TBI (with an average of 15%). In the veteran population, TBI has more serious consequences when it happens with traumatic events, emphasizing the importance of treating co-morbid PTSD in patients after TBI.

Stellate Ganglion Block for TBI-associated PTSD

Stellate-ganglion block (SGB) suppresses cervical sympathetic outflow, which in turn lowers central norepinephrine levels and calms amygdala hyper-reactivity—core neurochemical loops that drive post-traumatic stress disorder (PTSD) after a head injury. We believe SGB has this potentially powerful effect on PTSD through several pathways:

1. Norepinephrine “reset:” SGB rapidly lowers nerve-growth-factor (NGF) signaling, shrinks sympathetic sprouting, and drives brain norepinephrine levels down—quieting amygdala hyper-arousal that fuels intrusive memories and startle responses.
2. Restored cerebral blood flow: by interrupting the fight-flight response, SGB relaxes blood vessels in the brain, boosting blood flow to reduce fear memory consolidation.
3. Inflammation and HPA-axis modulation: TBI can cause a pro-inflammatory state in the brain that is dampened by SGB, reducing the chronic stress that leads to persistent PTSD.

Bilateral, two-level SGB is called the "dual sympathetic reset" or DSR. This has demonstrated significant efficacy in treating PTSD symptoms, with sustained improvements documented in multiple clinical studies in both military and civilian populations.

Stellate Ganglion Block for Cognitive Impairment

Depression and cognitive impairment are frequent and debilitating complications of TBI with limited treatment options. SGB may improve cognitive functioning and brain fog post-TBI by improving blood flow to the brain and reducing sympathetic overactivity, inflammation, and stress hormone imbalance. These cognitive improvements with SGB appear synergistic with IV ketamine in patients post-TBI.

For this reason, at Clarus Health, patients suffering from post-TBI complications may go through a SGB + IV Ketamine treatment protocol to maximize potential cognitive benefits.

Ketamine Synergy with TBI-associated Depression and Cognitive Impairment

Ketamine, beyond its antidepressant effects, specifically targets cognitive symptoms associated with depression. Interestingly, some of ketamine's pro-cognitive effects are independent of antidepressant response. When paired with SGB, these improvements in cognitive functioning and mood may significantly enhance the recovery trajectory and quality of life for TBI patients suffering from depression and cognitive deficits.

Start Healing from TBI with Stellate Ganglion Block

TBI and its chronic complications can be painful and complex to treat, often complicated by overlapping conditions such as PTSD, depression, headaches, and persistent cognitive impairment. Emerging evidence strongly supports the use of IV Ketamine and stellate ganglion blocks (SGB) as promising modalities to address these challenging complications. Both therapies demonstrate rapid and sustained efficacy in reducing headaches, improving sleep, alleviating PTSD symptoms, and enhancing cognitive and emotional functioning in TBI patients. Schedule a free consultation with Clarus Health to learn if SGB may be effective in supporting your recovery from traumatic brain injury.