Many headache patients have muscle spasms around the neck and shoulders. Injections of lidocaine often provide temporary relief, which may be needed prior to starting a program of neck-strengthening exercises and other treatments. When the muscle spasm continues to return after lidocaine injections, injections of Botox into neck and shoulder muscles may provide more long-lasting relief.

Headaches can result from "pinched" nerves around the head. This condition is particularly common in elderly headache sufferers and in the case of headaches caused by head or neck injury. The occipital nerve is one of the most commonly affected nerves. Blocking the involved nerve with lidocaine or steroids (cortisone) can be very effective in relieving this type of headache.