When do you consider nerve blocks for headache management in patients admitted to the neuro-intensive care unit with subarachnoid hemorrhage?

For aneurysmal SAH, I try different medication combinations for the first 5-7 days. After this time frame, if headache pain is still severe and/or the patient uses opioid meds too frequently, I request an occipital nerve block from our pain management team. In my experience, about two-thirds of patients who undergo nerve block report improved headache pain.