Headaches

Head pain is one of the more common complaints that patient may have when presenting to a doctors office.  Head pain tends to have multiple causes It maybe hereditary, musculoskeletal, related to life style, pain medication overuse, intracranial vascular anomaly or thrombus, infection or pinched nerve.

Early evaluation and identification of headache subtype is critical.  Also early initiation of treatment by a qualified health care professional is important to avoid the impact of rebound headache that commonly happens with self-medicating with over the counter medications.   Certain subtypes of headaches are more common in women while other occur more frequently in men.

Subtypes of headaches treated by Premier Neurology and Pain Specialists:

Migraines: all subtypes

  • Migraine with or without aura
  • Basilar migraines
  • Ocular migraines
  • Chronic migraines

Headaches typically last four or more hours that is unilateral in location with associated sensitivity to light or noise and nausea or vomiting. Typically is of moderate to severe pulsating quality and made worse with activity. Oral contraceptive can exacerbate migraines and increase the for stroke.

Tension headaches

  • This is the most common form of headache. Patient experience pain that lasts 30 minutes to 7 days, typically has bilateral location with tightening or pressing complaint that is not aggravated by activity. Frequency of headaches is variable.

Medication overuse headaches

  • This is a chronic daily headache that occurs as result of medication overuse. This can occur from opioids, NSAIDS (i.e Motrin ®, Excedrin ®), Tylenol or others. Typically person will have 15 or more headache days that last four or more hours.

Cluster Headaches

  • Typically occurs in Men and occurs in clusters. People experience 1-3 headaches per day that occur over a period of two weeks to 3 months triggered by seasonal changes. Person may experience severe unilateral pain behind the eye with tearing of eyes and nose lasting few minutes to several hours.

Idiopathic intracranial hypertension or psuedotumor cereberi

  • This is related to diffuse brain swelling and increased intracranial pressure. This is a complicated headache type that requires aggressive treatment. Unfortunately at times it results in vision loss.

Temporal arteritis

  • Usually occurs after the age of 60. A good portion of people may also complain of concurrent musculoskeletal pain and Jaw pain. Signs and symptoms: scalp tenderness, jaw and tongue claudication, muscles stiffness, fever, fatigue, shoulder and neck discomfort and vision loss. Early diagnosis is important to prevent vision loss.

Subarachnoid hemorrhage

  • Usual description is the sudden onset of “worse headache of my life” that typically occurs with physical exertion such as exercise or intercourse. This usually occurs secondary to aneurysm rupture. This is a medical emergency and you should present to the nearest hospital. If ignored this is life threatening.

Venous Sinus thrombosis

  • Sudden onset of headache that results from occlusion of brains venous system by a clot. Depending on the extent of the clot the intensity and clinical manifestation of headache is variable. This is a medical emergency and you should present to the nearest hospital. If ignored this is life threatening.

Headaches related to mass lesions

  • Brain cancer: maybe benign or malignant
  • Brain infection
  • Blood clots

Headaches related to trauma

  • Post-concussive headaches with or without loss of consciousness

Nerve related headaches

  • Occipital neuralgia
  • Supraorbital neuralgia
  • Trigeminal Neuralgia

Diagnostic workup:

  • Imaging: for select patients
    • MRI or CT scan of brain
    • CT angiogram and MR angiogram
  • Lumbar puncture for select patient

Treatment:

  1. Patient education
  2. Life style modification
  3. Diet modification
  4. Sleep optimization
  5. Cognitive Behavioral therapy
  6. Medications:
    1. This is dependent on the subtype of headache, thus, diagnosis by qualified professional is critical
    2. Acute abortive medications
    3. Chronic preventive medications
  7. Interventions:
    1. Nerve blocks
    2. Epidural steroid injections
    3. Cervical Medial branch blocks and radiofrquency ablation
    4. Botox ® therapy for chronic migraines
    5. Peripheral nerve stimulators
    6. Acupuncture
    7. VP-shunt
    8. Aneurysm coiling or clipping done by Neurosurgery or Endovascaular specialist
Headaches