HEADACHES
1. Primary Headaches
A. Migraines
second most common type of headache symptoms
- moderate to severe pain
- sensitivity to light, noises, odors
- blurred vision
- nausea or vomiting or upset stomach
- abdominal pain
- loss of appetite
- sensations of warm or cold
- paleness
- fatigue
- dizziness
- shifting from side-to-side
Treatments
- botox injections
- surgical options
- neurostimulation
- plastic surgery to remove the nerves associated with the migraine pain
- ear, nose and throat surgery to address sinus-related migraine pain
B. Tension
- most common type of primary headache
- pain that wraps around the head causing pressure
- commonly caused by stress, noises and bright lights
- intensity may increase with time
- pain originating in the back of the head moving to the front of the head
- interrupted sleep cycles
- depression
C. Cluster
- come in waves with increasing intensity
- affects men more than women
- often felt behind the eyes
- causes not well understood
- Believed to be by combination of vascular and neurological disorders in head and neck
- warning signs
- aura – visual impairment, unusual smell
2. Secondary Headaches
- cause is related to structural or functional problem in the head or neck
- pain from neck muscles
- excessive use of pain killers
Common symptoms of primary and secondary headaches:
- fatigue - pulsating pain
- chills - loss of appetite
- numbness, tingling, weakness - sweating
- pain on one side of the head - facial pain
Common causes and triggers may include:
- vasoconstriction - changes in hormone levels
- certain foods (dairy, fruit ,chocolates) - neurological disorders
- loud noises - allergic reactions
- bright lights - exercise
- alcohol - emotional stress
- excessive visual stimuli - interrupted sleep patters
- pain from spine related problems - certain smells/odors
Common Conditions
Migraine Headache
Tension Headache
Cluster Headache
New Daily Persitent Headache
- are chronic and unremitting with daily onset
- usually on both sides of the head
Intractable Migraines
- similar to chronic daily headache and are severe
- usually do not respond to conventional treatment
Occipital Neuralgia
- chronic pain in the upper neck/back of head and behind eyes
- pain originates from the occipital nerve in the back of the head/upper neck
- cause is attributed to damage of the lesser and greater occipital nerves
- commonly treated with nerve blocks, injections or peripheral stimulation
Supraorbital Neuralgia
- caused by damage or abnormal function of the supraorbital nerves
- pain is located to the lower forehead and may include upper forehead and scalp
- can be treated by nerve blocks, injections or peripheral nerve stimulation
Chronic Pain Syndromes
- of the head/neck can result in severe chronic headaches
- have underlying vascular or neurological causes
- often misdiagnosed as Tension, Cluster or Migraine Headaches
Reflex Sympathetic Dystophy (RSD) / Complex Regional Pain Syndrome (CRPS)
- characterized by pain that is not in proportion to the apparent injury which caused the disorder
- pain usually gets worse over time
- causes are unclear
- treatment can include physical medicine modalities, psychotherapy, sympathetic nerve blocks, medications, surgical sympathectomy, spinal cord stimulator or Intrathecal drug pumps
Neuropathic pain of the head
- example is Trigeminal Neuralgia
- has sudden intense onset with sharp, shooting pain in the head/neck
- usually has specific triggers
Acute headaches
- headache with a sudden, rapid onset with intense pain
- usually short lasting
Adolescent Migraines
- Migraines lasting longer than adult migraines in adolescents
Treatment Options
- intramuscular narcotic injections to control pain
- nerve block injections
- epidural steroid injections
- facet injections
- surgical removal of nerves
- implantable neurostimulation device
- risks of surgery can include, but not limited too:
- complications with anesthesia
- blood clots
- allergic reaction to medication(s)
- adverse effects due to undiagnosed medical conditions
- bleeding
- heart attack
- stroke
- kidney failure
- pneumonia
- bladder infections
- infections
- nerve damage
