Chronic Headaches

Headaches present on most days of the month for three months or longer

Headaches are a common source of pain in people of all ages. There are over 150 known types of headaches, each with its unique triggers, symptoms, and treatments.

While some headaches improve with medications and stress reduction, others intensify and appear on at least 15 days of the month, for months on end. At this point, a headache has become “chronic."

Chronic headaches cause depression, anxiety, fatigue, low concentration and prevent people from leading a productive life.

If your chronic headache has not improved with medications or other treatments from a neurologist or primary care doctor, it is time to visit a pain specialist. Pain specialists offer effective headache treatments that stop pain in the nerves, muscles, and joints of the head and neck.

How and why chronic headaches start

Headaches start when nerves or blood vessels in the head and neck are irritated or injured. The cranial nerves are often involved because they bring pain sensations from the eyes, ears, mouth, scalp, and neck to the brain.

Not all headaches are chronic. Headaches may become chronic with repeated exposure to triggers like stress, lack of sleep, smoking, or temperature changes. Repeatedly taking opioids or over-the-counter pain medications can cause chronic rebound headaches.

Types of headaches and their symptoms

Examples of headaches that pain specialists treat:

• Chronic migraines cause pain on one side of the head and present with an aura, flashing lights, sounds, and nausea. 

• Cluster headachescause a stabbing pain behind one eye, tearing, a droopy eyelid, and a stuffy nose on the affected side. They repeat in cycles.

• New daily persistent headaches have a “vice-like” quality and start on both sides of the head. Like migraines, they may cause nausea and sensitivity to light and sounds.

• Tension headaches (or stress headaches) have a pressing quality and appear on both sides of the head. They start after emotional stress and the pain can spread to the neck and shoulders.

• Cervicogenic headaches start one side of the neck and spread to the head. Neck (cervical spine) injuries often cause them. In young females, they may start when overly loose ligaments cause friction in the neck joints. In older people, they may start when arthritis damages the neck joints. https://www.treatingpain.com/conditions/cervicogenic-headaches/

• Occipital neuralgiais an ache or stabbing pain in the back of the head. It starts when the occipital nerves that run in the scalp at the back of the head are pinched.

• Nerve compression headaches result from pressure on a nerve in the face or head. An example is trigeminal neuralgia. 

Diagnosis for chronic headaches

It is essential to first rule out infections, tumors, or other urgent issues that can lead to headaches.

A pain specialist will:

• Perform a neurologic exam.

• Review head/neck X-rays, CT scans, MRIs, and past medical records.

• Use diagnostic injections (blocks) to find the source of pain.

Depending on the cause, headaches may improve with medications, neck bracing, referrals to physical therapy and chiropractic colleagues. The following treatments have shown promising results.

TREATMENTS

• CERVICAL EPIDURAL STEROID INJECTION
• OCCIPITAL NERVE BLOCKS
• OCCIPITAL NERVE STIMULATION
• TRIGEMINAL NERVE BLOCK
• STELLATE GANGLION BLOCKS
• MEDIAL NERVE BLOCK
• MEDIAL NERVE RFA
• SPHENOPALATINE GANGLION BLOCK (SPG)
• JOINT INJECTION
• TRIGGER POINT INJECTIONS
• BOTOX INJECTIONS
• PROLOTHERAPY
• PLATELET RICH PLASMA (PRP THERAPY)
• PERIPHERAL NERVE STIMULATION (PNS)
• SPINAL CORD STIMULATION (SCS)