Head Pain Syndromes

MIGRAINE HEADACHES

What is a migraine headache?

A migraine headache is a vascular headache associated with changes in the size of the arteries within and outside of the brain.

What are the causes of a migraine headache?

The exact causes of migraine headaches are unknown. The possible triggers of migraines are:

  • emotional stress
  • sensitivity to specific chemicals and preservatives in food
  • caffeine
  • changing weather conditions
  • menstrual periods
  • tension
  • excessive fatigue
  • skipping meals
  • changes in normal sleep patterns

Types of Migraines:

  • Migraine with aura (classic migraine)
  • Migraine without aura (common migraine)
  • Status migrainosus (long-lasting migraine)

An aura is a physiological warning sign that a migraine is about to begin.

Visual auras include:

  • Bright flashing dots or lights
  • Blind spots
  • Distorted vision
  • Temporary vision loss
  • Wavy or jagged lines

Other auras include:

  • “Funny feeling”
  • Non-descriptive
  • Ringing in ears (tinnitus)
  • Changes in smell, taste or touch

Signs and Symptoms:

  • Pain- pounding or throbbing in nature
  • Sensations of being very warm or cold
  • Nausea and vomiting, stomach upset, abdominal pain
  • Loss of appetite
  • Blurred vision, dizzyness
  • Sensitivity to light, noise and odors
  • Alterations in appetite, mood, and libido

Testing: 

There is no specific test for migraine headaches. Tests often performed to help with diagnosing or ruling out other conditions are: an MRI, Screening Labwork, and/or an Ophthalmologic Evaluation.

Diagnosis: 

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatments:

  • Medications
  • Prophylactic Therapy
  • Head & Neck Diagnostic Injections
  • Botox Injections
  • Radiofrequency Thermocoagulation of Sympathetic Ganglions
  • Cyrotherapy

What is a tension-type headache?

Tension-type headaches are referred to as stress headaches. Tension headaches may described as a mild to moderate constant band-like pain, tightness or pressure around the forehead or back of the head and neck. Tension-type headaches can be caused by tightened muscles in the back or the neck and scalp.

Common Causes:

  • Muscle tension
  • Inadequate rest
  • Poor posture
  • Emotional or mental stress
  • Anxiety
  • Fatigue
  • Hunger
  • Overexertion
  • Spine Problems – neck, thorax, low-back

Signs and Symptoms:

  • Mild to moderate pain affecting the front, top or sides of head
  • Mild to moderate pressure affecting the front, top or sides of head
  • Difficulty falling asleep and staying asleep
  • Chronic fatigue
  • Irritability
  • Disturbed concentration
  • Mild sensitivity to light or noise
  • General muscle aching

Diagnosis: 

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatments: 

  • Medications
  • Avoiding or minimizing the causes or triggers.
  • Diagnostic Injections
  • Botox Injections
  • Radiofrequency Thermocoagulation

What is a cluster headache? 

A cluster headache usually affects one side of the head and occurs repeatedly. The headache occurs in clusters followed by headache-free remission period.

What causes a cluster headache? 

The true biochemical cause of cluster headaches is unknown. However, headaches occur when a nerve pathway in the base of the brain is activated.

Signs and Symptoms: 

  • Unilateral (one-sided) headache
  • Retro-orbital (behind the eye) and temporal in location
  • Pain described as intense, severe, deep burning or boring quality

Testing: 

Diagnosis Blocks

Diagnosis: 

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatments: 

  • Medications
  • Nerve Blocks
  • Radio-Frequency Thermocoagulation
  • Cryotherapy

What is Occipital Neuralgia?

Occipital Neuralgia is a term used to describe a cycle of pain-spasm-pain originating from the suboccipital area of the skull that often radiates to the back, front and side of the head, as well as behind the eyes.

Signs and Symptoms: 

  • Persistent pain at the base of skull
  • Occasional shock-like paresthesias

Testing: 

Diagnostic Blocks

Diagnosis: 

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatments: 

  • Atlanto-Occipital Injection
  • Medications
  • Physical Therapy
  • Therapeutic Exercises
  • Greater & Lesser Occipital Nerve Stimulation
  • Radio-Frequency Thermocoagulation
  • Cyrotherapy

Are severe headaches which are almost universally described as ” migraines,” however cervicogenic headaches are not migraine headaches. Migraine headaches makeup about 8% of all headaches. The much more common, but just as severe, pounding, throbbing, stabbing, sometimes tingling, and nauseating headaches originate from tension, absorbed most frequently in the body in the neck and shoulder region. The majority of all headaches fall into the category of cervicogenic headache.

Signs and Symptoms:

  • Fatigue
  • Postural Malalignment
  • Injuries
  • Disc problems
  • Spinal joint degeneration, injury
  • Muscle spasm
  • Prior neck surgeries
  • Spinal stenosis
  • Other types of headaches

Testing: 

  • Physical exam
  • CT or CAT scan
  • MRI
  • Discography
  • Myelograms
  • EMG
  • Bone scans
  • Untrasound imaging
  • Diagnostic medial Branch Blocks of C2, C3, C4 and other cervical levels

Diagnosis: 

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatment: 

  • Drug Therapy
  • Physical therapy
  • Anesthetic/Corticoseteroid injections pain management
  • Spinal cord stimulator
  • Psychotherapy
  • Behavioral methods of pain control
  • Medial Branch Blocks
  • Radio-Frequency Thermocoagulation, Cyrotherapy
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