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DAILY HEADACHES—CAUSES AND TREATMENTS
Botox®
Botox® is most commonly recognized as a cosmetic agent to help reduce wrinkles. But recent studies indicate that Botox® is also helpful in alleviating headache pain.
A 2003 study presented at the American Headache Society 45th Annual Scientific Meeting produced results indicating that 80 percent of patients treated with Botox® for headache pain claimed to have less frequent pain, less intense pain or both after the injections. Of the 271 patients who received Botox® injections for the study, 60 percent reported good to excellent pain relief, 20 percent reported some pain relief and 20 percent reported no relief.
Three-quarters of the 271 patients had tried other therapies in seeking pain relief. Half of them had been over-using medication in an effort to find relief.
At Nexus Paincare, we treated a series of 50 patients suffering from tension headaches with Botox® injections. There was only one patient who wasn’t completely satisfied.
Many patients who receive relief from Botox® injections are able to reduce their medication dosages or stop taking pain medications all together.
For millions of Americans, chronic daily headaches have become a way of life. People who live with daily headache pain may find the key to lasting relief through Botox®. There are also several other treatments that successfully provide headache pain relief.
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Cervicogenic Headache
Headaches that involve pain that begins in the neck, frequently secondary to cervical facet syndrome, are called cervicogenic headaches. Proper diagnostic tests (nerve blocks) must be performed to determine that the neck is, in fact, the source of the pain. |
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Chronic Daily Headache
Chronic daily headaches probably represent a fusion of both migraine and tension headaches.
Chronic daily headache is a general term representing at least five different clinical entities:
1. Chronic Tension-type Headaches—the patient must have headache pain at least 15 days per month for at least six months. The average duration of headache must be more than four hours per day. The pain must have two of the following characteristics: pressing/tightening quality, mild or moderate severity, bilateral location, no aggravation by walking stairs or similar physical exertion. The patient should have a previous history of episodic or occasional tension type headaches. The headaches must have gradually increased in frequency over a three-month period; the patient must deny vomiting and have no more than one of the following symptoms: nausea, photophobia, phonophobia.
2. Transformed Migraine—the patient must have headache pain at least 15 days per month for more than one month. The average duration of headache must be more than four hours per day. The patient must have a history of previous episodic migraine and the current headaches must meet the IHS criteria for migraine other than duration. These patients typically have a non-descript headache between migraine episodes.
3. New Daily Persistent Headaches—the patient must have headache pain at least 15 days per month for greater than one month. The average headache duration must be more than four hours per day. The patient has no previous history of migraine or tension type headache. The onset of headache should be abrupt, occurring over less than three days. It has been suggested that this headache is related to a viral or post viral infection.
4. Hemicrania Continual Headaches—the patient must have persistent headache for at least one month. The headache should be strictly unilateral in location. The headache must be completely treated with indomethacin. The pain has all three of the following present: continuous but fluctuating character, moderate severity, lack of precipitating mechanisms.
5. Analgesic Rebound Headaches—this term refers to the inappropriate over-use of abortive analgesic medications for the treatment of chronic daily headaches.
The consequences of daily headache are myriad. These include:
1. Pain, nausea, vomiting, and dehydration.
2. Sleep disturbance. Very often patients will have difficulty falling or staying asleep as a result of headache pain. They may wake up several times during the night with a headache.
3. Curtailment of social and recreational activities. When you don’t feel good, you’re not going to participate in activities that you previously enjoyed.
4. Depression. Over time, loss of function and stress of dealing with headache pain leads to depression and lowering of self-esteem.
5. Disability. If the behavior remains unchecked, eventually patients become totally disabled by headache. |
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Cluster Headaches
Cluster headaches involve pain that is usually just on one side of the face or head that lasts for minutes or hours, recurring several times throughout the day. These headaches typically happen several days in a row followed by a remission time of a few days before the headache pain returns.
Spenopalatine blocks provide must cluster headache patients with immediate pain relief. |
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Sphenopalatine Block
This procedure is used to treat cluster headaches (pain that is usually just on one side of the face or head that lasts for minutes or hours, recurring several times throughout the day. These headaches typically happen several days in a row followed by a remission time of a few days before the headache pain returns). It is also used to treat burning pain in the face as described above. This pain sometimes occurs after spinal surgery.
A spenopalatine block is a process of numbing the sphenopalatine ganglion. Most patients feel immediate relief of the pain associated with cluster headaches after receiving this treatment. |
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Sphenopalatine Ganglion Neuralgia
Sphenopalatine ganglion neuralgia, also known as Sluder’s Syndrome, is characterized by neuralgia (an intense burning or stabbing pain caused by irritation of or damage to a nerve) of the sphenopalatine ganglion, which is a mass of nerve tissue located in the maxillary region of the head. Neuralgia in the sphenopalatine ganglia results in headaches, nasal pressure, and/or facial tenderness. This disorder is easily treated with a sphenopalatine block procedure. |
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Sluder’s Syndrome
Sluder’s syndrome, also known as sphenopalatine ganglion neuralgia, is characterized by neuralgia (an intense burning or stabbing pain caused by irritation of or damage to a nerve) of the sphenopalatine ganglion, which is a mass of nerve tissue located in the maxillary region of the head. Neuralgia in the sphenopalatine ganglia results in headaches, nasal pressure, and/or facial tenderness.
This disorder is easily treated with a sphenopalatine block procedure. |
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Supraorbital Block
Supraorbital refers to the area above the orbit of the eye. Some headache pain originates in this area of the head. Nerve block injections are helpful in diagnosing the pain generator.
A nerve block is a diagnosing tool that helps our doctors to know exactly which nerves are causing our patients to feel pain. Our doctors use a live x-ray-type machine (flouroscopy) to see the patients’ bone structures. They are often able to tell, based on the patients’ description, the general area where the pain is being generated. Our physicians select the nerve that is likely the cause of the pain. That nerve is temporarily numbed with lidocaine (the same numbing medication dentists use).
If the patient feels relief for a few hours before the lidocaine effects wear off, then the doctor can likely conclude that the pain generating nerve has been correctly identified. This process is repeated another time, just to assure that the pain relief was not a placebo effect. After two successful nerve blocks, our physicians educate our patients and move on to a more permanent treatment that will likely produce pain relief for 12-24 months—radio frequency lesioning. |
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