Headache Treatments

Botulinum toxin (Botox) is injected in small amounts near nerves involved with transmitting headache pain. It is FDA approved for chronic migraines (patients who suffer from headaches more than 15 days per month).

This treatment helps prevent migraines and decrease the frequency of headache, but it can take 2 or 3 treatments to see results.

One treatment involves 31 injections in key areas; the injections are done with an extremely small needle and takes about 20 minutes.

The most common risk is mild soreness for a few days, which we recommend using ice to alleviate. At first, we recommend three treatments, each 12 weeks apart to give the therapy an adequate trial.

More information about migraines can be found on the American Migraine Foundation website.

Headaches often arise from the base of the skull or back of the neck, and are called cervicogenic headaches.

The occipital nerves are located at the base of the skull, and are commonly irritated resulting in or contributing to chronic headaches. These nerves are amenable to a procedure which targets and “blocks” them by administering numbing medication and steroid. By blocking the occipital nerves, the cycle of cervicogenic headaches can be stopped or lessened.

The procedure takes only a few minutes. It is performed in the regular patient room. No sedation is required, therefore the patient does not need to fast. There is no recovery time. The most common side effects include dizziness or lightheadedness that resolves shortly after the procedure, mild soreness at the injection site which improves over time. Ice can help with any symptoms that occur after.

If the patient’s symptoms improve, this injection can be repeated several times annually. Additionally, the third occipital nerve is amenable to ablation using energy to interrupt the pain signal from the area of nerve irritation.

Ablation procedures are done in the procedure room with the use of x-ray imaging. Prior to performing an ablation, test blocks should be done to ensure proper diagnosis prior to ablating a nerve. Let your physician know if you are on blood thinning medications prior to an ablation procedure.

Medications can help improve headaches symptoms. There are medications which help prevent headaches and medications which help improve a headache once it starts.

It is also important to remember that overusing certain medications can actually cause headaches or make headaches worse. About 50% of patients with chronic headaches have a component of medication overuse headache.

While it can be difficult to wean off and stop overusing medications, it often provides dramatic improvement. Please tell your doctor all medications you are taking, including over-the-counter medications.

For patients who fail several medications for prevention of migraine, new medications have become available. These are called CGRP antagonists. With these, about half of patients will have half as many headaches. Side effects are typically minimal but include fatigue and short-term constipation.

Headaches are a difficult pain problem and unfortunately can cause years of pain and dysfunction.

It is important to realize for such a complicated health problem, several strategies may need to be used.

• Cognitive behavioral therapy with a psychologist can be extremely helpful to stop the cycle of dreading the next headache.
• Mindfulness exercises and practices often help. To learn more visit our Wellness page.
• Glasses with special lenses can sometimes help (FL-41)
• Devices that activate the vagus nerve can also help improve headaches. These devices are external and do not require any procedures.