Headaches can be extremely disabling when they become frequent and severe. Some people experience headaches more than 15 days each month. If that high frequency is maintained over 3 months the headaches are classified as chronic headaches. When often and severe, they take a toll at a personal, professional and recreational level.
Fortunately, there is a lot that doctors can do to help those with severe headaches. In addition to a wide variety of medications, there are new techniques that can provide significant relief.
- Migraine and tension headache sufferers with pain originating in the back of the head, front of the head and temple area can benefit from different types of nerve blocks. Nerve blocks are when a group of nerves that cause pain are blocked with the injection of a nerve-numbing medication.
- Treatment of the acute attack can be divided into 2 categories of drugs. Migraine specific medications, developed specifically for migraine and non-specific medications that work on other types of pain in addition to migraine. Examples of non-specific medications include NSAIDs, Acetaminophen, Butalbital analgesic combinations. Example of migraine specific medications include the Triptans (sumatriptan, rizatriptan, eletriptan, naratriptan, almotriptan, frovatriptan, zolmitriptan), DHE (DHE-45, Migranal), the Gepants (Ubrelvy, Nurtec), the Ditans (Reyvow). Gepants and Ditans can be safely used on those with cardiovascular and cerebrovascular disease if stable for 6 months as they do not have an effect on blood vessels.
- Botox is FDA-approved for chronic migraine. Botox was approved in October 2010 for treatment of chronic migraine, but many patients are not aware of its use for this condition.
- Monoclonal antibody therapy including Aimovig, Ajovy, Emgality, and Vyepti are medications that target a major neurotransmitter implicated in the genesis of migraine, CGRP (Calcitonin G related peptide). These are either self- administered subcutaneous injections or intravenous (vyepti)
- People suffering from cluster headaches can benefit from different types of nerve blocks or an implantable stimulator, which activates non painful fibers preventing the brain from getting messages from pain sensitive structures.
- Cervicogenic headaches, which are headaches that affect one side of the neck, can be treated with interventional treatment, injections and nerve blocks as well as medications and physical therapy
- People with occipital neuralgia, which causes pain in the upper neck, back of the head and behind the eyes, are typically treated with nerve blocks and potentially with a device that freezes the nerve (cryolysis).
There are also devices that can relieve headache pain:
- The use of a device that targets the nerves in the forehead, called Cefaly, has shown success in treating episodic migraine. In this device, implantable nerve stimulators are programmed to stop pain signals to the brain.
- Another device recently available is a vagus nerve stimulator, Gammacore, which has been used for both migraine and cluster headaches. This device is applied to the neck to stimulate the vagus nerve, which is the longest nerve in your brain.
- Even magnets have a role in the treatment of headaches. Transcranial Magnetic stimulation has been shown to relieve migraine with and without aura.
Avoid self-treating with over the counter medications. Limit treatment of the acute attack to 10 days per month. If you need to treat more often, what you need is prevention, reduction of the number of attacks. We have a lot of tools in our tool box.
We also have a number of scientific clinical trials, for those that would like to contribute to advance science and participate in clinical research.