Headaches are one of the most common physical problem people experience. When headaches are severe, they often control the life of their victim by disrupting job performance, daily activities and sleep. Common types of headaches are: tension, migraine, cluster and sinus. One more type of headache which is responsible for about 15-20% headache is Cervicogenic headache.
Nearly everyone has had headache pain, and most of us have had it many times. A minor headache is little more than a nuisance that's relieved by an over-the-counter pain reliever, some food or coffee, or a short rest. But if your headache is severe or unusual, you might worry about stroke, a tumor, or a blood clot.
Chronic recurrent tension-type headaches are more difficult to manage. Preventive medications: anxiolytics, SSRIs, andidepressants.
Non-pharmacologic therapies such as biofeedback, physical therapy, relaxation therapy, stress management training, and psychotherapy have also been shown to be helpful.
The intractable headache which is not responding to above measures requires minimally invasive approach like-
Prophylactic therapy: Drugs commonly used are CCB (Flunarizine), β-blockers (Propranolol etc.), Antidepressants( Amitriptyline), Anticonvulsants(Carbamazepine, Divalproex sodium etc.) In addition to above physical therapy, stress management therapy, relaxation training etc can also help.
Abortive agents The most potent abortive agents are the Triptans(5-HT) agonist which are Cerebral vasoconstrictors (e.g. : sumatriptan, zolmitriptan etc.) Another highly effective group of antimigraine medications are ergotamine-containing drugs-ergotamine tartrate & dihydroergotamine.
Interventional Pain Management:Injections of Botulinum Toxin in the scalp prevent migraine attack for prolonged period.
Preventive therapy: Verapamil, Lithium,methylsergide
Transitional treatments:High dose corticosteroids
Interventional pain management: For intractable cluster headache we can do different intervention like Chemical denervation of the supraorbital & Infraorbital nerves, chemical or radiofrequency denervation of gasserian ganglion, sphenopalatine ganglion block.
Treatment options or interventions
- Sphenopalatine Ganglion Injection / Radiofrequency
- Greater and lesser occipetal nerve injection / radiofrequency
- Small nerve block like supraorbital, supratrochlear, infraorbital, mental, etc.
- Botox Injection
- Trigger point injection