Headache Treatments

Headache Diagnosis

When working towards providing effective headache treatments it is imperative to have the correct diagnosis made by a professional. Many people with headaches are incorrectly assessed as having a sinus problem or tension headache when they actually have migraine headaches. This can lead to inappropriate or unnecessary treatment and prolonged disability.  A large majority of people with migraine headaches in the United States have still not been diagnosed, and therefore are not treated correctly.

Being evaluated by a neurologist or a headache specialist who can develop a specialized headache treatment plan is important. The headache specialist will take a log of your medical and family history. A number of questions will be asked to get a better understanding of the symptoms of your head pain. A complete examination of the head, neck, muscles, senses, reflexes and coordination will be done. These tests are extremely important to make sure the proper diagnosis is reached.

Occasionally the following tests may be needed to make certain there are no underlying causes of the headaches:

  • CT scan (CAT scan) — This type of scan creates images of the brain using radiation and computer technology. Sequential “slices” of the scan can demonstrate irregular activity in the brain such as hemorrhage, tumor or infection.
  • Magnetic Resonance Imaging (MRI) — An MRI machine is a scanning device that uses a magnetic field and radio waves to produce images and detect diseased tissue noninvasively.

Headache Treatment

Outpatient treatment at the Headache Center includes education about headache disorders, the identification of headache triggers and the development of a headache treatment plan for management of the headache problem.

In addition, our inpatient program offered by the Headache Center offers a safe and comfortable environment for treatment options such as medication detoxification, as well as intravenous medication to help break severe headache cycles. The inpatient setting can also help the patient get used to complex headache treatment regimens and provide monitoring for individuals with co-existing medical problems.

The best treatment for headache management is always determined after proper diagnosis and trigger identification. It is important to isolate what triggers headaches and if behavioral methods can be used to avoid the triggers in the first place.

The Headache Center provides two main approaches to headache treatment; medical treatment and pain management.

Medical Approach for Headache Treatment

Medical treatment for most headaches falls into three separate types of therapy: abortive therapy, “bridge” or transitional therapy, and preventive therapy.

  • Abortive Therapy for Headache Treatment

Abortive therapy consists of administering acute medications at the first signs of a headache to stop an episode. The medications may be an anti-inflammatory, a combination of analgesics or migraine-specific therapy. Anti-nausea medications are also frequently used. These medications are available as tablets, nasal sprays, injections and suppositories.

  • Transitional Therapy for Headache Treatment

Transitional (or "bridge") therapy is sometimes used when an individual has a more prolonged headache or is acutely overusing medications. Transitional treatments are often strong medications used for a short period to help correct a more difficult situation. Common treatments include steroid tapers, concurrent anti-inflammatory and motion sickness or anti-vomiting medication or other combinations.

Sometimes a transitional headache treatment or treatments are given intravenously and require the patient to be admitted to the hospital for brief periods for care. This could be advisable when there is:

  • Moderate to severe intractable pain with significant associated disability.
  • Unresponsiveness to appropriate aggressive outpatient or emergency room treatment.
  • Continuous nausea, vomiting or diarrhea that interferes with activities.
  • Need for supportive medical measures to treat dehydration, electrolyte imbalances, unstable vital signs or prostration.
  • Need for detoxification and treatment of toxicity, dependency and withdrawal from substances that cannot be safely monitored as an outpatient.
  • Overuse of outpatient or emergency room care during crisis.
  • Simultaneous dangerous medical condition.
  • Potential of dangerous underlying condition causing headache.
  • Psychological health considerations interfering in effective headache treatment.
  • Need for rapid improvement and aggressive drug treatment in a safe environment.

Pain Management Approach for Headache Treatment

Headache treatments also consist of other procedures used to help stop or prevent headaches. The pain management options include:

  • Occipital nerve blocks: An injection of a steroid or other medication around the nerves located on the back of the head just above the neck.
  • Frontal nerve blocks: An injection of a steroid or other medication around the nerves located on the face.
  • Supratrochlear blocks: An injection of a steroid or other medication around the nerves that are a branch of the frontal nerves, near the eye.
  • Trigger point injections: An injection of a steroid or other medication to treat trigger points which are painful knots of muscle that form when muscles do not relax
  • Chemodenervation such as Botox® to temporarily paralyze a muscle or group of muscles.

Some patients who have relapses of headache pain may need to consider the use of state-of-the-art treatments such as:

  • Occipital nerve stimulation: A process to treat chronic headache disorders which includes implanting devices that send electrical stimulation to the occipital nerve above the neck on the back of the head
  • Transcranial magnetic stimulation: A noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. It is also used as a headache treatment for chronic headache pain.

Make an appointment at the Headache Center:
Cushing Neuroscience Institute’s Headache Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply fill out our Request an Appointment  form, email us at neuro@nshs.edu or call us at (516) 325-7070.