Headache is one of the most common neurological problems, affecting 2/3 to 3/4 of people at some point in their lives, and almost 50% of people will have headaches in any given year. About 90% of headaches are considered “primary headaches” which are benign and not due to a brain disease or structural problem. The primary headaches can be classified into a variety of headache types, the most common of which are migraine and tension headaches. Migraines typically present with throbbing pain, often on one side of the head, nausea and vomiting, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with constant "band-like" pressure on both sides of the head. Less common headaches include hemicrania continua with continuous one-sided pain that sometimes worsens, neuralgiform headaches with brief one-sided headache pain associated with tearing and runny nose from one nostril, cluster headaches that occur daily for a period of weeks, and headaches triggered by coughing, physical exertion, or sex.
The approach to primary headaches depends on the frequency and severity as well as the type of headache. Headaches that occur once a week or less frequently can be treated with drugs that abort the headache, such as “triptans” (sumatriptan, rizatriptan, eletriptan and others) and nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or naproxen. It is important not to take them every day, as this can result in medication overuse or “rebound” headaches. When headaches occur several times per week, a prophylactic medication taken every day may help prevent headaches from occurring. There are many options, and your doctor will work with you to find the most appropriate treatment.
Secondary headaches are due to an underlying brain condition. Sudden, new or changing headaches, those with other neurological symptoms, or “the worst headache in my life” could be due to a medical emergency such as meningitis or subarachnoid hemorrhage (bleeding around the brain) and require immediate evaluation and treatment. Other less acute but concerning new headache patterns can be caused by brain tumors, chronic meningitis, or vasculitis (inflammation of the brain arteries) such as temporal arteritis. These conditions are relatively uncommon. You should contact your doctor if you experience a sudden change in headache pattern.
Nerve Block Injections
For headaches associated with nerve tenderness and inflammation in either the occipital (back of the head) or frontal (forehead) regions, injections of an anesthetic agent (lidocaine) with or without a steroid to reduce inflammation can cause long-lasting headache relief. Several of our neurologists have expertise in this technique which can provide rapid relief for some headaches.
Botox® for Migraine Headaches
Migraines headaches can be disabling and cause decreased productivity and lost days of work. A number of medications can be used to prevent migraine attacks, abort a migraine crisis or for symptom relief. If these treatments are not successful, another approach involves injecting botulinum toxin into muscles associated with headache pain. Botulinum toxin type A (Botox®) has been FDA approved for prophylactic treatment of migraine to reduce the number of days with headache. Patients typically have to have more than 15 headache days per month, headaches that last at least 4 hours each and have failed multiple medications in the past. Please call 1-84-GET-UCONN for more information or request an appointment online to discuss with one of our neurologists whether Botox is indicated for your migraines. You can find further information about headaches at the National Headache Foundation.