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Tri State Area Pain Management for

Migraines & Headaches

There are Multiple Types of Headaches

Types of headaches include migraine headache, tension type headache, cluster headache, and combination headache. There’s also a headache caused by occipital neuralgia. Headaches can also be caused from neck disorders, temporomandibular joint dysfunction (TMJ), trigeminal neuralgia or a condition called reflex sympathetic dystrophy.

Migraine headaches

Migraines are common and typically almost always develop before the age of 30. They can occur every few days to once every several months. Most migraine sufferers are female, and there’s a strong family history of migraine headaches. Migraines can be caused by changes in sleep pattern or by diet. Foods that contain tyramine, monosodium glutamate, nitrates, chocolate or citrus fruits can trigger migraine headaches. Hormonal changes, even birth control pills can also trigger onset of migraine headaches. Auras are a neurologic event that approximately 20 percent of migraine patients exhibit.

They precede the onset of the headache and may include visual disturbances, changes in smell, and hearing. Typically migraine headaches are limited to one side of the head, or unilateral. The pain is typically around the eye or behind the eye. It can be from mild to severe and pounding. Menstruation can be a common trigger of migraine headaches. Neurologic dysfunction can accompany migraine headaches rarely. No specific tests exist for diagnosis of migraine headaches. MRIs are helpful to rule out other causes of headache. Laboratory tests including CBC, erythrocyte sedimentation rate may be performed.

“Migraines can be caused by changes in sleep pattern or by diet.”

Migraine headaches are often confused with tension type headaches. Tension type headaches are often daily or continuous. They are typically in the back of the head or circumferential. The pain is described as aching, pressure and band-like. Usually it affects both sides of the head. Tension headaches are never accompanied by aura, and rarely accompanied by nausea and vomiting. The duration is often days.

Cluster headaches

Cluster headaches derive its name from the headache pattern. It occurs in clusters, followed by headache-free periods. Cluster headaches are much more common in males, with the male to female ratio of 5 to 1. Cluster headaches are present in .05 percent of the male population. They’re often confused with migraine headaches. 
Cluster headaches do not appear to be genetically linked, and sufferers do not experience auras. Cluster headaches typically occur 90 minutes after the patient falls asleep. There’s an increased frequency of cluster headaches in the spring and the fall. Typically cluster headaches occur 2 to 3 times a day and can last for up to an hour. Cluster periods typically last for 2 to 3 months and may have periods of remission of less than 2 years. Cluster headaches may be triggered by alcohol, nitrates, histamines, high altitude. There is no specific testing for cluster headaches. MRI is helpful to rule out other conditions.

Analgesic rebound headaches

Recently analgesic rebound headache has been identified as a syndrome that occurs after discontinuing abortive medications, or overuse of medications. Patients who overuse the medications become unresponsive to both prophylactic and abortive migraine medication therapy. Analgesic rebound headaches are typically under-diagnosed by healthcare professionals. Over the counter medications containing caffeine may be associated with analgesic rebound headaches. These types of headaches occur as a transform migraine or transformed tension type headache and may assume the characteristics of both types of the headaches and become chronic, daily headaches. Excessive use of any of the following medications may cause analgesic rebound headache: Simple analgesics such as acetaminophen, sinus medications, combinations of aspirin, caffeine, Butalbital, nonsteroidal anti-inflammatory medications, opioid analgesics ergotamines, Tryptan, sumatriptan. There is no specific test for analgesic rebound headache. Rather it’s a diagnosis by history.

Occipital neuralgia

Occipital neuralgia is typically related to trauma to the posterior head. It is caused by inflammation of the occipital nerves that run along the posterior part of the cranium. Repetitive micro-trauma may also cause occipital neuralgia, such as neck hyperextension in painting ceilings or working on the computer monitor for prolonged periods of time. Occipital neuralgia is typically described as chronic pain at the base of the skull with occasional shock-like sensations in the distribution of the occipital nerves. Tension headaches can be confused with occipital neuralgia. No specific testing is available for occipital neuralgia. MRI is useful for ruling out other conditions. Injection of the occipital nerve is helpful in confirming the diagnosis of occipital neuralgia.

Temporomandibular joint dysfunction

TMJ can also cause headaches. It’s typically unilateral. It’s caused by the joint between the mandible and the lateral pterygoid that is termed the temporomandibular joint. The joint is innervated by branches of the mandibular nerve. Muscles in the temporomandibular joint include temporalis masseter muscle, external and internal pterygoids, trapezoid and sternocleiedomastoid muscles. Radiographs of the temporomandibular joint are helpful to rule out arthritis of the TMJ. MRI may provide additional useful information.