Headaches: Migraine, Tension, Cluster, Occipital, TMJ
There are many different types of headaches, the most common being migraine, tension, and cluster. More than 70% of Americans will suffer headache pain severe enough to compel them to seek medical attention at some point during their lifetimes. A small but substantial minority of patients experience chronic daily or near daily headaches, which significantly impacts the quality of their lives and the lives of their families.
Migraine headaches can be severe and debilitating, with side effects such as upset stomach, blurred vision, and sensitivity to light and noise. Migraines are more common in women than in med and typically begin to appear in early adulthood. They may be caused by heredity, chemical imbalances in the brain, or triggers such as stress, hormones, weather, and certain types of food.
In some cases, these painful headaches are preceded or accompanied by a sensory warning sign (aura), such as flashes of light, blind spots or tingling in your arm or leg. A migraine is also often accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. Migraine pain can be excruciating and may incapacitate you for hours or even days.
Fortunately, management of migraine pain has improved dramatically in the last decade. Although there's still no cure, medications can help reduce the frequency of migraine and stop the pain once it has started.
Tension headaches are tight and aching, and may last for several hours. They can be triggered by intense emotional periods, poor posture, and clenching of the facial and neck muscles.
Cluster headaches have a quick onset, with intense pain arising on one side of the head and associated with symptoms of a bloodshot eye, runny nose, and sweating. These headaches have a shorter duration than migraines but are just as painful, if not more so.
What are some "red flags" in the diagnosis of headache?
In the patient’s history, symptoms suggesting a possible serious cause of headache include onset of headache over the age of 50, headache that progressively worsens, the "worst" headache ever experienced, change in headache symptoms, and increase in headache with exertion, coughing, or sneezing. Other symptoms include numbness and tingling in the extremities, weakness in an extremity, slurred speech, loss of coordination, confusion, loss of smell, ringing in the ears. On the physical exam, signs that can be of concern would include weakness or sensory loss in an extremity, high blood pressure, elevated temperature, unequal pupils or reflexes.
What treatments are used for headaches?
Treatment for headaches includes medication as well as relaxation, physical therapy, trigger point injections, greater and/or lesser occipital nerve blocks, sphenopalantine ganglion block, supraorbital nerve block, temporal nerve block, supratrochlear nerve block, infraorbital nerve block, and medial branch block.