Headaches deserve their own category of pain management. Anyone
presenting to a pain clinic for headaches has likely failed an exhaustive battery of tests
and treatments from their PCP and Neurologist. In a pain clinic, many patients believe
they are relegated to opiates and that nothing more can be done. Procedures for
headaches not often tried before coming to the pain clinic include cervical paraspinal
trigger points, occipital nerve blocks, third occipital nerve blocks, sphenopalatine
ganglion blocks, Botox, and occipital nerve stimulation. Stellate ganglion blocks have
been tried with disappointing results and are not performed for headaches at this clinic.
Medications for headaches vary widely, but opiates are not indicated on a daily basis and
will lead to worsening of pain and reduced function.
Botox is often performed by our Neurologists with good success. Many patients are
sent to our clinic to assess for cervicogenic headache. These headaches typically
start after a neck injury and radiate up the back of the head and present as
throbbing or tugging behind the eye. These headaches respond well to medial
branch block and RF ablation.
A special category of headaches that we treat is trigeminal neuralgia or atypical
facial pain. Many of these patients have had prior TMJ surgery or have concurrent
multiple sclerosis. Treatment usually begins with Tegretol or Trileptal and
Baclofen. If pain persists sphenopalatine ganglion block, gasserian ganglion block,
or spinal cord stimulation can be performed. More information on these procedures
is on the Sympathetic blocks page.