Category Archives: Headaches

Refractory Migraine Eliminated by Pulse Radiofrequency to Superior Cervical Ganglion -Good for Chronic Neck Pain as well

Awe inspiring case of chronic migraine headaches eliminated by pulsed radiofrequency (low burn) to a neck sympathetic ganglion.

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Post Craniotomy Headache Local Treatments

Post-Craniotomy Headaches are annoyingly common – “Headaches following craniotomies are reported in up to 91% of neurosurgical cases”.  Injecting craniotomy edge defect triggers,  scar neuromas, and botulinum to temporalis muscle are local treatment options.

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Supratrochlear Neuralgia

            This is a newly described condition. Ignored as a possible cause of head pain (astoundingly, 6/15 had a prior supraorbital nerve block but not trochlear). Tip off is it’s near midline location. Pressing or … Continue reading

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Ibuprofen an Alternative For Preventing High Altitude Sickness

“Severe high altitude headache  occurred in 3% treated with ibuprofen and 10% with placebo”

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Pain News – Short Snaps June 2017

June 2017 Pain News: I put them up as short snaps because not going to blog note them – hope you like. You will probably not find many in news elsewhere.

Posted in Abdominal pain, celiac, chronic fatigue, Fibromyalgia, Headaches, Injection, Interstial Cystitis/Gynecologic, Knee, psychology, shoulder | Leave a comment

Stabbing Headaches

Rather new entity is the stabbing headache – primary stabbing headache (PSH) – often in occipital area, happening 2-100 times a day and more occipital (back of head) in location.  Treatment is not all what you’d think – its indomethacin, … Continue reading

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Greater Occipital Nerve Blocks Help Triptan Overuse Headaches

Triptan overuse can exacerbate and well as signify uncontrolled headaches. Use of Occipital nerve blocks can make transition of limiting triptans easier.

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A Serious Version of Migraine with Aura – CADASIL

An heriditary version of migraine with aura could be cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Early on, nothing is evident even on MRI; but later, damage can be seen on MRI from this vasculopathy. Clinical features … Continue reading

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Post Dural Headache Treatments

Came across a wonderful list of drugs available for post-dural headaches: p13-14,23 If you can’t reach it, here is the list and more

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Chronic Migraines – Repeated Occipital Nerve Blocks Cut pain in 1/2 in 3 Months

Earlier I wrote about Nerve blocks controlling headaches. Quick Fix For Headaches – Repeated Nerve Supraorbital, Infraorbital, and Occipital Nerve Blocks – and What To Do For The Very Bad Several protocols had been made up. This present one, … Continue reading

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New Treatment for Uncontrollable headaches New RX for Nummular Headache Underlying

Had one case where I treated unrelenting headache with repeated IV Dihydroergotamine and metoclopramide just to find, as patient settled, that headache originated from a painful patch on the scalp called nummular headache. This is often due to a crushed nerve … Continue reading

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New Acute Headache – ? Cause

Eliminating chronic headaches and “cephalic illnesses” (stroke, seizures, cranial lesions, sinusitis, or central nervous system infections” left a group with new moderate- severe headaches that attended emergency. These people could have comorbid serious health issues such as heart failure, worsening … Continue reading

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Chronic Headache Tragically Missed Cause – Intracranial Hypotension – And Poor Imaging Issues

New cases series of patient twith chronic headache that oft went thru a litany of doctors without success with a clearly treatable disease. Each gave a history of  headache on arising and relieved by lying down that was discounted because … Continue reading

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Could Marijuana Help Headaches?

With Medical Marijuana,  migraine frequency dropped from 10.4 to 4.6 headaches per month.

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Migraine – How much Help From Herbals

The top 3 herbals I recommend for migraines include B2 400 mg/day, Coenzyme q10 >120 mg and magnesium.  Now a proprietary med has put in all 3 and got 30% less headache days.

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Pine Bark for Migraine?

Only study on Pine bark for migraine I could find used 1200 mg/day and did get impressive results on resistant migraines. But the best price I could get for that was $4/day..

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Migraine in Adolescence – Abortive Treatment -But in Canada you’ll Need a Pill Splitter

In the US, a drug combination for treatment of migraines has been released called  Treximet – sumatriptan (Imetrix) 10 mg and Aleve (Sodium Naproxen) 25  mg. It has been approved for use in adolescents 12-17. In Canada you’d have to … Continue reading

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Neck Pains From Atlanto-Occipital Joints

Top joint C0-1 refers to upper neck, face and upper shoulder tips. Exam requires you to grip c1 transverse processes and nod neck sideways. Certain manual techniques might help.

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Headache Just At Night – Try Indomethacin

Hyponic (night only) solely headaches are uncommon. In some ways they are distinct from migraines as the drug of choice is Indomethacin 50 mg twice daily.

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Simple Neck Treatment For Headaches

The neck gets involved in headaches and can make them worse. You can tell neck may be involved because end rotation is restricted. A simple technique to encourage rotation has benefits.

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High Dose Metoclopramide (20 mg IV over 15 min) Beats Subcut Sumitriptan (Imetrix) 6mg For Acute Headache

Metoclopramide 20 gm IV was VAS pain score  0.55/10 better on VAS than Sumitriptan injectable 6 mg. However, the later needed starting an IV and slow infusion over 15 minutes to avoid extrapyramidal oculogyric crisis (0.2% incidence with the 10 … Continue reading

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In Unilateral Chronic Episodic Headaches – Should Prolactin Levels Be Done?

Recently a series of patients with Prolactinomas (a pituitary prolactin – secreting tumor in brain) was published. They found they often presented with either one sided migraines (often orbital) or SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). … Continue reading

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New Daily Persistent Headache Lasting Over 1 Year Responding to Nimodipine (Nimotop)

Case of thunderclap (severe sudden onset) headache associated with inability to do calculations (acalculia) that persisted for 13  months despite interventions.  Nimodipine 30 mg, initially bid, then od, relieve headache. It was felt that cytokines and vasospasms persisted the headaches.  … Continue reading

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Teenage Chronic Headaches – 1/2 Might Be Chewing Gum

Isreali article found in teeenagers with chronic headaches, 19/30 cases resolved by quiting gum chewing

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Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls

I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.

Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized | 9 Comments