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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.
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.
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
“Severe high altitude headache occurred in 3% treated with ibuprofen and 10% with placebo”
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.
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
Triptan overuse can exacerbate and well as signify uncontrolled headaches. Use of Occipital nerve blocks can make transition of limiting triptans easier.
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
Came across a wonderful list of drugs available for post-dural headaches: https://www.asra.com/content/documents/aug-14.pdf p13-14,23 If you can’t reach it, here is the list and more
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 http://painmuse.org/?p=2886 Several protocols had been made up. This present one, … Continue reading
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
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
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
With Medical Marijuana, migraine frequency dropped from 10.4 to 4.6 headaches per month.
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.
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..
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
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.
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.
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.
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
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
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
Isreali article found in teeenagers with chronic headaches, 19/30 cases resolved by quiting gum chewing
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.