FAQs on Headaches and Treatment Options


Headaches are the most common neurological disorder, with half of the general population reporting one or more headaches during any given year. A headache is pain in the head, scalp, neck, or face. Tension-type headache is the most common type of headache, with a lifetime prevalence of around 50% compared to 18% lifetime prevalence of migraine. A headache can be a primary disorder, or head pain can be a mere symptom of a serious underlying medical condition.

What are the common types of headaches?

There are three main types of headaches. These are:

  • Tension-type headache – This headache occurs due to tense muscles of the scalp, neck, jaw, and/or shoulders. They are often associated with depression, anxiety, stress, and holding the head in an abnormal position. Tension-type head pain is described as squeezing, dull, and tight.

 

  • Migraine headache – This type of headache affects women more often than men, with a ratio of 3:1. A family history is one of the main risk factors for migraine headache, with reports of gene mutations associated with this condition in genome-wide association studies. Migraine is often associated with anxiety and mood disorders, epilepsy, and chronic pain conditions. Migraine with aura is a risk factor for ischemic stroke and brain lesions, especially for women with frequent attacks. Overall, migraine prevalence decreases after the age of 50 years for women, which is attributed to the onset of menopause. The severity of migraine varies, with 25% of patients reporting 4 or more severe attack per month, 48% reporting 1-4 severe attacks, and 38% reporting less than 1 attack per month.

 

  • Cluster headache – A rare type of headache is cluster headache. This type of headache affects men more often than women, and the pain is accompanied by nasal stuffiness, redness of the eye, and/or eyelid drooping. The associated symptoms occur on one side of the head (unilateral).

What causes headaches?

Primary headaches, such as migraines, tension-type, and cluster headaches, are caused by overactivity of the structures in the head that sense pain, such as the nerves and blood vessels.

Causes of onset are often called “triggers,” which can include temperature changes, odors, stress, physical exertion, certain foods and drinks, and more. Secondary headaches are symptoms related to another condition that stimulates the pain-sensitive nerves of the head region. Causes for this type of headache includes concussion, medications, dehydration, elevated blood pressure, infection, and blood clots.

What is the treatment for headaches?

Depending on the cause and type of headache, treatment options vary. Treatment options include:

  • Occipital nerve block (ONB) – With this procedure, the doctor inserts a small needle into the skin and scalp of the posterior head region. An anesthetic, with or without a corticosteroid, is injected into the tissue near the occipital nerves (occiput). In a recent clinical study, many patients with refractory chronic migraine reported 50% or more reduction in headache frequency and intensity at the long-term follow-up evaluation. All patients with occipital neuralgia reported pain relief.
  • Botox – Botulinum toxin type A is a potent neurotoxin, which is used for the prevention of headaches. This substance produces muscle paralysis and blocks acetylcholine release from the nerve cells. Using a tiny needle, the doctor performs numerous injections to the forehead, temples, jaw, and back of neck. In a recent study, researchers found that pericranial injection of Botox was an effective treatment, reducing migraine severity, frequency, and associated symptoms.
  • Radiofrequency denervation – With this procedure, the doctor inserts a small needle into the space between the cervical vertebrae (facet joint) using x-ray guidance. Radiofrequency energy is introduced to disrupt the pain signal transmission, so the nerves do not sense pain. In a recent study done to assess the clinical efficacy of radiofrequncy denervation in patients with cervicogenic headache, the treatment reduced headache severity in almost 75% of the patients at 12 months after treatment.