Headaches
Headaches are among the most common medical complaints and can persist as a debilitating condition in many individuals. There are many different types of headache, each with its own unique characteristics and evidence-based management. Headache disorders can be classified into major groups, which are then further subidivided into types and subtypes (see below).
Common headaches we see include:
Cervicogenic headache
Cervicogenic headaches are secondary headaches which are due to spinal problems in the neck, such as facet joint arthritis, disc degeneration or prolapse. Characteristics of cervicogenic headaches may include:
- Pain localized to the occipital, frontal, temporal or orbital regions
- Pain is triggered by movement of the neck
- Restricted neck range of motion
- Neck stiffness
- Unilateral pain, but may occasionally be bilateral
- Constant pain, with intermittent flares
- May have associated nausea, vomiting, photophobia, phonophobia
Cervical facet joint injections and/or cervical median branch rhizotomies may significantly improve cervicogenic headaches.
Occipital neuralgia
Occipital neuralgia is a condition where the occipital nerves that run through the scalp are inflamed or injured. There are 2 occipital nerves on each side being the greater and lesser occipital nerves. Occipital neuralgia causes headaches that is often described as a sharp, stabbing, electric shock-like pain in the upper neck and back of the head. The pain may occasionally be throbbing.
Occipital nerve block with pulsed radiofrequency ablation may provide substantial pain relief from patients suffering with an occipital neuralgia.
Migraines
Migraines are a neurological condition that can be very distressing and disabling. In fact, according to the World Health Organization, migraines are one of the twenty most disabling diseases. The diagnoses of migraine is made with the following features:
- Headache attack lasts between 4-72hours
- At least two of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity
- During headache at least one of the following: nausea and/or vomiting, photophobia and phonophobia
Treatment often involves a combination of preventative and breakthrough analgesia. Botox injections have shown to reduce headache frequency, headache-related disability and improved functioning through the PREEMPT trials.
Classification of headaches according to the ICHD-3
Part 1: The Primary Headaches
1. Migraine
2. Tension-type headache (TTH)
3. Trigeminal autonomic cephalalgias (TACs)
4. Other primary headache disorders (includes primary cough headache, exercise headache, headache associated with sexual activity, thunderclap headache, cold-stimulus headache, external-pressure headache, stabbing headache, nummular headache, hypnic headache, new daily persistent headache)
Part 2: The Secondary Headaches
5. Headache attributed to trauma or injury to the head and/or neck
6. Headache attributed to cranial or cervical vascular disorder
7. Headache attributed to non-vascular intracranial disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homeostasis
11. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure
12. Headache attributed to psychiatric disorder
Part 3: Neuropathies & Facial Pains and other Headaches
13. Painful lesions of the cranial nerves and other facial pain
14. Other headache disorders
Helpful Resources:
- Free Headache Diary
- Migraine and Headache Tracking App
- Headache Australia: Migraine information
- Educational video: Migraine
- Headache Australia: Your doctor and your headache
- Headache Australia: Tension-type headache information
- Health Direct: Tension-type headache information
- Migraine Trust: Cluster headache information
- Musculoskeletal Australia: Managing your pain
- The Pain Toolkit
DisclaimerThe above information is for general education only and is not intended as a substitute for your own independant health advice. At Western Pain clinic we comprehensively assess each patients pain condition and provide advice using the latest evidence-based treatments. If you would like to find out more information about headaches, please discuss this with our doctor during your consultation.