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| Arizona Pain Specialists 9787 N. 91st Street, Suite 101 Scottsdale, AZ. 85258 Phone: 480-563-6400 |
Most causes of HA’s are benign and have no underlying significant pathology, however, it is important to
have a physician or pain specialist rule out more severe causes before beginning treatment for the benign
causes.
Headaches themselves are one of the most common complaints from people visiting a physician. A
physician will then classify the HA as "Primary" or "Secondary." Primary HA's are not caused by an
underlying pathology or disease. Meaning, they are benign HA's which can further be subdivided as
Cluster, Tension, and Migraine headaches. Secondary HA's are associated with a pre-existing pathology
causing the pain, which may be benign or malignant of origin.
There are many causes of secondary headaches that should be excluded by a physician before assuming
a HA is of primary origin. Some of the more severe causes that require immediate treatment are intracranial
hemorrhages/ hematomas, meningeal infections (viral, bacterial, fungal), strokes, and malignant
hypertension. Other pathologies that are more subacute, or have an insidious onset may be malignant
tumors (primary or malignant) or ophthalmologic (glaucoma, cataract). There are other diseases
associated with HA and these all should be evaluated by your physician before treating your HA. Your
physician may wish to order radiological studies (MRI, CT scan), neurological exam, blood work, or an eye/
vision assessment to help rule out some of the causes of secondary HA
Primary headaches are much more common and can be broken down into three categories; Cluster,
Tension, and Migraine headaches.
Cluster Headaches:
In Cluster HA, men are more commonly affected than women with a peak age of onset around 25 years.
Patients will present with a severe, unilateral, pulsatile, periorbital pain that typically lasts anywhere from 20
minutes to 3 hours. Patients describe the pain associated with Cluster HA to be far more severe than is
experienced in Tension or Migraine HA’s. Risk factors for Cluster HA are vasodilating medications as well
as recent alcohol or illicit drug use. A specific trait to Cluster HA’s are that they occur in “clusters”, hence
the name, meaning they affect the same location of the head, around the same time of day, during the
same time of year. Patients may also experience tearing from the eye on the same side of the head as the
pain as well as nasal discharge or stuffiness, or neurological complications (Horner’s syndrome, ptosis). In
contrast with the other two types of primary HA, emotion and food are NOT triggers in Cluster HA.’s
Tension Headaches:
Tensions HA’s are considered the most common HA diagnosed in adults. The pain is described as a
restrictive, band like pain that is being wrapped around the patients head. Patients describe it as an
insidious (slow) onset and can be exacerbated by bright lights, noise, and especially stress. A patient
experiencing Tension headaches may also have an associated Depression, sleep disturbance, or poor
concentration. These typically occur towards the end of the day and are located in the upper neck and
occipital (back of head) region. Unlike Cluster and Migraines, Tension HA are not associated with any
neurological disturbances and are usually a diagnosis of exclusion.
Migraine Headaches:
Migraines are more common in women and affect a significant portion of the population. Migraine HA’s can
be experienced in children, adolescents, adults, and geriatric patients and varies significantly with each
person. They can be seen in anyone! The pain associated with Migraines is described as either unilateral
(one-sided) or bilateral (both sides), intense and throbbing that typically lasts over an hour but less than 24
hours.
Migraines are further classified as “Classical” and “Common.” In Classical Migraines the pain is unilateral
and is preceded by an aura . A Common Migraine is often bilateral and has no associated aura or
neurological manifestation.
One of the known phenomena of a Migraine HA is that many people, although not all, have an associated
aura that may occur before, during, or after the onset of the migraine. Some patients describe the aura as
scintillating flashes of light, a particular smell, spots of vision loss, as well as numbness of one or both sides
of the face, unsteadiness, weakness, or an altered level of consciousness. Nausea and vomiting are also
common among patients who suffer from Migraine headaches.
There are many occurrences that can "trigger" a migraine attack. Some of the most commonly associated
triggers are loud noise, bright lights, certain foods (chocolate, peanut butter, avocado, banana, citrus, dairy
products, and fermented/ pickled foods, MSG), certain medications (birth control pills, migraine
medications), menstrual cycle fluctuations, exertion activities, as well an underlying emotional and/ or
psychiatric diseases, such as Depression.
Mechanism:
In the past scientists thought that migraines were caused by changes in blood vessels within the brain.
However, recent research has led scientists and physicians today to believe that the pain originates within
the brain itself, involving various nerve pathways and the neurotransmitters within the brain in addition to
the vasodilatory affects.
Cluster HA are considered to be from the vasodilatation (opening) of the blood vessels in the brain. This
causes the acute and severe pain by compressing and irritating Cranial Nerve V (Trigeminal), which
innervates the sensory and some motor function of the face.
The etiology of Tension HA’s are less understood, however, is thought to be due to neurotransmitter or
chemical changes surrounding the brain due to stress and emotional factors. Another theory is continued
musculoskeletal (myofascial) irritations may cause Tension HA’s (2007 Ashina). Examples of continued
myofascial irritation or stimulation includes jaw clenching as well as poor posture of the back or neck.
Migraine Headaches are thought to be vascular in origin, similar to Cluster HA, and also associated with a
imbalance in the neurotransmitter Serotonin. Migraines are also considered to be familial, which means
there is a genetic link involved. The theory is that some patients with a family history of Migraines have
gene that predisposes them to the causes of Migraines (2007 Goadsby).
A study conducted in 2003 by the Departments of Anesthesia and Critical Care of Harvard University
showed that the cranial parasympathetic outflow contributes by sensitizing intracranial nociceptors
producing peripheral and/ or central desensitization occurring within a migraine attack. (2003 Yarnitsky D).
This can intensify and aggravate the pain that is actually caused by the migraine.
Sensitizing desensitization is a development involving both the peripheral nervous system (PNS) and the
central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals
through the spinal cord to the brain. Central sensitization is where there is an increase in the excitability of
neurons within the CNS, (brain and spinal cord) so that normal inputs from the PNS begin to produce
abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate
neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli. As a result, an
input that would normally produce a harmless sensation now produces significant pain. This occurrence is
classically seen in patients who suffer from primary HA, especially Migraines.
Treatment:
Pharmacologic treatment for primary headaches can be classified as “abortive” or “preventive.”
Abortive therapy:
Abortive therapies are directed at terminating the pain immediately. Although this may provide relief from
the HA, it does not decrease the frequency/ intensity nor does it prevent the attack from recurring. They
also are not equally effective each time and efficacy varies from person to person. Typical over the counter
medications have no use for Cluster headaches. Some commonly used abortive therapies for HA’s are:
• Oxygen - most commonly used acutely in Cluster HA.
• Ergots
• Triptans
• NSAID’s
• Anti-emetics
• Opiates
• Butalbital with aspirin or acetaminophen
Although many patients may experience relief with these treatments, there is also a concern of overuse and
dependence that may develop. In May 2007 the National Neurological Institute in Milan Italy published an
article stating “Most patients with frequent headaches eventually overuse their medications, and when this
happens, the diagnosis of medication-overuse headache is clinically important, because patients rarely
respond to preventive medications whilst overusing acute medications” (2007 Grazzi). Therefore it is very
important to monitor a patient on abortive therapy because if overusing their medications, their headaches
may become refractory to the preventive therapy causing their attacks to be more frequent and severe.
Preventive therapy:
Medications and techniques that are considered Preventive therapies are directed at reducing the
frequency and severity of the attacks. Unfortunately, most of these medications are not able to terminate
an acute episode so they are typically used in conjunction with the abortive therapies during an attack.
Some of the common preventive medications are:
• Cardiovascular drugs (Beta blockers, Calcium channel blockers)
• Antiseizure medications
• Antidepressants
• Antihistamines
In a recent publication from 2007, the relationship between Depression/ Anxiety Disorders in people with
Migraines were evaluated and showed a linked association. Therefore it is recommended that people who
are experiencing migraines or migraine-like symptoms should also be screened for Depression/ Anxiety
disorders. By treating both aspects, the physical and the mental, then the quality of life and symptom
management may improve (2007 Frediani F). Treatment for these disorders can be through medication or
behavioral therapy.
An extremely important aspect to treating headaches is through behavioral interventions and modifications.
Behavioral modifications, including biofeedback training, mind and body relaxation (yoga, acupuncture,
massage), and cognitive behavior therapy have been identified as successful treatments for migraine
headache (2006 Holroyd).
Arizona Pain Specialists know the importance of these treatments and therefore offer for their patients:
• Acupuncture
• Massage
• Exercise and Nutrition Counseling, Vitamin Supplements
• Prayer
• Cognitive Behavioral Therapy
• Group Therapy
• Biofeedback
• Chiropractic Manipulations
• Hormone Supplements
Recently there has been a flood of investigations going on to determine the efficacy of Botulinum A toxin
(Botox) injections for the treatment of Migraines. Some people receiving Botox injections for their facial
wrinkles have noted improvement of their headaches. Essentially, the Botox is injected in the same or
similar locations as is for the treatment of wrinkles in cosmetic practices. In 2007 The Chicago Medical
School at Rosalind Franklin University of Medicine and Science compared results of two large trials that
investigated the efficacy of Botox for the treatment of Migraines and Tension HA. They reported there were
positive findings in the association of the treatment of these HA’s with Botox (2007 Freitag).
Another publication in 2006 stated that 75% of patients treated with Botox injections for the prophylactic
treatment of migraines reported compete relief of their headache. No adverse effects were reported by the
treatment group either and was therefore quoted as “Botox (BTX-A) showed good efficacy and tolerability
as a prophylactic agent” (2006 Anand).
Qualified pain physicians, such as those at Arizona Pain Specialists offer an array of injections and
procedures that have proven efficacious in treatment of headaches, including the Botox injections. Some of
the other injections and treatments they offer are:
• Botox Injections
• Occipital Nerve Stimulation
• Cervical Facet Injections
• Cervical Epidural Steroid Injections
• Sphenopalatine Nerve Blocks
• Occipital Nerve Blocks
• Supratrochlear Nerve Blocks
• Supra/ Infraorbital Nerve Blocks
There have been numerous studies and publications on the effectiveness of these treatments for the relief
of headaches. Many of them stated that the conventional therapies are often not effective in treating the
associated facial pain and peripheral/ central desensitization that is commonly associated with Migraines.
The results of some of the reports are given:
In a study conducted by the Department of Anesthesiology, Intensive Care and Pain Management in Italy,
85% of patients responded positively with a favorable response when treated with blockade of the
supraorbital and greater occipital nerves in the treatment for Migraines. Caputi therefore concluded that
the blockade of the supraorbital and greater occipital nerves were shown to be effective in the treatment of
Migraine HA (1997 Caputi).
Transnasal sphenopalatine ganglion (SPG) block injections are also helpful in Migraines but have also had
positive results in treating medication- resistant Cluster headaches. A number of surgical treatments have
been attempted in cases of Cluster HA resistant to pharmacologic therapy, of which SPG blockade has
been shown to have the most successful results. "These results should be considered rather good
because, unlike other frequently used techniques, SPG blockade is not invasive and should therefore
always be attempted before submitting patients to more invasive surgical approaches" (2006 Felisati).
Also printed in 2006 was “Transnasal sphenopalatine gangion block provides a safe, low-cost, therapy that,
if effective, oftentimes can be self-administered for pain relief.” (2006 Obah).
Another author published, ”The nerve stimulator-guided occipital nerve blockade significantly relieved
cervicogenic headache and associated symptoms at two weeks following injection.” (2006 Naja).
Therefore, a combination of therapies have been proven to reduce the symptoms associated with
Migraines and other headaches. You should discuss what the best and most beneficial options would be
for you particular headache and associated complaints with your pain specialist.
Articles/ Studies:
Pathophysiology of tension-type headache: potential drug targets. Ashina M. CNS Neurol Disord Drug
Targets. 2007 Aug;6(4):238-9 PMID: 17691978
Headache. 2003 Jul-Aug;43(7):704-14 Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A,
Burstein R. PMID: 12890124 [PubMed - indexed for MEDLINE
Migraine and depression. Frediani F, Villani V. Neurol Sci. 2007 May;28 Suppl 2:S161-5 PMID: 17508165
Recent advances in understanding migraine mechanisms, molecules and therapeutics. Goadsby PJ.
Trends Mol Med. 2007 Jan;13(1):39-44. Epub 2006 Dec 1 PMID: 17141570
Chronic headaches: pharmacological and non-pharmacological treatment. Grazzi L, Usai S, Bussone G.
Neurol Sci. 2007 May;28 Suppl 2:S134-7 PMID: 17508160
Behavioral approaches to the treatment of migraine. Semin Neurol. 2006 Apr;26(2):199-207 Holroyd KA,
Drew JB. PMID: 16628530 [PubMed - indexed for MEDLINE
Botulinum toxin type A in chronic migraine. Expert Rev Neurother. 2007 May;7(5):463-70 Freitag FG. PMID:
17492897 [PubMed - indexed for MEDLINE]
Botulinum toxin type A in prophylactic treatment of migraine. Am J Ther. 2006 May-Jun;13(3):183-7 Anand
KS, Prasad A, Singh MM, Sharma S, Bala K. PMID: 16772757 [PubMed - indexed for MEDLINE]
Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial.
Pain Pract. 2006 Jun;6(2):89-95. PMID: 17309715 [PubMed - indexed for MEDLINE] Naja ZM, El-Rajab M,
Al-Tannir MA, Ziade FM, Tawfik OM.
Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and
headache pain. J Pain Palliat Care Pharmacother. 2006;20(3):57-9 Obah C, Fine PG. PMID: 16931483
[PubMed - indexed for MEDLINE
Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache.
Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G. Laryngoscope. 2006 Aug;116(8):1447-50
PMID: 16885751
Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Caputi CA, Firetto
V. Headache. 1997 Mar;37(3):174-9 PMID: 9100402
have a physician or pain specialist rule out more severe causes before beginning treatment for the benign
causes.
Headaches themselves are one of the most common complaints from people visiting a physician. A
physician will then classify the HA as "Primary" or "Secondary." Primary HA's are not caused by an
underlying pathology or disease. Meaning, they are benign HA's which can further be subdivided as
Cluster, Tension, and Migraine headaches. Secondary HA's are associated with a pre-existing pathology
causing the pain, which may be benign or malignant of origin.
There are many causes of secondary headaches that should be excluded by a physician before assuming
a HA is of primary origin. Some of the more severe causes that require immediate treatment are intracranial
hemorrhages/ hematomas, meningeal infections (viral, bacterial, fungal), strokes, and malignant
hypertension. Other pathologies that are more subacute, or have an insidious onset may be malignant
tumors (primary or malignant) or ophthalmologic (glaucoma, cataract). There are other diseases
associated with HA and these all should be evaluated by your physician before treating your HA. Your
physician may wish to order radiological studies (MRI, CT scan), neurological exam, blood work, or an eye/
vision assessment to help rule out some of the causes of secondary HA
Primary headaches are much more common and can be broken down into three categories; Cluster,
Tension, and Migraine headaches.
Cluster Headaches:
In Cluster HA, men are more commonly affected than women with a peak age of onset around 25 years.
Patients will present with a severe, unilateral, pulsatile, periorbital pain that typically lasts anywhere from 20
minutes to 3 hours. Patients describe the pain associated with Cluster HA to be far more severe than is
experienced in Tension or Migraine HA’s. Risk factors for Cluster HA are vasodilating medications as well
as recent alcohol or illicit drug use. A specific trait to Cluster HA’s are that they occur in “clusters”, hence
the name, meaning they affect the same location of the head, around the same time of day, during the
same time of year. Patients may also experience tearing from the eye on the same side of the head as the
pain as well as nasal discharge or stuffiness, or neurological complications (Horner’s syndrome, ptosis). In
contrast with the other two types of primary HA, emotion and food are NOT triggers in Cluster HA.’s
Tension Headaches:
Tensions HA’s are considered the most common HA diagnosed in adults. The pain is described as a
restrictive, band like pain that is being wrapped around the patients head. Patients describe it as an
insidious (slow) onset and can be exacerbated by bright lights, noise, and especially stress. A patient
experiencing Tension headaches may also have an associated Depression, sleep disturbance, or poor
concentration. These typically occur towards the end of the day and are located in the upper neck and
occipital (back of head) region. Unlike Cluster and Migraines, Tension HA are not associated with any
neurological disturbances and are usually a diagnosis of exclusion.
Migraine Headaches:
Migraines are more common in women and affect a significant portion of the population. Migraine HA’s can
be experienced in children, adolescents, adults, and geriatric patients and varies significantly with each
person. They can be seen in anyone! The pain associated with Migraines is described as either unilateral
(one-sided) or bilateral (both sides), intense and throbbing that typically lasts over an hour but less than 24
hours.
Migraines are further classified as “Classical” and “Common.” In Classical Migraines the pain is unilateral
and is preceded by an aura . A Common Migraine is often bilateral and has no associated aura or
neurological manifestation.
One of the known phenomena of a Migraine HA is that many people, although not all, have an associated
aura that may occur before, during, or after the onset of the migraine. Some patients describe the aura as
scintillating flashes of light, a particular smell, spots of vision loss, as well as numbness of one or both sides
of the face, unsteadiness, weakness, or an altered level of consciousness. Nausea and vomiting are also
common among patients who suffer from Migraine headaches.
There are many occurrences that can "trigger" a migraine attack. Some of the most commonly associated
triggers are loud noise, bright lights, certain foods (chocolate, peanut butter, avocado, banana, citrus, dairy
products, and fermented/ pickled foods, MSG), certain medications (birth control pills, migraine
medications), menstrual cycle fluctuations, exertion activities, as well an underlying emotional and/ or
psychiatric diseases, such as Depression.
Mechanism:
In the past scientists thought that migraines were caused by changes in blood vessels within the brain.
However, recent research has led scientists and physicians today to believe that the pain originates within
the brain itself, involving various nerve pathways and the neurotransmitters within the brain in addition to
the vasodilatory affects.
Cluster HA are considered to be from the vasodilatation (opening) of the blood vessels in the brain. This
causes the acute and severe pain by compressing and irritating Cranial Nerve V (Trigeminal), which
innervates the sensory and some motor function of the face.
The etiology of Tension HA’s are less understood, however, is thought to be due to neurotransmitter or
chemical changes surrounding the brain due to stress and emotional factors. Another theory is continued
musculoskeletal (myofascial) irritations may cause Tension HA’s (2007 Ashina). Examples of continued
myofascial irritation or stimulation includes jaw clenching as well as poor posture of the back or neck.
Migraine Headaches are thought to be vascular in origin, similar to Cluster HA, and also associated with a
imbalance in the neurotransmitter Serotonin. Migraines are also considered to be familial, which means
there is a genetic link involved. The theory is that some patients with a family history of Migraines have
gene that predisposes them to the causes of Migraines (2007 Goadsby).
A study conducted in 2003 by the Departments of Anesthesia and Critical Care of Harvard University
showed that the cranial parasympathetic outflow contributes by sensitizing intracranial nociceptors
producing peripheral and/ or central desensitization occurring within a migraine attack. (2003 Yarnitsky D).
This can intensify and aggravate the pain that is actually caused by the migraine.
Sensitizing desensitization is a development involving both the peripheral nervous system (PNS) and the
central nervous system (CNS). Local tissue injury and inflammation activate the PNS, which sends signals
through the spinal cord to the brain. Central sensitization is where there is an increase in the excitability of
neurons within the CNS, (brain and spinal cord) so that normal inputs from the PNS begin to produce
abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate
neurons in the spinal cord that normally only respond to noxious, or more severe, stimuli. As a result, an
input that would normally produce a harmless sensation now produces significant pain. This occurrence is
classically seen in patients who suffer from primary HA, especially Migraines.
Treatment:
Pharmacologic treatment for primary headaches can be classified as “abortive” or “preventive.”
Abortive therapy:
Abortive therapies are directed at terminating the pain immediately. Although this may provide relief from
the HA, it does not decrease the frequency/ intensity nor does it prevent the attack from recurring. They
also are not equally effective each time and efficacy varies from person to person. Typical over the counter
medications have no use for Cluster headaches. Some commonly used abortive therapies for HA’s are:
• Oxygen - most commonly used acutely in Cluster HA.
• Ergots
• Triptans
• NSAID’s
• Anti-emetics
• Opiates
• Butalbital with aspirin or acetaminophen
Although many patients may experience relief with these treatments, there is also a concern of overuse and
dependence that may develop. In May 2007 the National Neurological Institute in Milan Italy published an
article stating “Most patients with frequent headaches eventually overuse their medications, and when this
happens, the diagnosis of medication-overuse headache is clinically important, because patients rarely
respond to preventive medications whilst overusing acute medications” (2007 Grazzi). Therefore it is very
important to monitor a patient on abortive therapy because if overusing their medications, their headaches
may become refractory to the preventive therapy causing their attacks to be more frequent and severe.
Preventive therapy:
Medications and techniques that are considered Preventive therapies are directed at reducing the
frequency and severity of the attacks. Unfortunately, most of these medications are not able to terminate
an acute episode so they are typically used in conjunction with the abortive therapies during an attack.
Some of the common preventive medications are:
• Cardiovascular drugs (Beta blockers, Calcium channel blockers)
• Antiseizure medications
• Antidepressants
• Antihistamines
In a recent publication from 2007, the relationship between Depression/ Anxiety Disorders in people with
Migraines were evaluated and showed a linked association. Therefore it is recommended that people who
are experiencing migraines or migraine-like symptoms should also be screened for Depression/ Anxiety
disorders. By treating both aspects, the physical and the mental, then the quality of life and symptom
management may improve (2007 Frediani F). Treatment for these disorders can be through medication or
behavioral therapy.
An extremely important aspect to treating headaches is through behavioral interventions and modifications.
Behavioral modifications, including biofeedback training, mind and body relaxation (yoga, acupuncture,
massage), and cognitive behavior therapy have been identified as successful treatments for migraine
headache (2006 Holroyd).
Arizona Pain Specialists know the importance of these treatments and therefore offer for their patients:
• Acupuncture
• Massage
• Exercise and Nutrition Counseling, Vitamin Supplements
• Prayer
• Cognitive Behavioral Therapy
• Group Therapy
• Biofeedback
• Chiropractic Manipulations
• Hormone Supplements
Recently there has been a flood of investigations going on to determine the efficacy of Botulinum A toxin
(Botox) injections for the treatment of Migraines. Some people receiving Botox injections for their facial
wrinkles have noted improvement of their headaches. Essentially, the Botox is injected in the same or
similar locations as is for the treatment of wrinkles in cosmetic practices. In 2007 The Chicago Medical
School at Rosalind Franklin University of Medicine and Science compared results of two large trials that
investigated the efficacy of Botox for the treatment of Migraines and Tension HA. They reported there were
positive findings in the association of the treatment of these HA’s with Botox (2007 Freitag).
Another publication in 2006 stated that 75% of patients treated with Botox injections for the prophylactic
treatment of migraines reported compete relief of their headache. No adverse effects were reported by the
treatment group either and was therefore quoted as “Botox (BTX-A) showed good efficacy and tolerability
as a prophylactic agent” (2006 Anand).
Qualified pain physicians, such as those at Arizona Pain Specialists offer an array of injections and
procedures that have proven efficacious in treatment of headaches, including the Botox injections. Some of
the other injections and treatments they offer are:
• Botox Injections
• Occipital Nerve Stimulation
• Cervical Facet Injections
• Cervical Epidural Steroid Injections
• Sphenopalatine Nerve Blocks
• Occipital Nerve Blocks
• Supratrochlear Nerve Blocks
• Supra/ Infraorbital Nerve Blocks
There have been numerous studies and publications on the effectiveness of these treatments for the relief
of headaches. Many of them stated that the conventional therapies are often not effective in treating the
associated facial pain and peripheral/ central desensitization that is commonly associated with Migraines.
The results of some of the reports are given:
In a study conducted by the Department of Anesthesiology, Intensive Care and Pain Management in Italy,
85% of patients responded positively with a favorable response when treated with blockade of the
supraorbital and greater occipital nerves in the treatment for Migraines. Caputi therefore concluded that
the blockade of the supraorbital and greater occipital nerves were shown to be effective in the treatment of
Migraine HA (1997 Caputi).
Transnasal sphenopalatine ganglion (SPG) block injections are also helpful in Migraines but have also had
positive results in treating medication- resistant Cluster headaches. A number of surgical treatments have
been attempted in cases of Cluster HA resistant to pharmacologic therapy, of which SPG blockade has
been shown to have the most successful results. "These results should be considered rather good
because, unlike other frequently used techniques, SPG blockade is not invasive and should therefore
always be attempted before submitting patients to more invasive surgical approaches" (2006 Felisati).
Also printed in 2006 was “Transnasal sphenopalatine gangion block provides a safe, low-cost, therapy that,
if effective, oftentimes can be self-administered for pain relief.” (2006 Obah).
Another author published, ”The nerve stimulator-guided occipital nerve blockade significantly relieved
cervicogenic headache and associated symptoms at two weeks following injection.” (2006 Naja).
Therefore, a combination of therapies have been proven to reduce the symptoms associated with
Migraines and other headaches. You should discuss what the best and most beneficial options would be
for you particular headache and associated complaints with your pain specialist.
Articles/ Studies:
Pathophysiology of tension-type headache: potential drug targets. Ashina M. CNS Neurol Disord Drug
Targets. 2007 Aug;6(4):238-9 PMID: 17691978
Headache. 2003 Jul-Aug;43(7):704-14 Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A,
Burstein R. PMID: 12890124 [PubMed - indexed for MEDLINE
Migraine and depression. Frediani F, Villani V. Neurol Sci. 2007 May;28 Suppl 2:S161-5 PMID: 17508165
Recent advances in understanding migraine mechanisms, molecules and therapeutics. Goadsby PJ.
Trends Mol Med. 2007 Jan;13(1):39-44. Epub 2006 Dec 1 PMID: 17141570
Chronic headaches: pharmacological and non-pharmacological treatment. Grazzi L, Usai S, Bussone G.
Neurol Sci. 2007 May;28 Suppl 2:S134-7 PMID: 17508160
Behavioral approaches to the treatment of migraine. Semin Neurol. 2006 Apr;26(2):199-207 Holroyd KA,
Drew JB. PMID: 16628530 [PubMed - indexed for MEDLINE
Botulinum toxin type A in chronic migraine. Expert Rev Neurother. 2007 May;7(5):463-70 Freitag FG. PMID:
17492897 [PubMed - indexed for MEDLINE]
Botulinum toxin type A in prophylactic treatment of migraine. Am J Ther. 2006 May-Jun;13(3):183-7 Anand
KS, Prasad A, Singh MM, Sharma S, Bala K. PMID: 16772757 [PubMed - indexed for MEDLINE]
Occipital nerve blockade for cervicogenic headache: a double-blind randomized controlled clinical trial.
Pain Pract. 2006 Jun;6(2):89-95. PMID: 17309715 [PubMed - indexed for MEDLINE] Naja ZM, El-Rajab M,
Al-Tannir MA, Ziade FM, Tawfik OM.
Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and
headache pain. J Pain Palliat Care Pharmacother. 2006;20(3):57-9 Obah C, Fine PG. PMID: 16931483
[PubMed - indexed for MEDLINE
Sphenopalatine endoscopic ganglion block: a revision of a traditional technique for cluster headache.
Felisati G, Arnone F, Lozza P, Leone M, Curone M, Bussone G. Laryngoscope. 2006 Aug;116(8):1447-50
PMID: 16885751
Therapeutic blockade of greater occipital and supraorbital nerves in migraine patients. Caputi CA, Firetto
V. Headache. 1997 Mar;37(3):174-9 PMID: 9100402
Headaches (HA)
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Headaches are a pain or discomfort that can be generalized or
local affecting any part of the cephalum (head). There are many
causes of HA, some originating from the head region itself, others
are referred from the neck and upper back, as well as
ophthalmologic origins
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Headaches are a pain or discomfort that can be generalized or
local affecting any part of the cephalum (head). There are many
causes of HA, some originating from the head region itself, others
are referred from the neck and upper back, as well as
ophthalmologic origins
Botox injections have shown good efficacy in
reducing the frequency of Migraine Headaches.
reducing the frequency of Migraine Headaches.
Reclaim Your Life. Call for an
appointment Today.
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Arizona Pain Specialists can
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Book I - Pain Syndromes
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
Chapter 1 Low Back Pain
Chapter 2 Neck Pain
Chapter 3 Cancer Pain
Chapter 4 Headaches
Chapter 5 Spinal Stenosis
Chapter 6 Sciatica
Chapter 7 Arthritis
Chapter 8 Fibromyalgia
Chapter 9 Motor Vehicle Injuries
Chapter 10 Complex Regional Pain
Syndrome
Chapter 11 Vertebral Body
Fractures
Chapter 12 Hip and Leg Pain
Chapter 13 Diabetic Peripheral
Neuropathy
Book II - Interventional Procedures
Chapter 14 Epidural Steroid
Injection
Chapter 15 Facet Injections/Medial
Branch Blocks
Chapter 16 Radiofrequency Ablation
Chapter 17 Spinal Cord Stimulator
Implants
Chapter 18 IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19
Vertebroplasty/Kyphoplasty
Chapter 20 Discography
Chapter 21 Percutaneous
Discectomy
Chapter 22 Occipital Nerve Block
Chapter 23 Sympathetic Block
Chapter 24 Stellate Ganglion Block
Chapter 25 Intrathecal Pump
Implants
Chapter 26 Caudal Steroid Injection
Chapter 27 Adhesiolysis
Chapter 28 Cervical Steroid
Injection
Chapter 29 Sacroiliac Joint
Injections
Chapter 30 Celiac Plexus Block
Chapter 31 Head and Neck
Procedures
Chapter 32 Joint Injections
Chapter 33 Continuous Catheter
Nerve Blocks
Chapter 34 Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35 Disc Denervation
Book III Other Treatments
Chapter 36 Medication Management
Chapter 37 Acupuncture
Chapter 38 Prolotherapy
Chapter 39 Botox
Chapter 40 Massage
Chapter 41 Alternative and
Complementary Medicines
Chapter 42 Exercise and Nutrition
Counseling
Chapter 43 Prayer
Chapter 44 Cognitive Behavioral
Therapy
Chapter 45 Group Therapy
Chapter 46 Biofeedback
Chapter 47 Chiropractic
Manipulations
Chapter 48 Vitamin Supplements
Chapter 49 Customized
Pharmaceutical Formulations
Chapter 50 Hormone Therapy
Frequently Asked Questions
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