Headache is a common problem and majority of common headaches can be managed by commonly used painkillers. Some with more frequent episodes require prophylactic agents to reduce the frequency of attacks. However in some cases, despite all measures the headaches can be difficult to manage. Pain clinic can offer interventions which can help not only in establishing better pain control and improving quality of life but also in confirming the diagnosis (in some cases).Pain clinic offers multi-disciplinary approach to address concomitant magnifiers/ triggers such as anxiety, depression, altered sleep cycle, medication overuse, life style and poor posture.
The term Cervicogenic Headaches is commonly used for headaches originating from cervical spine pathology or surrounding soft tissues. These types of headaches are mostly accompanied by neck pain, stiffness and are commonly undertreated. Extra cranial sources of headaches such as nerves, joints and muscles can also be easily missed. Examples include neck facet or Atlantoaxial joint pathology, headaches secondary to third occipital nerve, supraorbital neuralgia, occipital neuralgia,sternocleidomastoid and trapezius muscle strain and spasms.
Some of the interventions available via the pain clinic include:
Facet joint injections & Radiofrequency - Headaches originating from facet joints are more commonly observed in the elderly and after whiplash injury (flexion/extension injuries).
Third Occipital Nerve Block & Radiofrequency- this nerve or the joint it supplies can be a source of headaches localised to the back of head on one side. The pain can sometimes spread towards the top of the head. An injection of the nerve and radiofrequency treatment can help to confirm diagnosis and provide long lasting relief.
Occipital Nerve Block & Radiofrequency-Greater occipital nerve block is most frequent peripheral nerve block used in management of cervicogenic headache. These nerves are located on the back of head and pain originating from these presents as shooting or stabbing pain with altered sensation in the distribution of the nerve. Local anaesthetic block can help in confirming the diagnosis and radiofrequency treatment can help provide long pasting pain relief.
Sphenopalatine Ganglion Block - Sphenopalatine ganglion is located behind the nose and serves as a relay centre for messages before being transmitted to brain. It is closely linked to one of the main nerves involved in headaches, facial pain (trigeminal nerve). A block of this ganglion is used in conditions such as cluster headaches, migraine and atypical facial pain.
Botox for Migraine- Botox when injected into muscles partially blocks the nerve impulses and reduces the muscle contractions. In chronic migraine this can help in reducing the frequency of headaches with effects lasting for 8 to 12 weeks.
Other commonly used injections include Trigger Point Injection and Nerve Blocks. These interventions are used in combination with physiotherapy, psychology, medications and Complimentary therapies (acupuncture, TENS, meditation, Ayurveda and wellness).