Chronic headache treatment experiences
Chronic headache treatment experiences - Dr. Prakash Deshmukh, MD and Dr. Kailash Kothari, MD
We have headache speciality clinic at all our centres.
I will be describing some of the cases so as to give you an idea about the type of headache we deal with. Chronic headache is being labelled as migraine and treated according with variable success rates. What we do differently is to look for extracranial causes for chronic headache which do exist for about 70% in patients with chronic headache.
Mrs Shalini,(Name Changed) 55-year-old was suffering from chronic headache on left side. She also started getting strange symptoms - left side face pain associated with burning sensation of left half of tongue and drooling of saliva from same side. This is not a normal case scenario. She thought it may be a dental related pain. She had undergone complete denture fixation on the same side to get rid of her pain, with no result. This is not a common scenario in patients with headache patients. But sometimes patients with headache and facial pain we do see such unusual symptoms. After detailed examination we provisionally diagnosed her to be a case of occipital neuralgia. Occipital nerve arises in the upper cervical spine and supplies sensation to the head. We did planned a greater occipital nerve block for her. We injected a mixture of local anesthetic and small dose of cortisone. Immediately after the block she had complete relief of pain and over a period of one week all her symptoms like burning sensation of tongue, drooling of saliva also has completely resolved. She maintained her pain free status and one year post procedure she had complete relief of pain.
(Palpating occipital nerve - Pain radiates to the head in same area of patient’s headache)
In another scenario we had Mrs Shinde (Name changed) 50-year-old female came to our clinic with giddiness /headache and neck pain, not responding to oral medications. On examination her neck on the side of pain was very tender on pressure. This is commonly seen in patients with facet joint inflammation. This is the common condition which is usually missed by many doctors as they are not aware of this disease called facet joint pain. In her case we planned for cervical medial branch block (These are small nerves supplying the cervical facet joints). We injected local anesthetic for injection without cortisone. After the injection she had complete relief of headache and giddiness. We asked her to report us back if pain recurred. Fortunately pain didn’t recurred and two years down the line she still has complete relief of headache and giddiness. In these cases usually pain recurs after few hours or days of local anesthetic block as the drug effect wears off. In those cases we perform radiofrequency ablation of the cervical medial branches for prolonged relief (1-3 years).
(Medial branches supplying facet joints)
(Injection of medial branch nerve to facet joint)
A young female age 25 years presented to our clinic for chronic headache treatment. She had a peculiar history her headache was triggered by loud noise,after which she used to get unconscious for 2-3 hours. Same incident happened during her marriage ceremony. All her test MRI, CT scan used to be normal. We planned greater occipital nerve block for her (Like the case above). After the injection she had complete relief from her headache. She did visit our clinic after one year just to say that she is totally free of her headache since last one year.
Many such patients are getting relieved of their sufferings from our clinic. Instead of suffering from headache, do visit a pain specialist to get relief from headache.