Chronic Headache and Migraine: Pain Management Options
Chronic headaches — defined as headaches occurring 15 or more days per month — significantly impair quality of life for millions of Americans. When standard preventive medications (topiramate, amitriptyline, beta-blockers, CGRP antagonists) are insufficient or intolerable, interventional pain management offers additional options.
Types of Chronic Headache We Treat
Cervicogenic headache: Headaches originating from the upper cervical spine (C1-C3) — particularly the C2-C3 facet joint — that are referred to the back of the head, occiput, and sometimes behind the eye. This is frequently misdiagnosed as migraine.
Occipital neuralgia: Pain in the distribution of the greater and/or lesser occipital nerves — shooting, stabbing pain at the base of the skull that radiates to the top of the head. Often associated with scalp tenderness.
Chronic migraine: When standard preventive medications fail, interventional approaches can reduce attack frequency and severity.
Interventional Options
Occipital Nerve Blocks: A first-line interventional treatment for both occipital neuralgia and cervicogenic headache. Local anesthetic and steroid are injected around the greater and lesser occipital nerves at the base of the skull. Relief often lasts weeks to months and can be repeated.
Cervical Medial Branch Blocks + Radiofrequency Ablation: For cervicogenic headache originating from the C2-C3 facet joint, diagnostic medial branch blocks followed by radiofrequency ablation of the C2-C3 medial branch nerves can provide 12+ months of relief from a single procedure.
Sphenopalatine Ganglion (SPG) Block: The SPG is a nerve cluster behind the nose involved in migraine and cluster headache pathophysiology. Transnasal SPG blocks can abort acute attacks and reduce chronic migraine frequency when used preventively.
Cervical Epidural Steroid Injection: When cervicogenic headache has a disc or nerve root component, cervical ESI can provide meaningful relief.
Botulinum Toxin (Botox): Dr. Rubin administers Botox for chronic migraine — the FDA-approved prophylactic treatment protocol. Injections every 12 weeks reduce migraine frequency by an average of 50%.
Cervicogenic Headache vs. Migraine
Many patients with "migraines" actually have cervicogenic headache — which is structurally different and requires different treatment. Features that suggest cervicogenic origin:
- Headache triggered by neck movements or positions
- Tenderness over the upper cervical spine
- One-sided headache that stays on the same side
- Reduced cervical range of motion
A diagnostic occipital nerve block or cervical medial branch block that significantly reduces the headache confirms cervicogenic origin.
For comprehensive headache evaluation, call 516-492-3100.