Migraine Headaches and Head Pain

Head pain can be cause by migraine headaches or, less frequently, by occipital neuralgia.

Migraine headaches produce an intense throbbing, pulsing pain in one area of the head. The pain is often accompanied by nausea, vomiting, and sensitivity to sound and light.

Some people have success preventing migraines from occurring.  Preventing a migraine can be easier than stopping a migraine once it has begun.  Some of the commonly prescribed medications for migraine prevention are:

• Beta blocker cardiovascular drugs like Propranolol (brands Inderal La, Innopran XL etc.), Verapamil (Calan, Verelan, etc.), and Lisinopril (Zestril)

• Antidepressants like Amitriptyline, Protriptyline (Vivactil), nortriptyline (Pamelor)

• Anti-seizure drugs like Valproate (Depacon), Topiramate (Topamax), and Gabapentin (Neurontin)

• Botox injections

Women whose migraines are triggered by menstrual cycles can prevent headaches with hormone therapy.  Sometimes lifestyle changes like managing stress with relaxation and exercise, eating regular meals on a schedule, avoiding foods or drinks that trigger headaches, and forming a regular schedule for sleeping.

Migraine Headache

Occipital neuralgia is caused by pinching, irritation or inflammation of the occipital nerves running from the top of the spinal cord in the neck up through the scalp. The main symptom is shooting, burning pain that typically starts at the base of the head and radiates up into the scalp. Sometimes patients may also experience pain on the sides of the head, sensitivity to light, and pain behind the eyes.

Occipital Neuralgia

Treatment Options

• Medications
• Procedures

• These medications my lessen or stop migraine pain once it has begun:

  Ergotamine, Ergot Combinations, Ergot Alkaloids (Dihydroergotamine): There are oral, rectal, nasal, injection, and intravenous versions of these prescription drugs.

  Triptans: Migraine patients often find these relieve pain and nausea. These prescription drugs come in oral, nasal, and injection formulations. Types include zolmitriptan (Zomig), rizatriptan (Maxalt), almotriptan (Axert), sumatriptan (Imitrex), naratriptan (Amerge), frovatriptan (Frova) and eletriptan (Relpax).

  Analgesics & NSAIDs: These over-the-counter drugs include aspirin, ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and naproxen sodium (Aleve). Avoid daily use that may cause medication overuse that makes headaches worse.

  Opiates: When you can't take triptans or ergot then narcotic drugs like codeine can treat migraine headache pain. They are a not a first-choice because narcotics are habit-forming and because they can actually cause "rebound headaches".

• Botox injections can be an effective treatment for migraine prevention after traditional medication has failed. It is injected in several areas around the head and can be effective in decreasing the number of migraine headaches experienced for a three month period. After three months it can be repeated for further benefit.

  Occipital Nerve Block: This procedure involves injecting a steroid and possible an anesthetic into painful occipital nerves at the base of the head and scalp. This can lessen or alleviate pain from occipital neuralgia for up to several months.