Chronic daily headaches (CDH) include all kinds of headaches (tension, migraine or cluster) occurring at least 15 days per month. Eighty-five to 90 percent of CDH patients have been diagnosed with tension or migraine headaches. Many of these patients experience daily or nonstop headaches adversely impacting their personal, professional and social lives.
Most CDH patients are well versed in commonly used treatments: general, abortive, prophylactic and interventional therapies. New hope in interventional medicine may be found for those patients who have tried and failed usual measures. Nerve blocks go directly to the nerve structure responsible for sending the painful message to the brain. Interventional procedures have none of the medication-associated risks, not to mention the cost of buying and monitoring these high risk medications over the course of a lifetime.
General measures include treatment for rebound headaches. Unfortunately, many times the very drug taken to relieve a headache may actually contribute to the onset of the next one. The only way to relieve these rebound conditions is through drug withdrawal, which depending on the drug, may require inpatient detoxification to minimize risk of seizures. Abortive therapies are started immediately following headache onset and usually include triptans, non-steroidal anti-inflammatory drugs (NSAIDs) and ergotamines. Due to other health problems, not all patients are candidates for these high risk medications. High risk opioids (controlled, habit-forming drugs) are sometimes used when abortive medications fail. Prophylactic medications are considered if headaches occur greater than twice a week and are started only after rebound medications have been tapered. Prophylactic agents include tricyclic antidepressants, anticonvulsants and beta-blockers. These drugs have risks for heart attacks, strokes, gastrointestinal bleeding, fatal irregular heart beats, liver/kidney/heart failure, asthma attacks, addiction or death.
Interventional nerve blocks serve two purposes: they aid in the correct diagnosis and/or provide immediate reduction in pain once the affected nerve has been correctly identified. Nerve blocks are not curative, but provide relatively long-term relief and reduce the need for high risk medications. Radiofrequency denervation blocks may provide even longer term pain reduction, usually lasting anywhere from six months to two years, depending upon the diameter of the affected nerve.
Chronic daily headaches, especially those failing to respond to usual treatments, markedly reduce quality of life. In the hands of an experienced, board-certified pain management specialist, interventional pain procedures/nerve blocks offer new hope for reduction of chronic, daily pain. All interventional procedures should be done in a certified facility capable of providing pre- and post-procedure monitoring by licensed, credentialed staff. Local anesthesia, inhaled anesthetics, and intravenous conscious sedation are customized to meet your individual needs. These procedures are done on an outpatient basis. Headache sufferers should see a health care provider immediately upon experiencing any of the following “red flag” symptoms with a headache: fever, stiff neck, weakness or numbness, “worst headache” ever, “thunderclap” headache, change in headache pattern, or new onset headache after age 50.
Kathlene Hodges, M.S.N., R.N., C.S., C.F.N.P., graduated from Delta State University with a clinical specialty in family practice. She has over 30 years experience in health care with the last 12 in advanced practice. Ms. Hodges is a member of the Society for Pain Practice Management and a charter member of the International Honor Society for Nursing. She serves as a speaker and pain consultant for the pharmaceutical industry.