All Headache Articles

Case Chat: Evolving Treatments for Chronic Headache and Migraine

In PPM's new Case Chat series, a recent chronic headache case is used to discuss how treatment approaches have evolved, including primary care assessment tools and multitherapy use.

Chronic Headache: How to Conduct a Virtual Neurological Examination

A telemedicine evaluation of a headache patient is always interesting and important. In this article, I briefly talk about two common types of headache – primary chronic daily headache and idiopathic intracranial hypertension headache – and review how to conduct a neurological examination as part of a real-time audio/video telehealth visit.

Video: Migraine and Mental Health

In this video Q&A, neurologist and headache expert Lawrence Robbins, MD, and patient advocate Jaime Sanders answer common patient questions on migraine treatments, self-care strategies, anxiety and depression as part of migraine disease, coping during COVID, and more.

American Headache Society Updated Guideline On Use of Neuroimaging for Migraine

Most experts agree that neuroimaging should be used sparingly and with caution when diagnosing and treating migraine. Yet, when to use and when not to use neuroimaging has long been a vexed issue. It’s not always clear when the risks of neuroimaging are justified.

AHS 2020: Annual Meeting Goes Virtual to Address COVID Impact, Frontiers in Headache Research

On Saturday, June 13, the American Headache Society (AHS) launched its annual scientific meeting, focused on headache medicine in the era of COVID and frontiers in headache research.

Ask the PharmD: What are the recommendations for preventing and treating pediatric migraine?

The prevalence of migraine in children increases with age and may affect up to 23% of children by age 15, which highlights a need for adequate treatment in these populations.

Erenumab and Onabotulinumtoxin A Show Additive Effect in Refractory Chronic Migraine

The prevalence of chronic migraine (CM) is estimated to be about 1.4% to 2.2% worldwide.1 Several preventive treatments are available for patients afflicted with this condition, including sodium valproate, topiramate, and propranolol.

Could Pulsed RF Provide Lasting Chronic Headache Relief in Refractory Patients?

While chronic headache disorders such as cluster headache and migraine are common, they are also largely underestimated and difficult to treat. Many patients experience a poor response to pharmacologic treatment because of inadequate analgesia, intolerable side effects, or the development of drug tolerance.1

The Mysterious Connection between Migraine and Obesity

Clinicians have long noted the connection between migraine and obesity. “Most neurologists have seen enough studies that show the link between obesity and migraine,” shared Sylvia Lucas, MD, PhD, clinical professor of neurology, specializing in headaches, at the University of Washington School of Medicine in Seattle.

CGRP Monoclonal Antibodies for Chronic Migraine: Year 1 of Clinical Use

Early clinical experience with a number of CGRP inhibitors for the prevention of migraine, including Aimovig, Emgality, and Ajovy.

Can CGRP Help Clarify Why Migraine Is More Common in Women?

In terms of treating migraine, a recent animal study explored how males and females may respond differently to calcitonin gene-related peptide (CGRP).

Tension-Type Headache: Evidence for Trigger Points

Headache and trigger points are often interconnected, especially when treating tension-type headaches (TTH).

Refractory Chronic Migraine: Mild, Moderate, or Severe

The need for a refractory chronic migraine scale for adults and adolescents.

Treatment Alternatives for Migraine

A discussion of sphenopalatine ganglion blocks and photobiomodulation as alternative treatments for migraine.

Intranasal Ketamine for the Relief of Cluster Headache

The author offers anecdotal evidence of ketamine as an anesthetic agent for relieving and reducing episodic as well as chronic cluster headache attacks.

Cervicogenic Headache: Diagnosis and Management

The authors share how an osteopathic approach to treating cervicogenic headache, which stems from the spine, may save time and cost

Chronic Headache and Central Pain Conditions

Understanding the overlap between chronic migraine or tension-type headache (TTH) and central pain conditions.

Possible Link Between Dry Eye Disease and Migraine

Older adults of both sexes may be at higher risk.

Special Report: CGRP Monoclonal Antibodies for Chronic Migraine

A retrospective review of the author's early clinical experience with the CGRP inhibitor erenumab (Aimovig) for the prevention of migraine.

Supraorbital Occipital Circumferential Stimulation as a Proposed Intervention for Chronic Primary Headaches

SOCS may serve as an effective treatment option to reduce symptoms.

Assessing and Treating Migraine in Women and Men

A look at the differences in risk, presentation, and care of migraine between men and women.

FDA Approves First Preventive Treatment for Cluster Headache

gammaCore is the first non-invasive, hand-held medical therapy applied at the neck as a therapy to prevent cluster headache.

The Homebound Adolescent: Managing Chronic Pain Conditions in the Pediatric Population

Clinicians can help to answer tough questions about homeschooling and school absences when a child is living with a chronic painful condition.

Biohaven to Begin Phase 1 Testing of New CGRP BHV-3500

Biohaven has received FDA authorization to dose first subject with BHV-3500, a new third-generation CGRP.

Men With Migraine Likely Have Increased Estradiol Levels

Many biological factors, including sex hormones, have been reported as a major contributor to migraine.

Migraine Game-Changers Announce Latest Data, Research Efforts at AHS

Biohaven, Lilly, and Allergan's new research from the American Headache Society (AHS) meeting.

At Stake: The Possible Long-Term Side Effects of CGRP Antagonists

Headache expert Lawrence Robbins, MD, asks a series of questions clinicians need to address before prescribing the long-awaited CGRP antagonists for migraine prevention.

A New Frontier in Migraine Management: Inside CGRP Inhibitors & Migraine Prevention

In this exclusive roundtable, developers recap the data on their CGRP inhibitors, including Aimovig, the first-ever monoclonal antibodies specifically designed to prevent chronic or episodic migraine.

Meet the Migraine Game-Changers

In this exclusive roundtable, Amgen/Novartis, Allergan, Lilly, and Teva recap the data that is moving their CGRP migraine preventives to the finish line. Introduction to CGRPs by Lawrence Robbins, MD

Migraine Sufferers At High Risk for Sleep Apnea and Other Disorders

Men with chronic migraine have been shown to be at a high risk of sleep apnea and other disorders.

Migraine Treatment Set for Reboot

Amgen, Novartis, Alder, Allergan, BioHaven, Lilly, and Teva are all anticipating FDA approval of their novel anti-CGRP chronic migraine preventive medications in 2018

ODT Formulation in Development for Migraine Treatment

CGRP receptor antagonists have been well tolerated in studies.

Low Risk of Serotonin Syndrome in Concomitant Use of Antidepressants and Triptans

Findings challenge a 2006 FDA advisory, questioning its validity

Understanding the Impact of Migraine

Lilly survey results point to need for new headache and migraine treatments as well as patient education.

Medication Overuse Headache: Inaccurate and Overdiagnosed

Diagnosing medication overuse headache, versus medication overuse, can be a tough task for practitioners. Here's how to differentiate the two.

Two New Products May Alleviate Cluster Headaches & Migraine Pain

Two New Pain Relief Stimulators May Alleviate Chronic Pain from Cluster Headaches & Migraines

In the Pipeline: Migraine Device

Device from Cefaly Technology promises to abort migraines more effectively than triptans.

Onset of Stress Offers a Reliable Warning of Ensuing Episodic Migraine

A patient’s perception of stress appears to offer a good forecast factor to predict the onset of episodic migraines.

Pharmacological Interventions in Sport-Related Concussion

Three case studies and a review of current practice guidelines offer insight into treating patients with chronic pain and other symptoms after a sport-related concussion.

Employing Monoclonal Antibody Therapy Lessens Episodic and Chronic Migraine Pain

Two studies published in the New England Journal of Medicine report favorable results when targeting calcitonin gene-related peptide with mAb treatments for migraine pain.

Skin Patch Resolves Migraine Pain More Quickly with Fewer Side Effects

A new study demonstrated that dermal application of zolmitriptan may provide significant relief from headache pain and most bothersome migraine symptoms.

IV Propofol for Treatment of Chronic Intractable Cluster Headache: A Case Series

John Claude Krusz, PhD, MD, provides 6 case reports where he as employed IV propofol in his out-patient clinic) to effectively management otherwise intractable migraine headaches.

Migraine Treatment: What’s Old, What’s New

For patients with migraines, defining the migraine will ensure proper selection of the medications and complementary therapies based on individual needs to address comorbidities and patient preferences.

Discussing Migraine: What to Try When Nothing Is Working

Headache expert Duren Michael Ready, MD, provides tips on what to try when nothing else is working.

Tips From the Field: Deconstructing the Art of Headache Medicine

7 tables with commentary help readers deconstruct the diagnosis of migraine.

Book Review: Advanced Headache Therapy

A lifetime of observations has been complied in Advanced Headache Therapy a new book by Lawrence Robbins, MD. Read Dr. Michael Ready's review.

Case History of Chronic Migraine: Update 2015 Part 2

Case History of Chronic Migraine: Update 2015

Case presentation of a chronic migraine patient in her mid-20's. Learn step-by-step treatment plan.

Managing Headaches in Children and Adolescents

Boys and girls experience headaches at a similar rate until they reach adolescents, when hormones kick-in. Learn more about how migraines affect boys and girls during childhood through adolescents.

Chronic Headache Management: Outpatient Strategies

Up to 4% of adults suffer from chronic headaches, mostly migraines. Dr. Lawrence Robbins reviews what we know about migraine types, comorbidities, as well as migraine triggers, and treatments.

Difficult to Treat Chronic Migraine: The Bipolar Spectrum and Personality Disorders

Patients with refractory chronic migraine (RCM) experience a great deal of disability related to their chronic headaches.

Difficult to Treat Chronic Migraine: Outpatient Medication Approaches

Patients with refractory chronic migraine (RCM) experience a great deal of disability and loss of their quality of life. Chronic migraine occurs in approximately 2% of the population, but we do not know the epidemiology or rate of occurrence of RCM.

Migraine Treatment From A to Z

Migraine headaches are a common cause of disability in the United States, affecting approximately 60 million American adults, or 17.1% of women and 5.6% of men.1 To help define migraines better, the term classical migraine has been replaced with migraine with aura, and nonclassical migraine now is referred to as migraine without aura.

CDC Initiative: Concussion in Sports and Play

Children and teens are more likely to have a traumatic brain injury (TBI), including concussion, and take longer to recover than adults. TBI symptoms may appear mild, but the injury can lead to significant life-long impairment affecting an individual’s memory, behavior, learning, and/or emotions.

Recognizing and Treating Concussions Related to Sports Injuries

The stories are heartbreaking. The young athlete who sustains a concussion while competing and needs intensive rehabilitation for cognitive, balance, sleep, and emotional symptoms—occasionally with long-term disability and pain.

New Rating Scale Helps Evaluate Refractory Chronic Migraine Patients

Chronic refractory migraine rating scale helps physicians better predict outcomes for patients with migraines.

Research Advance Of The Year

As 2013 winds down, I want to recognize the year’s most significant research advance in practical pain management. This year’s award goes to the elucidation and understanding of the sequelae of head trauma.

Cluster Headache: Providing Relief for a Debilitating Disorder

Abortive and prophylactic therapies work well to stem severity and frequency of cluster headaches.

Head Trauma: More Than A Headache

Headache may just be the tip of the iceberg in patients suffering a traumatic brain injury.

Traumatic Brain Injury

With traumatic brain injuries on the rise, pain practitioners need to understand the biomechanics, pathophysiology, and symptomatology of these injuries.

The Homebound Adolescent Headache Patient

Each adolescent with refractory headaches is unique, and requires an individualized approach. This involves the parents, siblings, school, and health care villagers (physicians and therapists) working together with the goal to decrease pain and increase function.

Key Clinical Pearls for Treating Headache Patients

Latest in a series of clinical pearls for practical headache treatment from Practical Pain Management and a headache specialist.

Case Studies in New Daily Persistent Headache

2 cases are presented on new daily persistent headache. How do you manage this pain patient?

Current Understanding and Management Of Medication-overuse Headache

Article explores medication-overuse headaches, a condition that is commonly overlooked and difficult to treat.

Anxiety in a Headache Patient: Case Challenge

Pain case challenge: In headache patients, anxiety may increase pain while pain may fuel anxiety. How to treat? Hear from a headache expert.

Migraine Treatment From A to Z

Review will highlight the current definitions of migraines as well as treatment options. Written by a migraine expert; includes review of current migraine medications.

Alternative Medicine in Chronic Migraine: What Clinicians Need to Know

A wide variety of complementary and alternative medicine (CAM) therapies exist for the treatment of migraine, including pharmacologic supplements, physical therapies, medicinal herbs and teas, and relaxation techniques. Should you be using these CAM therapies for migraine patients?

Man With Constant, Daily Headache Pain, Photophobia, Phonophobia, and Nausea

A 66-year-old man with long-standing history of chronic neuralgia of the right occipital nerve presents with constant, daily pain of variable intensity associated with photophobia, phonophobia, and frequent nausea. Case Challenge from Practical Pain Management.

Premedicated Mask May Hold Promise for Migraine Patients

The use of topical treatment modalities for migraine and/or tension-type headaches holds the promise of providing a safe alternative or adjunct to systemic medications. Such treatment also may reduce narcotic dependence and the incidence of rebound headaches.

Value of EMG in Patients With Non-Migrainous, Persistent Head Pain

Non-migrainous, persistent head pain can be challenging to diagnose, as both intra- and extracranial etiologies must be considered. Article covers use of EMG for patients with persistent head pain.

Difficult Migraine Patient

What do you do when your patient does not do well on their current migraine medications? An Ask the Expert question answered by Dr. John Claude Krusz.

Unmasking Post-traumatic Headache

Many cases of post-traumatic headache (PTH) go undetected and are inadequately treated. Article describes evaluation, diagnosis, and treatment of PTH.

Chronic Migraine: An Interactive Case History, Part 3

Read about this case: Heather is a 30-year-old hairdresser in a salon. Her work can be very physical, and her life has not been easy. Heather is currently on 50 mg of topiramate and 25 mg of quetiapine to prevent headaches but cannot tolerate higher doses of either medication.

A Muscular Approach to Headache

This article presents a novel approach to evaluating the potential contribution of dysfunctional muscles of the head to headache. The analysis is based on dynamic and quantitative surface electromyography (SEMG) of a number of muscles through a range of motions and facial expressions.

Clinical Pearls for Treating Headache Patients

Headache patients often have complex medical and psychological issues so that managing the headaches requires a combination of science, art, and compassion. The following are 35 pearls that the author has accumulated in his practice with this patient population.

Using Topiramate in the Treatment of Migraine

The number one drug used by neurologists for migraine and daily headache, topirimate, is still reluctantly used by primary care physicians. This article is an attempt to demystify a very effective medication in the physician's migraine armentarium.

Pediatric Headaches

Article discusses how initial treatment of pediatric headaches may benefit by using conservative, reversible modalities for tension headache before resorting to medications for migraine.

Treatment-resistant Migraines

Article provides an overview of treatment-resistant Migraines. Alternate strategies may be required for overcoming the treatment resistance of certain types of migraines.

Occipital Nerve Block for Cervicogenic Headaches

Cervicogenic headaches—often misdiagnosed as a sinus headache or ocular disturbances—may be effectively managed by the use of anesthesia to block the occipital nerve branches.

Choosing the Right Triptan

Discussion of triptan options in the treatment of migraines. Reviews available migraine medications.

Post-dural Puncture Headache Treatment

A case report on the use of a combination sumatriptan and Fioricet protocol in successful first-line treatment of post-dural puncture headache.

Preventing Post-dural Puncture Headache

Puncturing the dura membrane in a way that leaves a self-sealing flap may entirely eliminate post-procedure spinal fluid leakage that triggers puncture headaches.

Coexistent Headache and Chronic Pain

The combination of headache and chronic pain in a patient presents challenges to both headache and pain management clinicians due to the lack of overlap between the two specialties.

Head Pains

Modern management modalities are vital to treating headaches effectively.

Menstrually-Related Migraine Treatments

An overview of the efficacy of several triptan agents in menstrually-related migraine (MM), as well as of other treatment modalities that are commonly used in the treatment of MM.

Practical Headache Pearls

Extensive experience in evaluating and treating patients with migraines yields observations that can help the pain practitioner grapple with the complexities of migraine patients.

HeadacheRelief

Long-acting opioids can help alleviate the pain associated with severe, refractory chronic daily headaches.

Chronic Tension Headache

The use of sEMG biofeedback is effective for the treatment of chronic tension headaches. Get tips on how to use this on your patients from a pain management expert.

Acute Treatment of Cluster Headache

Sumatriptan 6mg subcutaneous is approved in a variety of countries for the acute treatment of migraine headache. Additionally, it is approved for the acute treatment of cluster headache attacks in the United States as the result of clinical trials. Two studies using subcutaneous sumatriptan 6mg, both reported by Ekbom,1,2 examined the 6mg subcutaneous dose.

Preventive Therapies for Cluster Headaches

The pain of the cluster attack is extreme and starts very quickly, usually without an aura or a warning. Read a discussion of cluster headache prevention in this article.

The Immune System and Headache

The involvement of the immune system in chronic headache has been speculated upon since the 1970s. 2,3 Various components of the immune system have been examined in relation to headache. 4,5 While great strides have been made in advancing our understanding of neuroimmunology, the complexities of the system make its specific role in headache pathology unclear.

Memantine for Migraine and Tension-Type Headache Prophylaxis

Memantine has only recently been introduced in the U.S. for dementing disorders, although it has been used in Europe for some time. It blocks N-methyl-D-aspartate (NMDA) glutamate receptors that are thought to be intrinsic to pain transmission, windup, long-term potentiation and central sensitization.

Chronic Migraine: An Interactive Case History, Part 2

Our patient Heather (not her real name) initially came in at age 24 and we chronicled her history and early treatment.1 In summary, Heather has moderate daily headache (CDH), with migraine 6 times per month. She also suffers from anxiety and depression (the mild end of the bipolar spectrum). Heather has irritable bowel syndrome (IBS; primarily diarrhea) plus neck pain.

Preventive Medications For Headache

A preventive is chosen with regard to the type of headache and presenting comorbidities—e.g., anxiety, depression, GI upset, medication sensitivities, etc.—and is individualized toward the patient’s needs. In using such medication, a realistic goal is to decrease the tension headache severity by 70%, not to completely eliminate the headaches.

Cluster Headache

Summary of cluster headache characteristics and update on abortive treatments utilizing first-line and second-line medications.

Vitamin D Levels In Pain and Headache Patients

Ongoing studies implicate low vitamin D levels with many disease states, including pain and headaches.

Chaos (Nonlinear Dynamics) and Migraine

By affecting chaotic (nonlinear) controls, new therapies may be employed that use less drug in the migraine cascade than is currently required.

Treating Myofacial and Other Idiopathic Head and Neck Pain

Article discusses how neuromuscular dentistry looks at the system as a whole—including teeth and bones—together with a comprehensive evaluation of the musculature involved.

Refractory Chronic Migraine

For many patients, refractory chronic migraines can be disabling and debilitating. Treating these patients may require a combination of therapeutic approaches.

Headache in Children and Adolescents

Headaches, especially migraines, have a significant impact on the lives of young people. Article explores treatment options for adolescents with severe headaches.

Personality Disorders in Migraineurs

With a higher than normal prevalence of moderate or severe personality disorder in patients who have migraines, recognizing the disorder allows alteration of both goals and approach.

Tension Headaches

While tension headaches are more prevalent in patients, there is often a presumptive migraine diagnosis due to the severity of pain, a migraine-centric focus, or the cross-over dental/medical nature of tension headaches themselves.

Preventive Medications for Chronic Daily Headache

A review of long-term continuation rates of daily preventive medications for chronic daily headache (CDH).

Dextrose Prolotherapy for Recurring Headache and Migraine Pain

This retrospective case series study revealed that Hackett-Hemwall dextrose prolotherapy appears to provide an effective, long-lasting treatment for recurring tension and migraine headache pain and their associated symptoms.

Long-Acting Opioids for Refractory Chronic Migraine

Study results for a group of difficult-to-treat migraineurs provide a basis for determining efficacy and guidelines for the use of long-term opioids in this population.

Efficacy of Stimulants in Migraineurs with Comorbidities

Stimulants may be beneficial for chronic migraine patients presenting with various comorbidities such as attention deficit hyperactivity disorder (ADHD), depression and fatigue.

Outpatient Interventional Treatments for Migraines and Pain Flare-ups

An outpatient clinic can provide an effective variety of IV treatments—individually or in combination— for definitive control of pain for a variety of pain disorders, including migraines and fibromyalgia.

Anticephalgic Photoprotective Premedicated Mask

Report of successful treatment for migraine and/or tension headaches utilizing an anticephalgic photoprotective mask with a topical medication containing bryonia and rhus toxicodendron.

New Daily Persistent Headache (NDPH)

An under-diagnosed disorder, new daily persistent headache is characterized by an abrupt onset of a new headache disorder in someone not generally troubled by headache.

Chronic Daily Headache

Chronic daily headache (CDH) is a disorder that is distressing for patients and frustrating for clinicians. The reasons why some patients may be predisposed to having chronic daily headache are not entirely clear. We now know of certain predicting factors that may indicate the likelihood of chronicity for migraine patients.

IV Ketamine Effect on Post-Concussional Migraine

Outpatient intravenous ketamine treatment of CRPS-Type 1 simultaneously eradicated post-concussional migraine in patient.

Management of Chronic Headache

A review of assessment and treatment of outpatient chronic headache patients along with a commentary on aggravating and mitigating factors.

Chronic Migraine: An Interactive Case History

A step by step guide through the diagnosis of a complex headache patient. How to diagnosis a chronic migraine patient.

Head and Neck Pain

Migraine-like Headache of Temporal Tendonitis