bad headaches

[laurie8387]

My husband is 51 and has had terrible "migraines" since age 14.  No type of medication has ever prevented or relieved the pain of the headaches.  He was recently diagnosed with cervicogenic headaches or occipital neuralgia instead of migraines.  After normal MRI, he had an occipital nerve block which completely took the pain away for 3 weeks, now it is back.  We have heard not to have that nerve cut.  Is there any other treatment out there?  Any info would be appreciated!

[Vanessa Lacuesta]

Hi,

Indomethacin has been shown to be responsive to headaches that are chronic, short lived ( last about 15 to 20 minutes and occurs several times a day) and sudden and severe in onset. Cluster headaches and exertional headaches have shown to respond to indomethacin therapy. The mechanism of action is not fully explained but most headaches that have been refractory to lithium and steroids have been shown to respond to indomethacin.

Also, repeated occipital nerve blocks may be necessary for persons who had headaches for years. One study showed that an additional block may needed for every 3 years of headache history.

Maybe you can discuss this with your pain specialist.

[laurie8387]

I thought I sent this yesterday but I guess it didn't go thru.  He has a headache almost everyday, about 2-3x per week  are so severe he can't get out of bed.  They sometimes get better toward afternoon, but he almost always has a dull HA. They start at the back of the head and go to the right side of his forehead.  He takes tons of Excedrin Migraine which I know is not good for him. (about 4 a day on avg) He doesn't have the eye tearing or redness, but is very sensitive to light when he has a bad one.  His nose is stuffy alot and the pain dr. he saw said that might be a sign of cluster HA.  Just lying down on his back or wearing a shirt with a tight neck can give him a HA.  The occipital nerve block worked like magic, but the pain returned after 3 weeks.  How does the neurostimulation work?   What about blockade of the nerves?  The pain dr. said that some people who have the nerve severed usually have the pain return only more severe than before.  He wanted to do a block (sphenopalatine ganglion block) it case it might be more of a cluster HA, but it sounded pretty awful going thru the cheek to get to it, so we didn't do that.  We have been to lots of neurologists who have given him meds for prevention and for acute attacks and none have ever worked at all. They always just assumed they were migraines. The pain dr was the first one to give us a dx that made sense! Do you think maybe we should go to a neurosurgeon?  Also,  I read somewhere that occipital neuralgia can be relieved with indomethacin.  Have you heard this?  Thank you so much for all the info!!!!!!!!

[Vanessa Lacuesta]

Hi,

Would you be able to elaborate on the character of your husband's headaches?
Do the headaches occur almost everyday?For how long everyday?

Episodic migraines may transform into chronic daily headaches. In the case of your husband, occipital neuralgia may be the cause. Other differentials would be a cluster headache but this is usually accompanied by a severe unilateral headache with associated pain over the eyes,eye redness or eye tearing. Are these present?

Occipital neuralgia may be temporarily relieved by an occipital nerve block.Recent literature have noted the advantage of repetitive occipital nerve block neurostimulation to patients who had experienced cervicogenic headaches for years.Blockade of the nerves C2 and C3 also showed equal degree of effectiveness as an occipital nerve block.One study also showed that a botox injection used for occipital nerve block is associated with a longer pain free period than traditional anesthetics.

Maybe you can discuss these with your physician.I hope this helps.