Advanced treatments - Headache and migraine treatments

A headache is defined as pain in the area of the head as well as the neck and there are many types. These are broadly classified according to their symptoms and their site of onset.

Headaches types can then be further sub - divided into either primary and secondary headaches. A primary headache is one that has no obvious cause whereas a secondary headache develops after an event such as an injury or an illness. ONLY primary headaches can be prevented with botulinum toxin.

Primary headaches include:

i) Tension headaches

ii) Migraines

iii) Cluster headaches

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i) Tension headaches

These are by far the most common type of headache (about 90%) and they are experienced by all people at some point during their lives. They are thought to be caused by tension within the muscles of the face, scalp or neck. Although the symptoms of this sort of headache will depend on which muscles are affected, this type of headache has certain general features:

  • They can occur on both sides of the head (such as the temple areas of the head) or can be one sided (for example if you have slept on your neck awkwardly)
  • They have a pressing or tightening quality (often people describe the sensation of a 'band' being tightened around their head)
  • They are not normally associated with other features such as nausea or visual disturbance
  • Often simple measures such as massaging the affected muscles have a relieving effect
  • This type of headache can be episodic (lasting for a few minutes to a few hours) or chronic (defined as occurring more than 15 days per month)

    • Common causes of tension headaches include:

    • Physical or emotional stress
    • Lack of quality sleep
    • Bad posture/ uncomfortable positioning during activites or sleep
    • Bruxism (teeth grinding)
    • Hunger or dehydration
    • Eye strain

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    ii) Migraines

    Migraines are less understood than tension headaches and they may have more than one underlying cause. Previously it was believed that they were caused by blood vessel spasms within the brain.

    More current thinking, however, suggests that abnormal electrical activity within areas of the brain (similar to epilepsy) may trigger the symptoms. This is supported by the fact that symptoms vary widely from patient to patient depending on what area of the brain is involved.

    Nevertheless, symptoms of typical migraine headaches include:

  • Being one sided (but can swap sides)
  • The sensation of a throbbing pain that is moderate to severe in intensity. The pain can be so intense that it is often associated with nausea or vomitting
  • A gradual onset in their severity, lasting anything from 4 - 72 hours. Patients often have episodic migraines recurring several times per month
  • Patients often know that a migraine will occur before it actually starts. This phenomenon is known as the 'aura' and can take many forms including visual disturbances, finger tingling or even smelling odd odours
  • Migraines are often aggravated by physical activity, sound or even light. Therefore it is characteristic of patients to seek darkened, quiet room to rest

    • Common causes of migraines include:

    • Bright lights, loud noises or specific odours
    • Physical or emotional stress
    • Lack of quality sleep
    • Smoking
    • Skipping meals
    • Alcohol
    • Menstrual cycles/hormone fluctuations and contraceptive medications
    • Foods containing: tyramine (red wine, cheese, smoked fish, marmite), monosodium glutamate (processed foods, takeway chinese food) or nitrates (processed meats)
    • Other specific foods such as chocolate, nuts, avocado, banana, citrus, onions, dairy products
    • Long exposures to light from computer screens, video screens or tvs

    This type of headache is therefore usually very different to a tension headache.

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    iii) Cluster headaches

    Cluster headaches are characterised by:

  • An excruciating one sided headaches of extreme intensity, worse than tension headache or even severe migraines. Patients describe the sensation of a stabbing pain behind the eye or around the temple area
  • A duration ranging from as short as 15 minutes to 3 or more hours
  • A rapid onset, often without any trigger or warning
  • Very often, physical signs also develop including eye lid/brow drooping, eye watering/redness or facial sweating/redness

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    Treatment of headaches

    Headaches of all types may respond to several simple treatments and these should ALWAYS be tried before seeking advanced treatments such as Botox:

    - Regular and quality sleep

    - Drinking at least 2 litres of water per day

    - Avoidance of known headache triggers as described above

    - Eating regular meals

    - Use of simple pain killers such as paracetamol when needed

    If these simple measures do not relieve your symptoms, you should seek medical advice. Headaches caused by injury need urgent medical attention.

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    Using botulinum toxin to treat headaches

    Several types of headache (including tension and cluster headaches) are thought to be caused at least in part by muscular spasm. This results in a spectrum of symptoms including pain and nerve irritation. By relaxing the problematic muscles, it has been shown in many independant clinical trials that botulinum toxin can alleviate headaches.

    It is this mechanism, by temporarily relaxing muscles, that botulinum toxin is most commonly used to treat wrinkles, in addition to several other treatments involving muscle tension including bruxism.

    Botulinum toxin treatments for headaches are NOT a first line therapy and should only considered when other investigations and treatments have proved unsuccessful. Treating headaches using botulinum toxin clearly relies on correctly diagnosing your type of headache first, as only tension, migraine or cluster headaches will respond to such treatment. Botulinum toxin is also not used to treat an active headache but rather to PREVENT periodic headaches.

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    The benefits of using botulinum toxin to treat headaches include:

    - Targeted relaxation of muscles that cause recurrent symptoms

    - Prevention of headaches BEFORE they occur rather than curing them with medication

    - Avoidance of the side effects of commonly used medications taken for headaches such as constipation and drowsiness

     

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