My Aching Head

By Sassan Hassassian, MD

Headache, or pain in the head and neck area, is common and can be caused by a multitude of disorders. The subject matter is so diverse that it could be a real pain in the neck, so-to-speak, for the physician treating the patient with those complaints. This is partly because of the complexity of structures in the neck and the brain.

In medicine, there are many complicated algorithms to differentiate one type of headache or neck pain versus another. However, this approach might not be intuitive to the patients as they seek a remedy for their illness.

As an interventional pain specialist, I usually make this process rather simple for patients. I tell them the first thing we need to discover is if the pain comes from inside the skull or outside of it.

In the majority of chronic cases where the source of the pain is within the brain or central nervous system, invasive or minimally invasive options do not play a big role. The prime example of this is migraine headaches, which are primarily a vascular or blood vessel phenomenon. Exceptions always exist in medicine and of course rare issues like tumors and such do not follow this simplification.

On the other hand, if the source of the pain is outside the skull, the patient might have a lot of options for treatment, which do not necessarily include taking medications on a regular basis. Some examples of conditions where the pain source is not in the brain include occipital neuralgia and cervical facet arthropathy.

Occipital neuralgia is a headache condition that causes pain in the back of the head radiating toward the sides and vertex of the head. It could happen on one side or both sides.

Occipital nerves are small nerves that supply sensation to the back of the head and the scalp. If they get irritated the pain manifests itself in the same area where these nerves supply sensation.

In persistent cases, a series of injections consisting of a combination of local anesthetic and an anti-inflammatory steroid can successively decrease the irritation of the nerves and treat the headache completely.

In refractory cases where pain is reduced by injection for only a short time, minimally invasive ablation by a radiofrequency probe can be attempted.

Another major culprit for neck pain and headaches outside the brain is facet joint dysfunction. Every vertebra has a pair of these joints in the back of them, and that's why our body and spine are not stiff like a cane.

They provide movement and flexibility. They notoriously get involved in whiplash injuries after auto accidents.

The pain presents in the neck and is associated with headaches. Older patients also get arthritis in these joints. The good news is that with proper diagnosis, they can be effectively treated through minimally invasive techniques without any surgery.

Headaches are complex, but with proper diagnosis, a lot of them can be treated without resorting to too much medication or major surgical options.