Major Types of Headaches

• Tension headache
• Migraine
• Cluster headache
• Sinus headache
• Exertion headache

What Are The Characteristics and Symptoms?

• Tension headache – dull, non-throbbing pain, frequently bilateral, associated with tightness in scalp or neck.
• Migraine – severe, one-sided throbbing pain, often accompanied by nausea, vomiting, and sensitivity to sound and light
• Cluster headache – excruciating pain in the vicinity of the eye; tearing of eye; nasal congestion
• Sinus headache – gnawing pain over nasal area, increasing in severity throughout the day; usually associated with infection producing blockage of the sinuses.
• Exertion headache – generalized head pain of short duration during or following physical exertion.

Who Is Most Likely To Have Headaches?

• Usually develop before age 40
• Are more common in women than men
• Are more prevalent in Caucasians than African-Americans
• Can be triggered by stress, hormonal fluctuations, certain foods, or bright lights or noises

Tension headaches:

• Are more prevalent in those age 30-39
• Are more common in women than men
• Are more prevalent in patients with a family history of them
• Are more likely to occur in patients who are also migraine sufferers
• Can occur when:

• Meals are skipped
• You have emotional stress
• You have poor posture
• You are fatigued
• You overexert yourself

Cluster headaches:

Risk factors may include:

• family history of cluster headaches.
• being male. More males than females get cluster headaches.
• being age 30-40, although they can begin at any age. However, it is rare for children age 10 or younger to develop cluster headaches.

Sinus headaches:

Risk factors may include:

• Chronic allergies and sinus infection
• Deviated septum and other anatomic deformities
• Nasal polyps

Exertion headaches:

Risk factors may include:

• Concomitant migraine or cluster headaches
• (more rarely) Organic disease, such as

• Aneurysm
• Tumor
• Blood vessel malformation

Treatment for Headaches:

Medication-based treatments:

Most headaches respond to pharmacologic treatments. Over-the-counter treatments such as aspirin, acetaminophen, and other NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen or naproxen are widely used. For more severe pain, narcotics such as hydrocodone (Vicodin) or hydromorphone (Dilaudid) can be helpful, but are not advisable for long-term use, as they may be habit-forming. Therapies such as ergot alkaloids (ergotamine, dihydroergotamine) and 5-HT antagonists, also known as “triptans” (sumatriptan, rizatriptan, zolmitriptan, etc.) are specific to migraine. and

Surgical Intervention:

For severe and/or intractable headaches that have been refractory to medication treatment, there are various surgical options which may provide long-term relief from headaches.

What Does Surgery Involve?

Removal of corrugator muscles (for migraine)/Botox treatment:

A recent study of migraine sufferers showed that removal of the corrugator supercilii muscles in the forehead (aka the “vertical frown” muscles) provided considerable symptom relief or even elimination of migraine symptoms for 95% of study participants. To predict success, Botox was used to paralyze the muscles, and most patients responded favorably. So if surgery is not desired, regular injections of Botox may achieve similar results.

Endoscopic Nasal Surgery (for migraines and tension headaches):

When opposing surfaces in the nasal cavity and the sinuses press against one another, it causes stimulation of the trigeminal nerve. This produces an irritant effect within the nose, and what is actually nasal pain is interpreted by the brain as being a headache. This peculiar circumstance is called “referred pain.”

So, if the underlying nasal abnormality is corrected, the migraine should improve. Usually, the procedure is performed under local anesthesia. An endoscope is used to visualize the nasal cavity and sinuses, and surgery entails removal of obstructive diseased mucosa or undesirable points of contact between the surfaces.

“Gamma Knife” Radiosurgery (for cluster headaches):

The knife referred to here is actually beams of gamma radiation from a machine which destroy tissue, so it is in fact surgery, but no incisions are required.

The radiation is pinpointed at the trigeminal nerve. 87% of patients experienced lasting relief of their cluster headaches from this one-time procedure.

Are You A Candidate?

You may be a good candidate for surgical treatment if you have:

• Chronic and severe cluster or migraine headaches of over a year’s duration, refractory to standard medical management.

What Are The Advantages Of Surgery for Headaches?

The correction of the anatomic defect usually gives excellent and permanent results.

How Long Does It Take?

Removal of corrugator muscle – about an hour

Endoscopic nasal surgery – 1-2 hours

Gamma knife – about 20 minutes

How Many Treatments Are Required?

One.

What Are My Alternatives?

• Over-the-counter analgesics
• Prescription analgesics
• Migraine-specific treatments (5-HT antagonists, ergotamine)

Will I Have Pain?

There may be minor pain and swelling for a few days; a short course of pain relievers is usually given. The gamma knife procedure is painless.

When Can I Go Back To Work Or School?

Usually about a week. Less for the gamma knife.

Who Will Perform My Headache Treatment?

The surgery will be performed by one of our highly-trained specialists in the field.

How Much Does It Cost?

This depends on the procedure. Please call TopSurgeons at 800-506-8084 for more information.

Will My Insurance Cover?

Insurance companies should cover this procedure.