Condition
Headaches & Migraines
Most recurring headaches fall into a few categories: migraine, tension type, cervicogenic headaches that originate in the neck, and occipital neuralgia from irritation of the nerv…
- Seen at
- All three offices
- Typical wait
- Within the same week
- Treated with
- 6 procedures
In short
What headaches actually is.
Headaches & Migraines
Most recurring headaches fall into a few categories: migraine, tension type, cervicogenic headaches that originate in the neck, and occipital neuralgia from irritation of the nerves at the back of the skull. They are often mixed together in the same person. Sorting out which mechanism is driving your headaches is what makes treatment work, because the treatments are not interchangeable.
Symptoms
How it shows up.
If several of these sound like your week, it is worth having the source looked at properly.
- A throbbing pain on one side of the head that gets worse with light, sound or movement
- Nausea, or needing to lie down in a dark quiet room until it passes
- Pain that starts at the base of the skull and travels up the back of the head
- A tight band of pressure around the whole head at the end of a long day
- Scalp tenderness, where even brushing your hair hurts
- Visual changes, flashing lights or blind spots before the pain begins
- Headaches that come several times a week and have started to run your schedule
What causes it
- Migraine, a neurological condition involving the trigeminal nerve system and blood vessels in the head
- Arthritis or injury in the upper neck joints referring pain into the head
- Whiplash from a car accident, which commonly triggers headaches weeks later
- Irritation or entrapment of the greater and lesser occipital nerves
- Muscle trigger points in the neck and shoulders that refer pain in predictable patterns
- Overuse of pain medication, which turns occasional headaches into daily ones
When to act
Stop waiting when this happens.
Do not sit on these
Any one of the following is a reason to be seen rather than to wait it out.
- Headaches are happening more than a few times a month or are getting more frequent
- You are taking over the counter pain medication for headaches more than two days a week
- The headaches started after a car accident, fall or concussion
- A sudden severe headache unlike any you have had, a headache with fever and a stiff neck, weakness, confusion or vision loss, all of which are emergencies
- Prescribed migraine medication is not working or you cannot tolerate the side effects
Diagnosis
Finding the actual source.
A diagnosis is not a guess from an image. It comes from the exam, the history and, where nerves are involved, electrodiagnostic testing.
- A detailed headache history covering location, triggers, warning signs, frequency and exactly how much medication you are taking, since medication overuse headache is common and reversible
- Examining the upper cervical spine, checking whether pressing on specific joints or muscles reproduces your usual headache
- Palpating the occipital nerves at the back of the skull for the tenderness that identifies occipital neuralgia
- A neurological exam, with imaging ordered when there are warning signs such as a new pattern after age fifty, neurological deficits, or a headache that began with trauma
- A diagnostic occipital nerve block, where relief within minutes confirms those nerves are carrying the pain and predicts who will benefit from ongoing blocks
- Diagnostic cervical medial branch blocks when the upper neck joints look like the source, before considering radiofrequency ablation
Nerve testing happens here, not elsewhere
EMG and nerve conduction studies are done in the office and read by Dr. Sheikh the same day, rather than sent out and waited on.
Treatment
How headaches is treated.
Ordered from the most common first step to the options reserved for pain that has not responded.
15–45 minNerve BlockA nerve block is an injection of local anesthetic, often with a steroid, placed next to a specific nerve or c…Read more →
Trigger Point InjectionA trigger point injection treats a knot in a muscle, a tight band that will not release and that often refers…Read more →
Facet Joint InjectionA facet joint injection treats the small paired joints at the back of the spine that let you bend and twist.Read more →
30–90 minRadiofrequency AblationRadiofrequency ablation uses heat from a radio wave to interrupt the small nerves that carry pain from an art…Read more →
20–45 minSympathetic Nerve BlocksA sympathetic nerve block targets the sympathetic nervous system, the automatic network that controls blood f…Read more →
15–30 minEpidural Steroid InjectionAn epidural steroid injection puts anti-inflammatory medication into the epidural space, the area just outsid…Read more →Questions
Headaches & Migraines, answered.
When is a headache an emergency?
A sudden severe headache that peaks within seconds, a headache with fever and a stiff neck, or one with confusion, weakness, slurred speech or vision loss all need emergency care immediately. A new headache pattern after age fifty, or one following a head injury, should be evaluated promptly rather than waited out.
What is the difference between a migraine and a regular headache?
Migraine is a neurological condition, not just a bad headache. It is typically one sided and throbbing, worsens with routine activity, and comes with nausea or sensitivity to light and sound. Tension headaches are a steady band of pressure without those features, and many people have both.
Can my neck be causing my headaches?
Yes, and it is underdiagnosed. The upper three cervical nerves share a relay in the brainstem with the nerve that supplies the face and scalp, so neck irritation is felt as head pain. If pressing on a specific spot in your upper neck reproduces your headache, that is a strong clue.
Do nerve blocks work for migraines?
Occipital nerve blocks help a substantial share of patients, particularly those whose headaches start at the back of the head or who have scalp tenderness. Many people feel relief within minutes. They work best as part of a plan alongside your neurologist rather than as a replacement for migraine medication.
How long does an occipital nerve block last?
Highly variable. Some patients get a few weeks, others get several months, and a subset have a long remission after a single block. The local anesthetic wears off in hours, but the reduction in nerve irritation can outlast it considerably. Repeat blocks are usually spaced at least a month apart.
Can too much headache medicine cause headaches?
Yes, and this is one of the most common reasons headaches become daily. Using over the counter or prescription pain medication more than two or three days a week can create medication overuse headache. Breaking that cycle sometimes requires nerve blocks to cover the withdrawal period.
Will I have to take medication forever?
Not necessarily. Many patients reduce medication substantially once the neck or nerve component of their headaches is treated directly. The aim is to cut the frequency far enough that medication becomes occasional rather than daily, which also removes the overuse problem.
Get a real diagnosis for headaches.
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