Headache Clinic

Tension headaches are very common. In most patients, the pain is relatively mild and does not lead them to visit a clinic. However, for some individuals, the pain becomes chronic, with a high frequency of headache days, leading to a significant reduction in quality of life. These patients require preventive treatment and follow-up. The pain is usually described as a tightness around the head, often accompanied by scalp sensitivity. It typically does not present with additional symptoms.

The mechanisms that cause tension-type headaches are not fully understood. Treatment for this type of headache includes pain relievers as needed, with a focus on avoiding excessive consumption of them. In some patients, preventive medication may be necessary. Additionally, relaxation therapies such as guided imagery and physical therapy focused on the head and neck, with posture exercises, can help alleviate the suffering of patients.

Cluster headaches are less common than migraines or tension-type headaches, but they can cause severe distress due to the extremely intense pain. These headaches are more common in men than in women and usually affect younger individuals, although the average age is slightly older than for migraines. In most patients, the pain occurs in clusters that last for several weeks, interspersed with remission periods lasting several months.

During a cluster period, the patient experiences intense, one-sided headaches, usually around the eye and forehead. The pain is often accompanied by tearing, redness of the eye on the affected side, and watery nasal discharge. The headache typically lasts up to 3 hours and may even wake the patient from sleep. The treatment for acute attacks includes injections of sumatriptan, a medication from the triptan class, or inhalation of oxygen. Some patients may also require preventive medication. Another treatment that may help these patients is local anesthetic injections into the head's nerves. Recently, injections of CGRP protein antibodies have also been found to alleviate pain in these patients.

Cervicogenic headaches are caused by a condition of the cervical spine (upper part). They are relatively common in older individuals suffering from degenerative changes in the cervical spine, though they can also occur at any age in people who have experienced trauma to the head and neck area. The pain is usually one-sided, primarily at the back of the head, although it may spread forward and worsens with neck movement. Local tenderness is often found in the neck or the back of the head.

Patients suffering from this type of headache generally respond well to nerve block treatments in the head. Pain relief medications as needed also help. Additionally, an important part of treating cervicogenic headaches includes physical therapy and posture exercises.

This is a headache that may be caused by several types of headaches such as migraine or tension headaches, and usually appears years after the onset of the initial headache. Although only a relatively small percentage of patients with headaches will reach this stage, they make up a significant portion of patients in headache treatment centers. These patients suffer from significant functional impairment due to chronic pain.

Many of them also suffer from anxiety and depression. A common phenomenon in these patients is the overuse of pain-relieving medications, which ultimately worsens the pain. Treatment for these patients is complex and requires a team effort from a neurologist, psychologist, dietitian, and sleep disorder specialists. Sometimes, it is necessary to treat these patients temporarily in a hospital with intravenous medications. With appropriate treatment, these patients can recover from chronic pain and show significant clinical and functional improvement.