Treatments for Headache Conditions at the UCSF Headache Center
Treatment of our patients is determined to some extent by the conditions our patients have. However, many headache types respond to similar treatments. These tend to fall into one of the following categories:
1. Oral preventive and acute medications – Pills nasal spray, liquid and injectable medications, including herbal medications.
2. Nerve blocks
3. Trigger point injections
5. Electrical and magnetic stimulation devices
Oral medications for prevention of headaches
There are a number of categories of medications used to prevent headaches and facial pain. Below are listed the important categories with some names of medications:
Beta blockers – Propranolol, atenolol, metopralol, nadalol
These tend to lower heart rate and blood pressure but are very well tolerated and effective.
Tricyclic antidepressants – Amitriptyline, nortriptyline, doxepin
Most of these are in fact not use much for depression but are quite useful in migraine, tension-type headache, and neuralgia. Side effects tend to be some sedation, dry mouth and possible increased appetite.
Other antidepressants - venlafaxine, duloxetine
These are a bit less useful than the tricyclics but are nonetheless effective for some Antiepilepsy medications – topiramate, valproate, gabapentinzonisamide
While different members of this family have different properties they can all be very effective in
a number of types of head pain. Side effects vary but a common thread is a tendency to produce some mild cognitive difficulty in some patients at higher doses.
Calcium channel blockers – verapamil, amlodipine
These are sometimes effective in migraine, but can be particularly effective in cluster headaches.
Antispasmodics – baclofen, tizanidine
These are best in pain due to nerve damage or irritation like neuralgias and are generally well tolerated but sedating.
These are used at the time of the headache for the express purpose of reduction symptoms at the time. We not only target head pain but also nausea and vertigo.
Triptans – sumatriptan, naratriptan, rizatriptan, zolmitriptan, almotriptan, eletriptan and frovatriptan
These are mainly available in oral form, but sumatriptan has an injectable form which can be used at home, and both sumatriptan and zolmitriptan have nasal spray forms
Non-steroidal anti-inflammatory medications (NSAIDs) – ibuprofen, naproxen, diclofenac
Mostly in pill form, these can be very effective though in general not as potent as triptans.
Antiemetics – promethazine, prochlorperazine, ondansetron
Nausea often becomes more disabling than the head pain and must be treated when it is severe. These can be used in rectal suppository form and ondansetron has a very effective under-the-tongue version.
Nerve blocks and trigger point injections
Both of these approaches involves injecting anesthetic medication in the head and or neck for acute relief, or more commonly, prevention of headaches. They are done in the office and require very little preparation. The medications used include lidocaine and bupivacaine. The nerves targeted include the occipital nerves (back of the head), supraorbital nerves (forehead) and sphenopalatine ganglion nerves, (done without a needle but with a catheter carefully inserted into a nostril). Muscles we target run, mostly, in the upper neck and near the jaw.
Botulinum toxin is produced by a bacteria called clostridium and surprisingly, it can produce outstanding results when used to treat a number of medical conditions, including chronic migraine. The chronic migraine protocol involves 31 injections of a very small amount (using a tiny needle) in the forehead, temples, back of the head and neck. The procedure takes only about 5 minutes and is repeated every 3 month to maintain relief.
Electrical stimulation on the skin can be done with several devices which can be purchased and used at home. Magnetic stimulation has also been shown to help, especially migraine with aura.