Nothing turns a productive day sour quite like a headache. While the occasional headache is a nuisance, it will usually subside with time or the help of over-the-counter pain medicine. For some people, however, headaches are frequent or severe enough to impact their quality of life.

Ogden Clinic’s newest neurologist, Dr. Sydney Piercey, specializes in managing chronic headaches and migraines. Learn more about the treatment options she provides below.

What’s the difference between a headache and a migraine?

Headaches are usually caused by irritation of the nerve around the head called the peripheral nerves. There are different types of headaches. For example, a tension headache (triggered by irritation of the spinal nerves and muscle contraction in the head and neck regions) is the most common headache with dull pain or pressure in the back of the head or neck. Sometimes a tension headache can feel like it’s wrapping and squeezing the entire head.

A sinus type headache, produced by irritation of the nerve in the face, is associated with pain in your cheekbones, forehead, or the bridge of your nose. Although often seen in the setting of infection or allergies, sinus type pain can occur independently and the treatment will depend on what the underlying cause is.

A migraine is a recurrent, moderate to severe, headache that is caused by abnormal firing of the nerve within the brain that spreads and then causes dysregulation of the blood vessels and peripheral nerves. In addition to moderate to severe head pain, patients with migraine typically have other associated symptoms such as throbbing sensation that becomes worse with physical activity, nausea, sensitivity to light, sound, or smells.

Do you address every type of headache?

I do. Often times patients with ongoing headache pain can have superimposed migraine pain as well. The headache can act like embers in a fire. Just as embers can flare up in certain settings, headache pain can evolve into a painful migraine at times. Treatment depends on the specific type of pain the patient is having and what may be triggering that pain.

When should I seek professional treatment?

In general, when the headache is interfering with everyday activities or not responding to your current treatment. Your primary care provider is a great first stop for headache treatment. They can explore lifestyle factors like stress management and improving your sleep and can also prescribe medications when indicated to help headache symptoms subside.

If your headache persists after treatment or if it’s getting worse, it’s time to visit a neurologist. You should see a neurologist if your headache changes in character or if you have stroke-like symptoms with the headache such as numbness, tingling or weakness.

What types of treatments are available?

If your headaches are intermittent, i.e. 1-2 times per week, I focus on what’s called rescue medication: treating the headache itself early-on with triptans (migraine-specific medication) and/or anti-inflammatory medication.

If headaches increase in frequency or intensity (more than 2-3 days per week), then a preventative medication strategy is a reasonable option. This strategy stops the headache before it even starts. Your diagnosis will help determine the best strategy, which could include:

• Seizure-category medication like Topamax or Depakote,
• Adding or adjusting blood pressure medication for headache prevention,
• Or, if oral medications fail, we can block the nerves with trigger injections or botulinum toxins (Botox®).

How does Botox® prevent headaches?

Physicians discovered the neurological use of Botox® while treating patient’s other neurological issues such as cervical dystonia (involuntary neck contractions). Headaches can be a symptom of cervical dystonia and patients reported that both their neck contractions and headaches subsided after being injected.

Independent clinical trials were then done and showed Botox® could be administered safely and effectively in most people for headaches. That being said, it is important to work closely with a provider familiar with Botox® because, as with other medications, there are potential serious side effects that need to be taken into consideration prior to use.

Botox® works by blocking the neurotransmitter release from nerve endings to muscles and allows the muscles to relax. This is a temporary treatment method but each treatment can be effective for months at a time.

How long will I need to be on medication?

Patients often need medication until symptoms are well controlled. Then the goal is to get most people off the medication at some point, if possible. The same is true for toxins: after a series of injections, I often find that we “reset” the way the nerves behave and people don’t experience headaches as often. I try to increase the length of time between toxin injections until we no longer need them. Some patients, however, may require chronic therapy to control their type of symptoms.

With any treatment plan, I advise diet changes, increasing exercise, improving sleep, and reducing stress to combat headaches. Sometimes these lifestyles changes are easier to make once the pain is controlled. I tell my patients: Medication doesn’t make you better; ideally it helps so you can do the things to make yourself better.

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Dr. Sydney Piercey practices at Ogden Clinic’s Professional Center in Ogden. To schedule an appointment with her, call (801) 475-3000.

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