Headaches

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Hello, Happy to take your questions today.

Welcome Dr. Christo. Let’s begin.

Sinus headaches are commonly diagnosed, but are often an uncommon cause of persistent headaches. Many patients actually have symptoms related to migraine: throbbing, pulsating one sided pain associated with either nausea or light and sound sensitivity. If the headaches continue, I would recommended seeing your primary care doctor or neurologist for an evaluation. In the meantime, you could consider another over the counter agent like ibuprofen or aleve without any additives. If you have non-infectious sinus symptoms, then a trial of nasal steroids under the direction of a physician may also be helfpul.

First, I’m glad that you have found an effective treatment for your migraines. The non-pharmacological treatments (relaxation, thermal biofeedback, EMG biofeedback, cognitive behavioral therapy) are often not covered by insurance. There is evidence that these are useful, however. The public and even physicians tend not to be aware of less traditional therapies because they aren’t studied to the same degree as the pharmacological treatments.

I’m unaware of studies on whole foods and headaches. However, dietary triggers only affect certain patients with migraines and each person often has a separate set of triggers. These triggers often include alcohol, red wine, processed meats containing nitrites, MSG, aspartame (sweetner), chocolate, aged cheeses, and acidic foods. If you are avoiding processed foods by consuming whole foods, then this may contribute to the relief of your headaches triggers and therefore your headaches.

Many sinus headaches are actually migraine headaches and will respond to migraine medications. The antidepressants are used to help prevent migraines and other classes include the tricylic antidepressants (amitriptyline). Other preventive medications are propranolol, timolol, topiramate, divalproex. If you want to try non-medication treatments for migraine, then botox has recently been approved. Acupuncture, hypnosis, TENS (transcutaneous electrical nerve stimulation) are also used with less evidence supporting their effectiveness.

I would strongly suggest an evaluation by your physician to help sort out other causes of your headache at night. Headaches that wake you up are not typical and should be assessed. Acetaminophen (tylenol) can be helpful or an agent like ibuprofen that does not contain caffeine.

I would consider the non-pharmacological therapies: relaxation, thermal biofeedback, congitive behavioural therapy, hypnosis. If the headaches are extreme,then your doctor will have to weight the benefit of pain relief with any risks to the fetus when selecting a medication.

Spinal taps can cause a headache called a “postdural puncture headache” (spinal headache). Patients typically say that the headache is worse when standing or sitting up and eases when lying down. The headache is associated with light and sound sensitivity. Spinal headaches will get better without any treatment, but it can take weeks. If you have a spinal headache, certain medications plus caffeine intake can help. Otherwise, we do a procedure called a “blood patch” (remove a small amount of your blood and inject it into the epidural space) that usually resolves the headache.

You’re taking the common and approved medication for trigeminal neuralgia. Other medications that are used are: baclofen, clonazepam, oxcarbazepine, phenytoin, and depakote. Surgical options include microvascular decompression. Radiation surgery has some success as well. Radiofrequency procedures that place a needle near the trigeminal nerve to heat the area and create a lesion can ease the pain, and something called glycerol rhizolysis that involves placing a nerve-altering agent around the trigeminal nerve can be an effective treatment. All of these procedures can cause side effects which you should discuss with your doctor before proceeding.

Thank you for your questions today.

That’s all the time we have for today. Thanks for your great questions. We’ll back in the second week of January on another pain topic.