Chronic migraine headache has a specific set of criteria for diagnosis. You may experience chronic migraines if you have headaches of any type at least 15 days per month for at least 3 months. On 8 or more of these headache days, you should experience symptoms classic for migraine. This includes the headache affecting only one side of your head, a pulsating quality, symptoms worsen with activity, avoidance of bright lights and/or loud noises, and presence of nausea and/or vomiting. A sensation known as an aura may occur before the onset of the headache for some people.
Abortive Migraine Treatments
Abortive treatments for migraine headaches are intended to reduce or eliminate the symptoms caused by a specific headache episode. Medication classes commonly used to abort a migraine headache include non-steroidal anti-inflammatory drugs, triptans, and ergotamines. Adjunctive medications to treat nausea and vomiting may be used in some situations as well.
Preventative Migraine Treatments
If you suffer from chronic migraine headaches, it is frequently appropriate to start treatment with a preventative medication to reduce the frequency of your headaches. These medications are not used to treat an individual headache episode. Instead, they are taken on a specific schedule and will reduce the frequency and severity of your headaches over time. There are multiple classes of medications used for migraine prevention, including anti-hypertensives, antidepressants, anticonvulsants, and others.
Botox for Chronic Migraines
If you continue to suffer from chronic, persistent migraine headaches despite trying multiple preventative medications, you may be a candidate for Botox injections for chronic migraines. Botox (onabotulinumtoxinA) is FDA approved for the prevention of chronic migraines. It is a series of injections performed every 12 weeks to reduce the frequency and severity of your headaches. The studies used to obtain FDA approval showed a reduction in headache days up to 9 days per month for patients that started with at least 15 days per month with headache symptoms.
Headaches from occipital neuralgia originate in the back of the head and radiate to the top of the head along the pathways of the occipital nerves. These nerves are branches from the upper cervical spinal nerves. They provide sensation to the back, top, and sides of the head. People with occipital neuralgia report episodes of piercing, stabbing, or sharp pain and their heads are frequently tender at the locations of the occipital nerves.
Occipital Nerve Blocks
Many cases of occipital neuralgia improve with injection of local anesthetic and corticosteroid in the back of the head and behind the ear at the locations of the greater and lesser occipital nerves. If you obtain only temporary relief with the nerve blocks, you may be a candidate for radiofrequency ablation of the occipital nerves, which can produce 6 to 12 months of pain relief.