Conditions We Treat

Nearly everyone will experience headaches during their lifetime; however, most are not severe. The major types of headaches are migraine, tension, medication overuse and inflammatory. The most common type of headache is a migraine, which affects 30 million Americans. Chronic daily headaches occur on more than 15 days a month and are one of the top 10 disabling neurological conditions according to the World Health Organization. While “neuralgia” literally means “nerve pain,” headache, face and neck pain can also be caused by occipital neuralgia. Often, patients have a combination of pain disorders, migraine and occipital neuralgia.

Anyone can have a headache severe enough that it is not treatable with over-the-counter medicines or prescription medications at home. Our USC Headache and Neuralgia Center experts treat a wide range of conditions, including:

Headache – Nearly all of us have had a headache at some time. Headaches are marked by pain somewhere on the face, head and scalp, and can sometimes extend down into the neck.

Migraine – An inherited neurological disorder that is characterized by over excitability of specific areas of the brain. Although we do not clearly understand how a migraine brain is different or what happens in the brain to start a migraine, we know that individuals with migraines are more susceptible to the influence of transient factors, also called triggers, that raise the risk for having a migraine attack. These triggers include hormonal fluctuations; environmental stimuli such as weather or bright lights; certain smells; alcohol; certain foods; poor sleep; and high stress.

Post-concussion headache – One of a number of symptoms that can arise after a concussion that resulted from a head injury. Headaches, dizziness and other symptoms often arise about a week after an injury and can last for weeks or even months after the injury. The risk of having a post-concussion headache does not appear related to the severity of the original injury.

Occipital neuralgia – Two nerves are responsible for transmitting most of the feeling we get on the top and back of the head. Called the occipital nerves, they reach out from the spinal cord through muscles in the neck and back of the head, extending over toward the forehead. When irritated, the nerves can generate a shooting, zapping, electric or tingling pain. Neuralgia (nerve pain) can be spontaneous or can be caused by a pinched nerve brought about by arthritis, injury or surgery to the scalp. Tight muscles in the neck have also been associated with occipital neuralgia.

Tension headache – The most common type of headache, this variety is not usually severe enough to require extended medical attention. Despite the name, stress or tight muscles do not cause tension headaches. In fact, their cause is largely unknown. While usually mild in nature, tension headaches that are severe enough are treated by a number of strategies at the USC Headache and Neuralgia Center.

Sinus headache and allergy related headaches – While most people with sinus headaches probably have a migraine or some other form of head and neck pain, sinus infections and pressure on internal nasal and sinus structures can cause significant pain. Allergic reactions can also cause pain in the sinus areas.

Medication-overuse headache – Also called rebound headache, this type of pain is caused by the overuse of headache medications. Typically, medication can provide relief for short-term headaches, but the pain can return or “rebound” as your body adjusts to the long-term presence of pain drugs. Medication-overuse headaches are the third most common form of headaches, followed by tension headaches and migraines.

Cluster Headache – Cluster headaches are rare, with a prevalence of less than 1% (one in 1,000). In recent years, some exciting new discoveries have been made with regard to the pathophysiology and treatment of this unusual and mysterious headache. More commonly seen in men than women, this type of headache occurs in clusters and in a repetitive manner, such as at the same time of day, year or season.

Trigeminal Neuralgia – Trigeminal neuralgia and hemifacial spasm are two conditions affecting nerves in the face. Symptoms of trigeminal neuralgia include short episodes of sharp facial pain. Hemifacial spasm, while painless, may cause severe twitching of the facial muscles.

Treatments We Offer

The USC Headache and Neuralgia Center offers the latest techniques to break stubborn headaches and migraines when usual medications fail. Our center’s treatments include advanced acute headache and facial pain infusion and procedures.

Headache Rescue Program

Chronic migraines and other headaches can alter how the brain functions, often making headache systems worse. Neuromodulation is the positive change in brain and nerve signaling that brings about pain relief and can be accomplished through medications and non-medication-based methods. Infusions of various medications can, over time, halt these alterations and return brain function back to normal. Often, medications are combined to determine which ones are the most effective. This procedure is performed on an outpatient basis at the USC Headache and Neuralgia Center. Infusions include intravenous, intramuscular or subcutaneous medications, specially used to break severe headache cycles. Some examples of medications used on an acute basis:

• Oxygen therapy
• Intravenous (IV) magnesium
• IV ketorolac tromethamine (Toradol)
• IV valproate sodium (Depacon)
• IV steroids
• IV anti-nausea medication

Physical Therapy for Headaches

Our Headache and Temporomandibular Joint (TMJ) Management programs offer relief to individuals experiencing pain caused by headaches and TMJ dysfunction. Our physical therapists create comprehensive treatment plans that help address the cause of the pain and educate patients on how to manage their symptoms. Our specialists have extensive experience in pain and headaches and will evaluate and treat with the following goals:

1. Develop an exercise program
2. Help patient identify musculoskeletal triggers
3. Improve muscle strength
4. Improve posture
5. Improve spine mobility
6. Improve tolerance for work, home and recreational activities
7. Reduce headache frequency and severity

Lifestyle Redesign® Program for Chronic Headaches

Our Lifestyle Redesign® (LRD) program for chronic headaches is conducted by occupational therapists, and consists of weekly sessions during which key parts of a patient’s daily life (sleep habits, eating routines, stress, ergonomics, etc.) are addressed and improved. LRD draws from a variety of preventive treatment strategies and was developed collaboratively with neurologists and occupational therapists. Our occupational therapists specialize in headache management and review all aspects of a patient’s routines to search for habits that might contribute to headaches. Once a possible cause is identified, a plan is set in place to modify these habits to improve self-management of an individual’s condition. LRD helps patients regain or develop function in activities of daily living and self-care and improves self-management of chronic conditions. Sessions are held for one hour once a week for eight weeks. Some of the topics addressed include the following:

• Dietary triggers
• Energy conservation and fatigue management
• Ergonomics and body mechanics
• Exercise
• Pacing
• Sensory processing
• Sleep hygiene
• Stress management and relaxation training
• Time management and organization

Pain Psychology

Our pain psychologists specialize in comprehensive biofeedback training and neuromodulation of pain based on teaching mind- body techniques. In combination with other modalities of treatment, these therapeutic methods can provide long-term improvement in pain reduction and headache management.

Procedures

Sometimes, injections of medicines or chemicals that “block” the transmission of pain signals can alleviate headache pain. For any nerve block, a chemical is injected in or near a key nerve. Nerve blocks will not work for all patients. In addition, some nerve blocks may not immediately halt headache pain, but could prevent future headaches.

Occipital nerve block – The most common nerve block procedure, involving an injection in or around the nerves in the scalp over the back of the head.

Supra-orbital nerve block – A nerve block includes injections of nerve-blocking chemicals in the face, just over the eye.

Trigger point injections – An injection is performed on and around painful “trigger points” characterized by muscles in constant tight knots either resulting from headaches or causing headaches.

OnabotulinumtoxinA injection – The same medicine used to treat wrinkles is approved to treat chronic migraines. For headache treatment, onabotulinumtoxinA is injected into several sites on the face and neck every 12 weeks.

Sphenopalatine ganglion block – The sphenopalatine ganglion (SPG) is a collection of nerve cells that is closely associated with the trigeminal nerve, which is the main nerve involved in headache disorders. A nerve block is a procedure to stop pain transmission through anesthesia to the nerve. In a SPG block, an anesthetic agent is administered through the nose. The procedure is done in the office or clinic.

Intravenous ketamine infusion – Our team pain specialist provides this special outpatient infusion to patients who have unmanageable headache and pain and who qualify for this treatment.

Radiofrequency nerve ablation – A technique useful for reducing pain caused by specific nerves, specialized needles are injected into a nerve to deliver a microwave (or other electric signal) that inactivates the targeted nerve.

Peripheral nerve stimulators – Electrical stimulation of small sensory nerves on the scalp can result in pain relief. This is another technique for treating headaches brought about by a single nerve, usually the occipital nerve in the back of the head. In this case, an electrode is inserted just under the skin to deliver a current that replaces occipital nerve pain with a tingling sensation.

Brain Surgery for Headaches and Neuralgias

Microvascular decompression – This minimally invasive surgical procedure has been shown to be effective against headaches brought about by the trigeminal nerve. The trigeminal nerve is found in the side of the face. With this procedure, a neurosurgeon removes any arteries or blood vessels that may be touching and putting pressure on the trigeminal nerve.

Patient Resources

American Headache Society
The nation’s largest society of headache specialists.
www.americanheadachesociety.org

Miles for Migraine
Miles for Migraine is a nonprofit organization with the mission of improving the lives of people with migraine and other headache disorders.
www.milesformigraine.org

American Migraine Foundation
Founded by the American Headache Society, this foundation supports innovative migraine research.
www.americanmigrainefoundation.org