Facial Pain


Last updated on April 7th, 2021 at 08:07 pm

ONE-SIDED HEADACHE WITH CONGESTED RUNNY NOSE, OR RED, TEARING AND SWOLLEN EYE. 5 REASONS WHY – 2021.

@Neuralgroover

BACKGROUND

Do you have a one-sided headache, left-sided headache, right-sided headache, or one-sided head pain with some variation of one-sided symptoms such as runny nose, nasal congestion or stuffiness, red eye, tearing eye, droopiness of the eyelid, puffiness or swelling around the eye, facial sweating or flushing, or clogged ear feeling? These symptoms are called autonomic symptoms, and they are a central part of several distinct headache syndromes. The headaches that occur with this combination of features are distinct types of headaches, all requiring different treatments. Therefore, it is important in differentiating them to ensure proper treatment and less misery!

 

TRIGEMINAL AUTONOMIC CEPHALALGIAS (TACs)

There is a class of headaches called the trigeminal autonomic cephalalgias (TACs), and all are terribly painful. There are 4 types of headaches within the TAC family, and include cluster headache, hemicrania continua, paroxysmal hemicrania, and SUNCT / SUNA (Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing / Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms). All of the TAC syndromes warrant preferably a brain MRI and MRA to exclude other causes such as pituitary lesions, aneurysms, or other abnormalities.

 

The TACs all share 2 common and core features. 1st, they are characterized by a severe headache that is strictly one-sided and focused around the eye, behind the eye, below the eye, in the temple or forehead areas. 2nd, they must include at least 1 autonomic symptom on the same side of the headache [lacrimation (runniness/tearing of the eye), conjunctival injection (redness of the eye), facial sweating or flushing (skin turning blushed), nasal congestion, rhinorrhea (runniness of nose), sense of ear fullness, eyelid edema (swelling), or partial Horner’s syndrome (miosis (pupil becomes small)) and/or ptosis (droopiness of the eye)].

 

So how do you differentiate these headache types when they all have similar features? Differentiation between them is based purely on their headache attack duration and pattern. So, it is actually quite easy to differentiate them as contrasted below.

 

CLUSTER HEADACHE

Cluster headache is the most common TAC syndrome and is discussed and detailed further here. It is characterized by attacks of severe unilateral (one-sided) orbital (around the eye), supraorbital (above the eye), and/or temporal pain lasting 15 to 180 minutes if untreated. There is either agitation/restlessness with the headache attack and/or at least 1 autonomic sign or symptom on the side of the headache as described above. Headache attacks typically occur from 1 every other day to 8 per day for more than half the time during a cluster cycle.  Chronic cluster headache is defined by attacks that occur for more than 1 year without remission, or with remission periods lasting less than 1 month.

 

Cluster headache attacks occur in “clusters”, or cycles, of frequent headache attacks. These cycles of cluster attacks may last for weeks or months before they go away completely. Within a cluster cycle, patients may get multiple attacks during the day or overnight. They often classically wake the patient up in the middle of sleep, usually around the same time every night or morning. The patient often gets up and paces around the house in agitated misery. They certainly can occur during the day as well. Remission periods can last months to years. Cluster cycles often occur at a predictable time of year, such as season changes (Fall and Spring are most common). Men tend to be affected 3 times more than women, but it is seen in both men and women. It is a severely painful headache, and has been termed “suicide headache” because of the pain severity.

 

Treatment of cluster headache is detailed further here.

 

HEMICRANIA CONTINUA

Hemicrania continua a continuous daily one-sided headache (side-locked, does not alternate sides) of at least 3 months duration with moderate to severe exacerbations. There should be either agitation or restlessness and/or at least 1 autonomic sign or symptom on the side of the headache as described above. Although not included in the criteria, sometimes patients describe a sensation such as something irritating in the eye on the side of the headache, such as sand, grit, or a hair, but nothing is found. Hemicrania continua is discussed and detailed further here.

 

To make the full diagnosis of hemicrania continua, the patient must respond completely to a therapeutic trial of indomethacin (a specific anti-inflammatory (NSAID) medication), used in a very specific way (“Indomethacin trial”). For this reason, this headache is 1 of 2 types of “Indomethacin-sensitive” headaches because Indomethacin is typically the only thing that works (paroxysmal hemicrania is the other Indomethacin-sensitive headache). The diagnosis of hemicrania continua is confirmed by the headache completely stopping after reaching a specific dose of Indomethacin.

 

Besides indomethacin, other treatments of hemicrania continua are detailed further here.

 

PAROXYSMAL HEMICRANIA

Paroxysmal hemicrania is characterized by attacks of severe unilateral (one-sided) orbital (around the eye), supraorbital (above the eye), and/or temporal pain lasting 2 to 30 minutes. There must be at least 1 autonomic sign or symptom on the side of the headache as described above. The attacks have a frequency of more than 5 per day for more than 50% of the time when the disorder is active.  Chronic paroxysmal hemicrania continua is defined by attacks occurring for more than 1 year without remission, or with remission periods lasting less than 1 month. Paroxysmal hemicrania is discussed and detailed further here.

 

To make the full diagnosis of paroxysmal hemicrania, the patient must respond completely to a therapeutic trial of indomethacin (a specific anti-inflammatory (NSAID) medication), used in a very specific way (“Indomethacin trial”). For this reason, this headache is 1 of 2 types of “Indomethacin-sensitive” headaches because Indomethacin is typically the only thing that works (hemicrania continua is the other “Indomethacin-sensitive” headache). The diagnosis of paroxysmal hemicrania is confirmed by the headache completely stopping after reaching a specific dose of Indomethacin.

 

Besides indomethacin, other treatments of paroxysmal hemicrania are detailed further here.

 

SUNCT / SUNA

SUNCT/SUNA are two variations of a rare type of headache called short-lasting unilateral neuralgiform headache attacks, and they are discussed and detailed further here. Short-lasting unilateral neuralgiform headache attacks (which include SUNCT and SUNA) are characterized by moderate to severe unilateral (one-sided) orbital (around the eye), supraorbital (above the eye), and/or temporal pain. The duration of the pain lasts for 1–600 seconds (1 second to 10 minutes, although most often about 5 seconds to 4 minutes), and may occur as single stabs, series of stabs, or in a sawtooth pattern. There must be at least 1 autonomic sign or symptom on the side of the headache as described above. Attacks must have a frequency of at least one per day for more than half of the time when the disorder is active. However, the attacks generally occur in a very high daily frequency when active, sometimes even up to 200 attacks per day or 5-6 attacks per hour.

 

SUNCT and SUNA both share the above criteria. The difference between the two is that SUNCT requires both conjunctival injection (redness of the eye) and lacrimation (runniness/tearing of the eye), whereas SUNA requires only 1 or neither of these 2 features.

 

Treatment of SUNCT / SUNA is detailed further here.

 

MIGRAINE

Migraine is not a TAC syndrome, but it can sometimes have overlapping characteristics with the TACs in terms of its one-sided nature and associated autonomic features in some patients. For this reason, I have included it in this discussion. Migraine is discussed and detailed further here. The autonomic symptoms seen in migraine are not required by criteria for diagnosis, in contrast to the TAC syndromes which do require these symptoms for diagnosis. In some patients with migraine, their headache attacks can have some of the autonomic features described above. For many patients, migraine also activates the sinus pathways, so sinus symptoms of sinus/facial pressure, congestion and drainage are common. This is often misdiagnosed as “sinus headache”. However, if there is any throbbiness, pulsating, or pounding, it is almost guaranteed to actually be of a migraine origin rather than of a sinus origin.

 

Migraine headache attacks last 4 to 72 hours if untreated or unsuccessfully treated. There must be 2 of the following 4 features present: a unilateral (one-sided) headache, pounding/throbbing/pulsating quality, moderate-to-severe pain intensity, and worsening by routine physical activity. There must also be 1 of the following 2 features present: nausea and/or vomiting, or both photophobia (sensitivity to light) and phonophobia (sensitivity to sound).

 

Treatment of migraine headache is detailed further here.

 

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

 

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Last updated on April 5th, 2021 at 12:57 am

HEADACHE CHART AND HEADACHE LOCATIONS FOR DIFFERENT TYPES OF HEADACHES.

@Neuralgroover

 

I can picture it now. You’re sitting there late at night breaking out into a cold sweat, heart racing, convincing yourself a brain tumor is the cause of your headache as you are Googling a variety of terms such as…

 

…temple headache, headache behind eye, headache behind eyes, headache on top of head, headache in the temples, headache back of head, headache in front of head, headache on one side, front of head headache, headache on right side, headache on left side, headache in temple, headache forehead, pain behind eye, headache behind the eyes, headache and nausea, pain behind eyes, headache on left side of head, headache on right side of head, headache in back of head, front head headache, headache temple, headache at the front of head, stomach upset, left side headache, right side headache, headache behind right eye, temples headache, headache behind left eye, nausea and headache, pain in head, sharp pain in head, neck pain and headache, constant headache, head pressure, ice-pick headache, headache front, pressure headache, sex headache, exertion headache, cough headache, right temple headache, left temple headache, throbbing headache, headache meaning location, frontal headache, types of headaches diagram, headache types chart, pounding headache, headache locations chart, headaches in eyes, pain top of head, headache above left eye, headache map, headache above right eye, etc., etc., etc…

 

Ok, I think you get the point. Sound familiar? Now that you’ve earned your honorary Doctor Google degree, let me help provide some direction for you and your headache self-research.

 

And let me tell you a BIG secret…

 

Headaches are not diagnosed based only on their location. They are diagnosed by the “company they keep”. In other words, the characteristics, patterns, and associated symptoms that go with the headache are the more important key pieces of information which narrow down the most likely headache types. Headache location by itself without any other information is actually quite useless. The International Classification of Headache Disorders (ICHD3) classifies every headache type according to the headache and all of the associated features. Each headache type must match a specific set of characteristics and associated symptoms set forth in the criteria, and headache location is only one of many features taken into account.

 

By combining the headache location with associated symptoms, patterns, and characteristics of the headache, it can then be more accurately narrowed down. This in turn makes choosing the correct treatment more accurate and effective. This is absolutely key. The end result is that you are on the more appropriate path to improvement rather than someone throwing “headache” pills randomly at a headache that they haven’t given a specific name to, and the treatment they are using may not be the treatment that your specific type of headache needs (and sometimes it can even make it worse). I see this scenario in my headache clinic every day given the shortage of headache specialists. This is why I created a FREE headache and facial pain symptom checker as discussed further down.

 

Let’s take migraine as just one example. Migraine can vary widely in its location between patients and between attacks within the same patient. Any one of those Googled headache location terms listed at the top could potentially represent migraine. Those locations could also represent many other specific types of headaches as well, and they would require a much different type of treatment or evaluation than migraine would. The headache location doesn’t fully match with migraine until you combine it with the required criteria of associated symptoms that make the migraine diagnosis which may include a combination of symptoms such as nausea, sensitivity to light (photophobia), sensitivity to sound (phonophobia), throbbing or pounding pain, moderate to severe pain intensity, worsening with exercise, one sided predominance, and of course ruling out other more concerning “secondary” causes of the headaches. So clearly, Googling the headache location alone doesn’t help you figure out the cause or type of the headache at all, nor the most effective treatment. The bottom line is that location of pain alone doesn’t narrow down the type of headache or facial pain that you have. The associated symptoms and patterns that go with the headache are the keys to the possible headache types.

 

Thus, I created a FREE headache and facial pain symptom checker. The purpose is to help you with more personalized self-research with a list of possible headache types to discuss with your local doctor in hopes of helping you and your doctor have a better discussion of possible headache types, as well as better treatment considerations. Remember, any type of headache and facial pain requires an office visit and physical examination with your doctor. This symptom checker tool is purely educational to provoke thinking of a variety of headache possibilities. However, bad causes of headache can present as mild and simple headache disorders such as migraine. So, a visit to your doctor to evaluate your headache is a mandatory step that you must do.

 

When you are trying to narrow down the type of headache or facial pain you may have, these are the additional characteristics and symptoms that you need to take into consideration, and are the key questions a headache specialist will ask you in the office. Go through the following list of headache features, think about each one, and write down your responses. If you have different types of headaches, it is important to focus on and think about only one type at a time (even though they are typically different manifestations of the same underlying headache disorder).

 

1) Location of pain. As mentioned above, pain location is only one of many important characteristics of a headache disorder, but without factoring in the associated symptoms, patterns, and characteristics, it is quite useless alone. I have broken down 8 general patterns of headache and facial pain locations to choose from. Go through the following headache location charts and pick the one that is most consistent with your headache or facial pain location. These are screenshots from the first step of the headache and facial pain symptom checker algorithm. There may be some variation to your attacks and the location may vary between different attacks, so pick the one which summarizes the areas involved overall for the particular type of headache you are analyzing.

 

2) Frequency of the headache or facial pain attacks. How often do the attacks of headache of facial pain occur? Once per day and several days per month, 8 different attacks per day, etc.? Is there a pattern to the attacks, such as a seasonal occurrence?

 

3) Duration of the headache or facial pain attacks. When you get an attack of headache or facial pain, how long does each individual attack last until it goes away completely if it is untreated or unsuccessfully treated? 30 minutes, greater than 4 hours, 15 minutes, several days, etc.?

 

4) Description and characterization of the headache or facial pain. How would you describe the pain of the headache or facial pain if you had to put it into words? Throbbing, pounding, pulsating, achy, excruciating, pressure, electrical, shock, burning, sharp, stabbing, ice pick stabbing, etc.?

 

5) Associated neurological symptoms. Is the headache associated with visual disturbances such as lost vision, flashing lights, shapes, zig-zags, colors, wavy lines, kaleidoscope, jagged edges, etc.? Is there numbness or tingling in an area of the body associated with a headache attack such as on one side of the face and body? Is there weakness on one side of the body with the headache? Are there problems speaking or getting words out with a headache attack?

 

6) Additional symptoms. Is your stomach upset or do you feel nauseated or sick to your stomach with a headache attack? Do you vomit? Do you feel sensitive to bright light and/or loud sound when the headache is at its worst (where you would prefer to be in a dark quiet area if you had the chance)? Does an eye turn red or tear excessively during a headache attack? Does your nose run or get congested on one side during a headache attack? Does your eyelid droop on one side or does it get puffy around an eye on one side with a headache attack?

 

When you are done going through and thinking about all of these headache characteristics, patterns, and associated symptoms, take a run through this FREE headache and facial pain symptom checker algorithm questionnaire which I created to help you with more personalized self-research with a list of possible headache types and treatments to discuss with your local doctor.

 

Good luck, and I hope this tool leads you in a better direction of more educational and useful discussions with your doctor regarding possible headache types and more effective treatment considerations!

 

Do me a HUGE favor and if you have found this headache symptom checker tool helpful and it led to a more successful outcome of narrowing down your headache types and treatments when you saw your local doctor, PLEASE let me know and drop me a message here or on Twitter!!

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

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Last updated on April 7th, 2021 at 08:24 pm

STOP LETTING YOUR CHRONIC MIGRAINE AND CHRONIC PAIN DEFINE YOU AND YOUR BRAIN PLASTICITY.

@Neuralgroover

Background

I see the worst of the worst headache, migraine, chronic migraine, facial pain, fibromyalgia, and chronic pain from many states and countries. I see patients who have been debilitated by pain, patients whose pain has destroyed their family, marriage, work life, social life, and the ability to function normally. They are void of hope and have lost all self-esteem and confidence, replaced by depression and seclusion. They hide in the shadows of life. They come into the office with dark sunglasses, hoods up, appear detached, soft-spoken with little to say, and have fully committed themselves to the mindset that they will never get better. And they won’t because they don’t allow their brain to develop the plasticity to escape out of that mindset and behavior. We’ll talk about this concept and brain plasticity more later. I have seen patients who slide into this mindset commit suicide because they see no way out. These patients are rampant and come from all walks of life; professionals such as attorneys to blue collar workers to the jobless. It is an equal opportunity nightmare of chronic pain syndromes. These patients evolve from a once normal life and function to one of minimal to no ability to function normally in life, career, or relationships. I have seen plenty of people pull out of this described rut of a chronic pain lifestyle. It’s possible, but it takes work. Most importantly, it takes the step of convincing yourself that it is possible and will be done, and then readjusting your behaviors, mindset, and thought process accordingly. Give yourself no other option than improvement and realize that there is always hope for improvement. The placebo response in clinical trials involving pain patients (and similar in other subgroups) averages around 30%! That means on average, 30% of pain patients will develop significant improvement despite taking a placebo (fake) treatment. This happens because they convince themselves that they are using the new treatment, and thus they convince their mind that they are improving, and they do! Your mind is the most powerful weapon in your battle against your chronic pain, so learn to use it to your advantage.

 

Let me be clear that chronic pain is real, it is valid, it can be debilitating, it shouldn’t be ignored or overlooked, it can validly negatively impact all aspects of life which can be out of the control of the patient. I profoundly empathize with these patients. However, there is a lot that is in control of the patient which they often do not realize, and that is my purpose for this blog article. Specifically, they do not realize that they are creating a self-fulfilling prophecy of never improving in pain or function, directly related to their behavior and mindset. No, this discussion doesn’t apply to everyone and all cases, but I would say it does apply to the majority of patients.

 

Many of these patients create websites, blogs, and social media accounts dedicated and centered around their chronic pain experiences. Their chronic pain becomes their persona, and who they are. It redefines them. This can certainly be helpful to others to learn about similar pain experiences and to feel that they are not alone, and I think it is fantastic that other patients can have these outlets and sources to share their experiences. However, it can also become a dominating way of life which dissolves away any thought, hope or attempt at improving their pain and overall function. These patients get to a point where living any other way besides centered around their chronic pain would seem abnormal to them. They focus their life, their daily activities, their restrictions, their abilities, and their relationships around their chronic pain. It defines them and dictates their life. They are chained and restrained from this focus. This behavior begins to feed into itself and they continue down a path where there becomes no chance at improvement because they don’t allow their mindset or focus to see that as a valid option, and thus do not initiate behavioral changes to try to influence positive changes.

 

This phenomenon is also reflected in patients who have chronic daily headache, chronic pain, chronic neck pain and whiplash syndrome related to a motor vehicle accident, work related injury, or some other event where they were injured. If there is litigation (lawsuit) involved, it is well known as a clinical predictor that they will rarely improve, because of potential secondary gain (financial, disability, etc.) from their pain, which their subconscious maintains focus on. There have been studies supporting this correlation as well. This phenomenon is not seen in other countries which are not as litigious and ready to sue over anything. We used to have a large unique chronic pain rehabilitation program which was very effective and helpful to many patients. A large focus of this program was on behavioral changes to influence improvements in overall pain and functional abilities. However, patients were excluded from entry if they were involved in any ongoing lawsuit related to their pain, because these patients invariably never got better until the lawsuit was settled and done, and it would be much more beneficial and cost effective to them after legal issues were resolved. We would then admit them following the conclusion of their legal battles if they continued to have chronic pain issues. I have seen many patients reverse their course from that dark reclusive patient scenario described above with the right mindset and approach.

 

How does pain behavior influence brain plasticity and your chances of improvement?

Anatomically and physiologically, this reclusive and socially isolated behavior and mindset of telling yourself that it is impossible for pain to improve or that one cannot function and live a normal life with chronic pain becomes a self-fulfilling prophecy. DON’T LET THAT HAPPEN!! This is solidly based in scientific and biological evidence. Behavior influences cellular, molecular, and physiological changes in the body and brain. Studies have shown that behavior (such as pain limiting behavior, social avoidance, etc.) causes structural and circuitry changes in the brain, which can be lifelong. Social behavior can also cause changes in the brain, although this can be more reversible. These structural changes in the brain and the circuitry of the brain, influenced by behavioral changes (behavioral neuroscience) and mindset, are called brain plasticity. Essentially, plasticity refers to the nervous system’s ability to constantly modify its organization, structure, function, and circuitry connections in response to experiences, behavior, and an endless list of other influencing factors such as pain, stress, diet, emotion, medications, and many other things. Brain circuits related to chronic pain overlap with circuits involving anxiety, depression and some mood disorders. Mood disorders such as depression can affect the plasticity of chronic pain, and likewise chronic pain can influence plasticity of depression and other mood disorder circuitry.

 

Treatment and conclusions of chronic pain

Treatment is difficult, requires patience, and involves treatment trial and errors (if one treatment doesn’t work, another is tried). The single most important treatment involves you, your behavior in how you respond to your pain, your mindset, and attitude which all in turn influence your brain plasticity positively, and chances of improvement. Do not let your pain define who you are and what you are able to do. Expectations are important in that you should realize that (typically) there is no quick fix or “cure” (but if you stumble across one, which can happen, great!). Learning to live, deal, and function with the chronic pain is vital. If you realize this and make it a primary goal, it can in turn lead to improvements over time by modulating your brain plasticity and electrical circuitry. Most preventive treatments can take 2-3 months to see effects, and there is no way to expedite that. Hang in there and be patient.

 

Chronic migraine, fibromyalgia, and some other chronic pain syndromes often cluster together. The way to look at these types of chronic pain syndromes is that the neurological system is “hyperactive”, “overactive” or “hypersensitive”. So, the goal is to try to “turn down the volume” of this “hypersensitive” neurological system with medications or other types of treatments.  Never conclude that there is no possibility of improving. Remain active physically, socially, emotionally, and maintain active relationships. Treating depression or mood disorders is very important, and a good psychiatrist can make a big difference with this. Chronic migraine and chronic daily headache should have appropriate treatments which may include preventive treatments, CGRP mAb once monthly treatments, supplements and natural therapies, neuromodulation devices, eliminating rebound (medication overuse headache), and using appropriate abortive (as needed) therapy such as triptans, gepants and ditans. Most importantly, remain hopeful. There is always hope and there are constantly new types of treatments becoming available. You can do this!!!

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

 

 

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Last updated on April 10th, 2021 at 05:00 am

WHEN TO SEE A HEADACHE SPECIALIST AND HOW TO PREPARE TO GET THE MOST FROM THE APPOINTMENT.

@Neuralgroover

 

Background

I see patients in our headache center from all over the United States and from many other countries. Many patients travel hundreds of miles by car or airplane for these visits, due to the shortage of available headache specialists (about 570 in the US). Many patients are lucky enough to be relatively close to a headache specialist. Whichever scenario you fall into, you want to get the most out of your appointment with a headache specialist in order to get on a better path to less headache or facial pain burden.

 

When to see a headache specialist

So first of all, when should you see a headache specialist? First off, any type of headache, head pain, or facial pain, is reason enough to see a headache specialist. Basically, headache specialists specialize in any type of pain or discomfort involving anywhere in the head or face. They also commonly see patients that may have other neurological symptoms which may not necessarily be associated with headaches, but their doctor wants to rule out a migraine “equivalent” disorder. Some patients can have neurologic symptoms without headache (visual, sensory, speech, vertigo, weakness, nausea/vomiting, abdominal pain), which may actually reflect a painless migraine disorder, such as migraine aura without headache. I have compiled a list below of a few of my thoughts of when your headache or facial pain treatment journey signals that it is time to see a headache specialist.

 

Reasons to see a headache specialist:

-You have a headache, head pain, or facial pain.

-Your doctor tells you, “your headache is all in your head”.

-Your doctor tells you, “there’s nothing else I can do for you”.

-Your doctor says, “I don’t treat much headache, but…”.

-You continue to have frequent headaches despite trying several preventive medications.

-You just don’t feel like you are making any progress despite a couple office visits with your doctor or their NP or PA (or you never even get to see the doctor).

-You don’t feel like your doctor is listening to you or taking your symptoms seriously.

-The doctor spends only a few minutes in the visit, so you feel rushed and unable to discuss all of your concerns.

-Your doctor is googling your symptoms in the office.

-Your doctor recommends that you take opiates/opioids for migraine treatment.

-Your doctor says it is ok to use NSAIDs, OTCs or triptans more than 10 days per month or butalbital/fioricet/fiorinal more than 5 days per month on average for migraine treatment.

-Your doctor says your headache is “because you are depressed”.

-Your doctor does not give you a more specific classification or name for your diagnosis.

 

What information should you gather before the visit?

Unfortunately, we all know how strapped for time most physicians are during office visits due to a variety of factors such as low insurance reimbursement and the need to increase patient volume to compensate for this and break even. So to get the most out of your office visit, making it efficient and helpful, it is important to compile certain information in preparation. Typing out this information and bringing it to your office visit is a great idea. It is also a great idea to keep this as a running file that you can continue adding to in your personal files. This helps to eliminate time wasted in the office that could easily be organized and thought through prior to the visit, allowing more time for the important parts of the office visit; optimizing the diagnosis and treatment plans. Some of this information you may not have available, and that is certainly ok. You may be able to retrieve some of it from records, memory, and your local pharmacist.

Never assume that your local doctor’s office has faxed all of your records ahead of the visit. If that happens, great. However, many times patients are told that the records will be sent, but when we see the patient, we have no records that were sent. So, it is always best to bring all of your records yourself. Furthermore, it is good to have copies of all of your medical records, testing, etc. for your personal files anyway.

 

The following list are items that I have found to be the most useful for patients to have gathered and thought of prior to the visit, allowing the most efficient and useful office visit:

A) Acute/abortive headache or pain treatments (used “as needed”). This information is also needed in order to pursue insurance approvals for various types of treatments such as the newer gepants (Ubrelvy, Nurtec) or ditans (Reyvow).

-All that have been tried (which triptans, NSAIDs, neuromodulation devices, etc.)

-Doses used

-Responses (effectiveness, side effects) of each treatment

 

B) Preventive headache or pain treatments (used daily to lessen headache frequency/severity). This information is also needed in order to pursue insurance approvals for various treatments such as Botox or the CGRP mAb antagonists (Aimovig, Ajovy, Emgality, Vyepti).

-All that have been tried

-Maximum doses used

-Duration that each treatment was used

-Responses (effectiveness, side effects) of each treatment

 

C) Testing

-All CD and radiology reports for all brain MRIs, CTs, and other relevant testing for your headache or pain. Most CDs do not include the radiology report, and you need to request that separately. It is a good idea to have copies of all of these things for your personal files regardless. Bring them all to the office visit for the doctor to review.

-All bloodwork done in the past 5 years. Labs particularly important for headache evaluations include TSH, CBC, CMP, Vitamin D, Vitamin B12, ESR, CRP, ANA, to name a few, but this may vary and include more or less, depending on the specific clinical scenario.

 

D) Think about the clinical features of your headache or facial pain as listed below. These will be important questions that your headache specialist will ask. So, it is good to answer these questions in your head prior to the visit, so you can provide more accurate and thought out answers. This helps to prevent being put on the spot by questions you never really thought about which may result in forgetting some important details. For a free headache and facial pain self-diagnosis tool which incorporates all of these important questions that a headache specialist asks, look here.

-Location of the headache or facial pain

-Frequency of the headache or facial pain attacks

-Duration of the headache or facial pain attacks

-Description and characterization of the headache or facial pain attacks

-Neurological symptoms associated with the headache or facial pain (visual disturbances, numbness, tingling, weakness, speech disturbances, vertigo, etc.)

-Other associated symptoms with the headache or facial pain (nausea, sensitivity to light or sound, one sided autonomic features (runny eye, red eye, runny or congested nose, droopy or puffiness around eye))

 

Conclusions:

If you are able to gather all or much of the above listed information prior to your headache specialist appointment, you’ll be well on your way to a much more efficient and beneficial office visit. As a result, you and your doctor will be able spend more time in the office discussing the most important things rather than spending it trying to look up records or digging through your memory for various details. As a result, your doctor will have more time to better formulate a list of the most likely diagnoses, and best treatment approaches for minimizing the disruption of your headache or facial pain on your life. Good luck!!

 

IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!

FIRST, LET’S DECIDE WHERE TO START:

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX  MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.

 

IF YOU DON’T HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR POSSIBLE TYPES OF HEADACHES OR FACIAL PAINS BASED ON YOUR SYMPTOMS, USE THE FREE HEADACHE AND FACIAL PAIN SYMPTOM CHECKER TOOL DEVELOPED BY A HEADACHE SPECIALIST NEUROLOGIST HERE!

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.

 

IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING TO ASK QUESTIONS TO A HEADACHE SPECIALIST OR OTHER HEADACHE, MIGRAINE, AND FACIAL PAIN WEBSITE MEMBERS, VISIT OUR FREE DISCUSSION FORUMS HERE.

 

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