A couple of our recent blogs have been about serious brain conditions that were found because of an extreme headache. Of course, most of the time a headache is just a headache and not a sign of impending doom; you can drink a glass of water, take a pain reliever or a nap and you’ll be just fine.
That isn’t to say, we don’t take headaches seriously. Sometimes they can be terrible and unrelenting and really interfere with your life. When these kinds of headaches aren’t improved with the usual conservative treatments, they can make life unmanageable. In these extreme cases, Dr. Christopher Winfree from the Pain Center says there is a relatively minimalist surgery that can help.
He says, “the nerves that are causing the pain can be isolated, in some cases, right under the skin, and tiny electrodes can be placed on or near the nerve to stop the pain. ” This works by tapping into what is called the Gate Control theory of pain and is called neuromodulation.
Introduced in 1965 by Melzack and Wall, the Gate control theory essentially says that another sensation such as pressure or vibration can over-ride the pain sensation before it gets to the brain. With neuromodulation, a mild electrical current is used to create the sensation of vibration.
Neuromodulation can be done most anywhere along a nerve’s pathway. Dr. Winfree says that in the case of chronic headaches he usually places tiny electrodes on or near the occipital nerves at the base of the skull. This is usually done just on the side of the head where the headache is. These nerves branch out and provide the sensory information for the back and top of the head as well as into the temple and eye area. In other words, where most headaches occur. The electrodes are attached to thin lead wires that connect to a battery operated stimulating device that is implanted just under the skin of the patient’s chest.
Dr. Winfree says this is a relatively new treatment option for chronic headaches but in particular, can be quite effective in treating three of the worst kinds of primary headaches: Migraines, Chronic Cluster Headaches, and Hemicrania Continua. All three of these headaches have in common that they usually occur on just one side of the head, they can be debilitating and they are not caused by something else (like an aneurysm or tumor, for example).
In brief, a Migraine headache is a persistent headache that can last a few hours to a few days. Patients usually describe the pain as pulsing and often they come with nausea or vomiting and a severe sensitivity to sound and light. Many people also experience an “aura,” such as a funny smell or flashes of light before their migraine comes on.
Like a migraine, Hemicrania Continua can also be accompanied by nausea and vomiting. This kind of headache is usually not as painful, though it can be punctuated with greater intensities, and lasts much longer (greater than three months). When tolerated, the treatment of choice is the drug indometacin. Patients can also show signs of autonomic nervous system involvement such as a tearing, a drooping eyelid, constriction of the pupil, or a runny nose.
These symptoms may also be present with The Cluster headache. This has been called one of the most painful conditions known to man and is characterized by intense, brief and unexpected bouts of pain, usually behind one eye or temple.
All three of these headaches can be debilitating and difficult to treat but occipital nerve stimulation is increasingly an option for these patients. Dr. Winfree says, “Using neuromodulation to treat these kinds of headaches is a new frontier and as such more research is needed. Most of the studies done so far have small sample sizes, but of the groups tested, the results are encouraging.” Though small, it is nonetheless, a glimmer of hope for a number of people in a great deal of pain.
Recent Blog Posts Involving Headaches: Eight Years Ago I Got The Worst Headache Of My Life, Bret Michaels Suffers Brain Bleed. Dr. Solomon Helps Us Understand What That Means.
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