FAQs on Headache Treatment in Philadelphia

Headache is a common illness that affects millions of people each day. There are several types of headaches, and symptoms depend on which type you have. The most common types of headaches are primary headaches, which include migraine headache, tension-type headache, and cluster headache.

How common are headaches?

In the clinical setting, headaches are the most common neurological disorder seen. The prevalence of tension headache is reported as 52%. Migraine headache has a prevalence rate of 16%.

What are the types of headaches?

  • Tension-type headaches – The pain is usually on both sides of the head (bilateral) and is reported as a band-like sensation.
  • Migraine headaches – The pain is usually on one side of the head, described as throbbing, and is associated with nausea and/or vomiting. Visual symptoms (aura) consists of seeing zig-zag lines, flickering lights, spots, and spectra.
  • Cluster headaches – The pain is most always on one side of the head, and occurs during sleep or at night. Associated symptoms include watering of the eye, nasal stuffiness, conjunctiva redness, and drooping eye—all on the same side as the pain. These usually affect men who smoke and are 20 years of age or older.

What causes headaches?

Triggers are events, substances, and situations that bring on headaches. Examples include:

  • Hormonal changes
  • Stress
  • Sleep problems
  • Certain foods
  • Certain medications
  • Muscle tension
  • Smoking
  • Sinus and allergy symptoms

How does the doctor diagnose headaches?

If you have headaches, the doctor will ask you questions about your symptoms, conduct a physical examination, and order some diagnostic tests. These include laboratory and imaging tests, such as magnetic resonance imaging and computerized tomography.

How are headaches treated?

The treatment depends on the type of headache, the frequency of the pain, and the severity of the headache. Treatment options include:

  • Medications – Many medications are used to treat headaches, such as tricyclic antidepressants (amitriptyline and nortriptyline), as well as topiramate, gabapentin, and valproic acid. For immediate relief, abortive agents are used, such as Imitrex.
  • Occipital nerve block (ONB) – With this procedure, the doctor injects a long-acting anesthetic near the occipital nerves at the back of the head. A recent study found the majority of people who had this procedure experienced 50% or more headache pain reduction, and ONB was proven to be an effective long-term treatment for occipital neuralgia.
  • Botox injections – Botulinum toxin type A is a powerful neurotoxin used to prevent certain headaches. The doctor injects the temples, jaw, forehead, and back of neck with this muscle paralyzer to alleviate muscle spasms and tension. A recent research report found that Botox was useful for reducing migraine pain severity and frequency of headaches.
  • Acupuncture – This ancient Chinese therapy is used to alleviate pain associated with headaches. To restore body energy and stimulate release endorphin release, fine needles are inserted into the back of the neck and other targeted regions. One research report found that acupuncture was more effective than a placebo for relieving headache pain.
  • Radiofrequency denervation – With this procedure, the doctor inserts a special needle with probe into the tiny facet joints of the cervical spine (neck region). Radiofrequency energy is emitted to destroy a portion of the nerve root and block pain signal transmission. A recent clinical study found this procedure to have a 75% success rate.


Lee, JB, Park, JY, Park, J, Lim DJ, et al. (2007). Clinical efficacy of radiofrequency cervical zygapophyseal neurotomy in patients with chronic cervicogenic headache.

Merikangas KR, Lateef T. Epidemiology and quality of life of migraine. In: Fernández-de-las-Peñas C, Chaitow L, Schoenen J, editors. Multidisciplinary management of migraine: pharmacological, manual and other therapies. Sudbury, MA: Jones & Bartlett Learning; 2011.

Palmisani, S, Al-Kaisy, A, Arcioni, R et al. (2013). A six year retrospective review of occipital nerve stimulation practice – controversies and challenges of an emerging technique for treating refractory headache syndromes. The Journal of Headache and Pain, 14 (67). doi:10.1186/1129-2377-14-67

Siberstein, S, Mathew, N, Saper, J, & Jenkins, S (2000). Botulinum toxin type A as a migraine preventive treatment. BOTOX Migraine Clinical Research Group. Headache, 40(6), 445-450.