Headaches are the most common reason that patients will consult with a neurologist. I divide headaches into three main groups. Many people who have headaches are concerned that there may be a severe underlying cause and my priority is to exclude these and to make a diagnosis so that treatment can be started.

Dangerous headaches

Dangerous headaches may be due to raised pressure in the head, irritation of the meninges surrounding the brain from, for example, a bleed or infection or damage to the vessels supplying the brain.

Local causes

The second group are from local causes; eye problems, sinus disease or jaw problems can cause frontal pain. Degeneration in the neck, particularly with associated muscle spasm can cause occipital pain.  Patients with these cervicogenic headaches often respond to a combination of physiotherapy, medication and nerve blocks.

Primary headache conditions

By far the commonest cause are the primary headache conditions.

Migraines are common affecting up to 10% of men and 20% of women. When managing migraines my priorities are to make a confident diagnosis and to exclude serious causes. Next, it is helpful to identify headache triggers and to support patients in avoiding and managing these.

In people with infrequent headaches, I prescribe medications to use as required to “abort” a headache and there are specific “triptan” drugs that replace the serotonin that is depleted during an attack.

In patients whose headaches are frequent and severe enough to disrupt their lives, I recommend regular preventative treatment. This can range from supplements that have proven efficacy to a range of medications to reduce the frequency and severity of attacks.

For patients with severe attacks, I provide injectable therapies including occipital nerve blocks and Botulinum Toxin. There are a new group of self-administered monthly injections that block the chemical CGRP that has been shown to initiate attacks.  These have dramatically improved the outcomes of patients with severe migraines and have become a mainstay of treatment of patients with severe migraine.

In some people migraines can transform into a chronic daily mixed migraine and tension headache that may also affect mood and it is rewarding to work with patients in order to control these. I also manage less common headache conditions, such as cluster headaches, coital and exercise headaches.