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Migraine and chronic headache treatment

Persistent headache rarely has a single cause. Dr Chris Martin assesses migraine, neck-driven headache and occipital neuralgia together, then matches treatment to the mechanism — nerve blocks and radiofrequency for the neck and occipital nerves, preventive injection cycles for chronic migraine where criteria are met, and medication review where overuse is sustaining the pattern.

Headache that occurs on most days has usually acquired more than one driver by the time it reaches a specialist. Migraine may have become chronic. The upper neck may be contributing. Acute medication taken on many days may itself be sustaining the pattern. Sleep, mood and neck posture at work all feed in. Treatment that addresses only one of these tends to disappoint, which is why assessment comes first and takes time.

Assessment

The consultation establishes which headache types are present — most people with daily headache have more than one — and what has turned an occasional problem into a constant one. A headache diary covering four weeks, with the days you took acute medication marked, is far more informative than any scan. Examination of the upper neck and the occipital nerves tests whether they reproduce your pain. Imaging is reviewed where it exists; it is rarely needed to make the diagnosis, and a normal scan does not mean nothing is wrong.

Treating the neck component

Headache arising from the upper cervical joints — cervicogenic headache — is common after whiplash and in people who work at screens. It is tested directly with diagnostic blocks of the nerves supplying the upper facet joints. Where the block relieves the headache, radiofrequency treatment of the same nerves can provide relief lasting months. This is one of the better-supported procedures in pain medicine for a specific, testable problem.

Occipital nerve blocks and radiofrequency

Pain at the base of the skull that shoots over the back of the head, often with one tender point, suggests occipital neuralgia. An occipital nerve block both tests this and treats it; radiofrequency treatment is available where blocks help repeatedly but briefly. Occipital blocks are also used in some people with chronic migraine to interrupt a prolonged attack.

Preventive injection treatment for chronic migraine

For people meeting the definition of chronic migraine — headache on fifteen or more days a month, with migraine features on at least eight — targeted injections into specific muscles of the head and neck, repeated roughly every twelve weeks, are an established preventive option where adequate trials of standard preventive medication have not succeeded. The injections are performed in the rooms, take about fifteen minutes, and the response is judged over two cycles before a decision is made about continuing. Eligibility and funding are separate questions and are explained at the consultation.

Medication review

Taking acute headache medication on more than ten to fifteen days a month can, in itself, keep headache going. Where that pattern is present, it is addressed first — preventive treatment works poorly until it is. This is managed with a plan rather than an instruction to stop, because the transition can be difficult. See Medication review.

What else matters

Sleep, regular meals, neck posture, physiotherapy directed at the upper neck and management of mood all affect headache frequency, and are part of the plan rather than an afterthought. Many people find that frequency falls substantially once the drivers are identified and worked on in combination.

Risks

Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Common questions

What is the difference between chronic migraine and cervicogenic headache?

Chronic migraine is migraine that has become frequent — fifteen or more headache days a month. Cervicogenic headache is referred from the upper neck joints. They feel similar, often coexist, and are treated differently, which is why the assessment separates them with examination and, where needed, diagnostic blocks.

Do I need a neurologist or a pain specialist?

Either may be appropriate, and many people see both. A pain specialist is particularly useful where the neck is contributing, where nerve blocks or radiofrequency are being considered, or where medication overuse needs a structured plan. Your GP can advise which referral fits your situation.

How long do occipital nerve blocks last?

The local anaesthetic effect lasts hours. Any longer benefit develops over the following days and varies widely — some people gain weeks or months, others little. Where blocks help repeatedly but briefly, radiofrequency treatment is considered.

How often are the chronic migraine injections repeated?

Roughly every twelve weeks. The response is judged over two cycles using a headache diary, and treatment continues only where it is clearly reducing headache days.

Will I need a scan?

Usually not. Most headache diagnoses are made on history and examination. Imaging is arranged where the pattern suggests something that needs excluding, or to plan a specific procedure.