Although primary headaches such as migraine, cluster, paroxysmal hemicrania, hemicrania continua and new daily persistent headachehave their origin in the brain, the pain is felt in the face (forehead, eye, temple, and jaw), back of the head (occipital) and upper neck (cervical). The nerves that provide sensation to the facial, occipital and cervical regions also carry the headache signal, which was originally generated by the brain.  As an example, the trigeminal nerve may transmit the headache signal to the face via the supraorbital/supratrochlear nerves, the occipital nerves to the back of the head and the cervical spinal nerves to the back of the head and upper neck.

The sphenopalatine ganglion is a nerve that sits deep inside the nose. Under normal circumstances, it is responsible for producing secretions in the nasal passages and tear formation in the eyes. As seen with the trigeminal nerve, the sphenopalatine ganglion can also carry the headache signal.  It is frequently seen in those who suffer with cluster and hemicrania continua and not uncommonly in migraine and occasionally new daily persistent headache.

In the case of cervicogenic headaches, the headache pathways are the same nerves which provide sensation to the painful cervical structure, which in turn is the source of the headache/neck pain.  These structures most commonly include the facet joints (C1-2, C2-3, C3-4), and upper discs (C2-3/C3-4) and the C2 nerve root/dorsal ganglion.

Your treatment will start with a detailed evaluation of your medical history and a thorough examination, after which an individualized treatment approach will be developed.

Interventional Headache Treatment begins with the injection of local anesthetic (Novocaine) into specific areas of the head and neck. The goal of the injection is to determine which nerve can be anesthetized, in order to temporarily “turn off” the headache. This is referred to as a diagnostic nerve block.  If the diagnostic block is positive, it allows us to determine which nerves can be treated at a later date with Radiofrequency procedures, which in turn can provide sustained pain relief.

Some nerve blocks can be performed in the office, while others require x-ray guidance and are performed as a brief outpatient procedure. The office injections produce transient discomfort when the local anesthetic is placed. There is usually a small amount of soreness at the injection site the following day. The nerve blocks which require x-ray guidance are performed at an outpatient facility, using a small amount of sedation.

Radiofrequency procedures are used to heat the nerve which is responsible for carrying the headache signal. In doing so, the nerve’s ability to send a pain message is interrupted. The radiofrequency procedure is performed utilizing a thin, Teflon coated needle, which is placed directly onto the “target nerve” (the nerve carrying the pain message). Once in position, a small electrode is passed through the needle, which in turn heats the nerve. The procedure is done utilizing x-ray guidance, which allows for a high degree of accuracy and safety. The treatment requires no incision or stitches and is done on an outpatient basis, using local anesthetic and intravenous sedation. Pain medications may be prescribed for post procedural discomfort.

Depending upon the condition and which structure is being treated, radiofrequency procedures can provide pain relief which lasts for 6-18 months.

1. 1. Chronic migraine
   2. Cluster headache
   3. Paroxysmal hemicrania
   4. Hemicrania continua
   5. New daily persistent headache (NDPH)
   6. Cervicogenic Headache (Neck Pain with Headache)
   7. Chronic neck pain
   8. Trigeminal neuralgia
   9. Occipital neuralgia

If medications or other non-interventional treatment is indicated and has not been previously prescribed, Dr. Kline may recommend that as an option. In some instances, Dr. Kline will refer patients for parallel treatment such as biofeedback and physical therapy. In general, Dr. Kline offers interventional treatment, since most of his patients have already received more traditional care.

Interventional Headache Treatment is for individuals who have had prior conservative care but continue to suffer with headaches. If you have had no prior conservative treatment, then Dr. Kline can make recommendations to address that.