Headaches and Migraine

Headaches and Migraine

  1. Tension-type headache


This is the most common type of headache with the clinical features as: 


  • Constant pain spreading all over the skull  
  • Pain radiating forward from the occipital region 
  • Feeling ‘dull’, ‘tight’ or like pressure. 
  • Sometimes, continuous pain for weeks without interruption 
  • The severity of pain varies individually. 
  • There is no photophobia. 
  • No complaint of vomiting 
  • Pain increases as the day goes on. 



Diagnosis of tension headache is mainly clinical.  Your doctor can diagnose your headache from a description of your pain. Therefore, never forget to include all the details,  such as pain characteristics, pain intensity, pain site, etc. In most cases, your physician will diagnose tension headache based upon the above clinical feature. However, he may run some imaging tests in certain cases to rule out an underlying serious problem. Following are the most important imaging tests in this regards: 


  1. MRI (Magnetic Resonance Imaging) Brain 
  2. CT (Computed Tomography) Scan Brain 




Management of this type of pain is mainly based on discussion with patients about the causes of this type of disease and the explanation that this is not a serious disease. Many medications both OTC and prescription, are available to reduce the cluster headache, including:


  • Pain relievers: Simple over-the-counter (OTC)  pain relievers are the first line of treatment for tension headache. These OTC medications include aspirin, naproxen, and ibuprofen. 
  • Prescribed drugs for tension headaches include naproxen, ketorolac and indomethacin. 


  • Combination drugs: Aspirin or acetaminophen or both can be combined with caffeine or a sedative drug to form a single medication. These drugs can be more effective. Some of these combinations are available over the counter.  


  • Triptans can be used in persons suffering from both migraines and episodic tension headaches because they are effective against the pain of both headaches. 


Preventive medications:

Your doctor may advise you on some medications to minimize the frequency and intensity of tension headache. This is especially important when you suffer from frequent or chronic headaches that aren’t easy to go away. Preventive medicines include:  


  • Tricyclic antidepressants such as amitriptyline and protriptyline, are widely used drugs to prevent tension headaches. Beware of the side effects of the drugs. 
  • Anticonvulsants and muscle relaxant such as Topiramate may prevent tension headaches.


Preventive medications can take several weeks or more to build up in your body before they take effect. So, you have to wait before seeing their effects. 



  • Rest
  • Ice packs 
  • Adopt coping strategies to manage your stress
  • Maintain a good posture.


Alternative treatments

The following alternative treatment options may help:

  • Acupuncture
  • Gentle massage 
  • Deep breathing
  • Biofeedback
  • Behavioural therapies


  1. Migraine


Migraine affects 20% of women and 6% of men at some point in their lives. Its causes remain largely unknown. The following factors are associated with migraine: 

  • Family history, suggesting a genetic predisposition. 
  • Hormonal influences can also exacerbate it. 
  • Medications such as  oral contraceptives and vasodilators
  • Sensory stimulation
  • Foods such as aged cheeses and salty and processed foods 


Clinical features

Prodromal symptoms that appear before the attack are: 

  • Constipation
  • Mood changes
  • Swift Food cravings
  • Neck rigidity 
  • Increased urination 
  • Excessive thirst 
  • Yawning 
  • Frequent yawning


Symptoms  of migraine aura include:


  • Visual hallucinations
  • Flash Of light in front of eyes 
  • Temporary loss of vision 
  • Pin and limb sensation in their limbs.
  • Abnormal body moves 
  • Difficulty in   speaking 


In around 20% of patients, migraine begins with aura (previously called ‘classical’ migraine). Shimmering, silvery zigzag lines (fortification spectra) start appearing across the visual fields for up to 40 mins, sometimes. This can sometimes cause temporary blindness. Another 80% of patients suffer from migraine without aura. Following are the characteristics of a migraine attack: 


  • Severe and throbbing pain 
  • Photophobia
  • Irritation to noise or even voice 
  • Vomiting 
  • Pain exacerbated  by movement 
  • Limbs weakness



Doctors, particularly expert in headaches (neurologists), can diagnose migraines based on your history, clinical features, and general physical and neurological examination. Your doctor may advise the following tests to rule out any serious underlying disease: 


  1. MRI. It can help a  doctor diagnose any tumour, stroke, bleeding in the brain, infections, and other problems. 
  2. CT scan. A series of X-rays created through a CT scan creates a detailed image of the brain.



Acute attack: 

  • Simple analgesia with aspirin or paracetamol
  • Antiemetic  medications to stop the vomiting if there is any 
  • Triptans such as sumatriptan are used to treat the severe attacks of migraine. 
  • Dihydroergotamine 
  • Lasmiditan 
  • Ubrogepant: This oral calcitonin gene-related peptide receptor antagonist has been recently approved for the treatment of acute migraine with or without aura in adults. I
  • Opioid medications can be used in individuals who can’t take other drugs due to any reason. 



  • Avoidance of identified triggers or exacerbating factors. 
  • If frequent, try calcium channel blockers
  • Beta-blockers such as propranolol
  • Antidepressants, particularly tricyclic antidepressants (amitriptyline) can prevent migraines. 
  • Anti-seizure drugs such as Valproate and topiramate 
  • Botox injections. Injections about every 3 months offer protection against migraine in some adults.
  • New drugs such as calcitonin gene-related peptide (CGRP) monoclonal antibodies 


Other treatment options: 

  • Acupuncture.
  • Biofeedback. 
  • Cognitive behavioural therapy. 
  • Herbs, vitamins and minerals.
  • A high dose of riboflavin (vitamin B-2)   


  • Cluster headache (migrainous neuralgia)


This is much less common than migraine. Males predominate  5: 1, and onset is usually in the third decade of life. A cluster headache is called so because it generally lasts for several weeks to months. Moreover, it tends to occur seasonally, such as every spring or every fall. A cluster headache happens quickly, usually without any warning signs. Some people might experience migraine-like nausea and aura. Common signs and symptoms of cluster headache are: 


  • Excruciating pain  generally in, behind (retro-orbital) or around one eye
  • Radiating to other parts of the face 
  • Unilateral pain 
  • Restlessness
  • Excessive tears 
  • Redness of your eye on the affected side
  • The runny nose on the affected side
  • Profuse sweating on the affected side
  • Drooping eyelid 



The exact cause and mechanism of cluster headache are unknown. But the cluster pattern of this type of headache suggests that it has something to do with the body’s biological clock (hypothalamus). Unlike other types of jeans, it is not associated with any particular food item. Other medications such as nitroglycerin are thought to trigger cluster headaches. 



Your doctor can diagnose cluster headaches due to the characteristic nature of the headache and the pattern of how it attacks. A detailed description of the attacks, location and severity of your pain and details of any associated symptoms will help your doctor diagnose it.  Based on your signs and symptoms, doctors will perform a general physical examination and neurological examination to assess your brain functions. Hev may advise some blood tests Moreover, imaging tests such as MRI and CT scan of the brain can be done as the last test to diagnose this headache or rule our tiger serious conditions. 



There is no permanent treatment for cluster headaches. Medications are used to decrease the intensity of pain, shorten the headache period and prevent further attacks. Following treatments are given to solve the acute attack of cluster headache: 


  • Oxygen 
  • Triptans 
  • Octreotide 
  • Local anesthetics such as lidocaine ‘
  • Dihydroergotamine


Moreover, the following medication can be used to prevent cluster headaches. 

  • Calcium channel blockers such as verapamil 
  • Corticosteroids such as prednisone 
  • Lithium carbonate.
  • Occipital nerve block 


Surgical options: 

In rare cases, when the cluster headache doesn’t go away, the doctor may have to advise surgical options which include: 

  1. Sphenopalatine ganglion stimulation 
  2. Noninvasive vagus nerve stimulation (VNS) 


Potential future treatments

Following treatment are under research and can be used in future: 


  1. Occipital nerve stimulation
  2. Deep brain stimulation


  1. Trigeminal neuralgia


  • Unilateral lancinating facial pains
  • Severe,  very brief but repetitive pain
  • It causes the patient to flinch as it happens with motor tic. 
  • It can be triggered by touch.
  • It can appear and disappear again and again



Trigeminal neuralgia usually resolves with medicines. However, if it does not, surgery may be performed. Following medicines are approved time used against trigeminal neuralgia. 


  • Anticonvulsant such as carbamazepine oxcarbazepine lamotrigine, phenytoin, clonazepam, and gabapentin 
  • Antispasmodic agents. such as baclofen 
  • Botox injections


Surgical Treatment

Following are the Surgical options for trigeminal neuralgia: 


  • Microvascular decompression
  • Brain stereotactic radiosurgery (Gamma knife)
  • Rhizotomy
  • Glycerol injection
  • Balloon compression
  • Radiofrequency thermal lesioning


The Takeaway Message: 


If you’re suffering from any type of headache that is not getting relieved by over-the-counter (OTC) medications, it would be the best idea to consult your doctor. He can listen to your signs and symptoms, can examine you, run some test and can formulate an effective personalized treatment plan for your headache. 




Burch R. Migraine and Tension-Type Headache: Diagnosis and Treatment. Med Clin North Am. 2019;103(2):215-233. doi:10.1016/j.mcna.2018.10.003


Robbins MS. Diagnosis and Management of Headache: A Review. JAMA. 2021;325(18):1874-1885. doi:10.1001/jama.2021.1640


Kahriman A, Zhu S. Migraine and Tension-Type Headache. Semin Neurol. 2018;38(6):608-618. doi:10.1055/s-0038-1673683


Diener HC. Headache: insight, understanding, treatment and patient management. Int J Clin Pract Suppl. 2013;(178):33-36. doi:10.1111/ijcp.12049


Chowdhury D. Acute management of migraine. J Assoc Physicians India. 2010;58 Suppl:21-25.


Gallagher RM, Cutrer FM. Migraine: diagnosis, management, and new treatment options. Am J Manag Care. 2002;8(3 Suppl):S58-S73.


Wei DY, Khalil M, Goadsby PJ. Managing cluster headache. Pract Neurol. 2019;19(6):521-528. doi:10.1136/practneurol-2018-002124


Suri H, Ailani J. Cluster Headache: A Review and Update in Treatment. Curr Neurol Neurosci Rep. 2021;21(7):31. Published 2021 May 5. doi:10.1007/s11910-021-01114-1


Rozen TD. Antiepileptic drugs in the management of cluster headache and trigeminal neuralgia. Headache. 2001;41 Suppl 1:S25-S32. doi:10.1046/j.1526-4610.2001.01154-5.x


Jensen RH. Tension-Type Headache – The Normal and Most Prevalent Headache. Headache. 2018;58(2):339-345. doi:10.1111/head.13067


Scripter C. Headache: Tension-Type Headache. FP Essent. 2018;473:17-20.

Snack Recipe from MA Heather

Double Chocolate Energy Bites  


1 cup Dry Oats  

1/2 cup Flax Seed Ground 

2/3 cup Peanut Butter  

2 tablespoon Honey  

1/2 cup Mini Chocolate Chips  


  1. Mix everything together in a bowl. 

  1. Let it chill in the refrigerator. (30 Min) 

  1. Form into balls and enjoy. 

  • * Store in an airtight container. 

Watch Heather Make This Tasty Simple Snack! 


Video- Heather Delicious Snack! 



Marteena P’s Anti-inflammatory Berry Smoothie

What Are We Feeding Our Body??? 

Acute Inflammation can cause pain of varying types and severity. Pain may be constant and steady, throbbing and pulsating, stabbing, pinching and even burning. Pain results when the buildup of fluid leads to swelling, and the swollen tissues push against sensitive nerve endings. The pressure sends pain signals to the brain, causing discomfort. 

Did you know that in just 5 minutes you can make a smoothie that can help reduce inflammation in the body? 

Mellisa S. Discusses Knee Pain

Working at CPC has been a teaching/learning experience for me. I have always had knee pain but working at CPC has showed me that this is not normal. There are different treatments for knee pain. I talked to one of the providers at CPC who explain to me that we can start off with just a steroid injection and work our way up if we needed to. I explained to him that I have always had knee pain, swollen joint, hard to walk at time, and even hear some cracking noise. When I was at work my knee would get so swollen that my pants would be so tight around my knee. At times I would walk, and my knee would feel like it was about to give out on me and cause me to fall. My knee pain was affecting me walking, running and even working out.  After talking to my provider, he wanted to start off with a steroid injection first and if that didn’t work, we would start with some gel injections. I got my first steroid injection in November around Thanksgiving; we are in March and I am knee pain free. In the begin of February I started noticing my knee pain coming back, I talked to my provider who start that most time steroid knee injection only last 3 months. I am young and I don’t want to keep coming in to get injections. I told him what I can do so I won’t keep having to get knee injection every 3 months. He said fight through the pain and talk some anti-inflammatory medication to see if you can get the swollen down along with the pain.  I took some Aleve for a couple of day, and today my knee pain is gone. I can now walk, running and work out with no pain. 

Cancer Pain by Lindsay W.

Before coming to CPC, I worked in hospice and specifically with patients who had been diagnosed with cancer. Pain in general comes from wave form which is considered the bio-physics of physical anatomy. The cells frequency is the origin to all forms of pain, including cancer. Any type of pain, not just cancer pain, can affect all parts of a person’s life-physically, mentally and can even cause depression. The amount of pain you have depends on different factors, the type of cancer, the extent of the illness, other health problems you may have, and your pain threshold. Cancer surgery, cancer treatments, or tests can also cause pain. Pain from the cancer can be caused by a tumor pressing on nerves, bones, or organs.  Surgical pain: Surgery is often part of the treatment for cancers. Depending on the kind of surgery you have, some amount of pain is usually expected and can last from a few days to weeks. Phantom pain: Phantom pain is a longer-lasting effect of surgery. This type of pain is usually an unpleasant feeling that seem to be coming from the absent body part. No single pain relief method controls phantom pain in all patients all the time. Many methods have been used to treat this type of pain, including pain medicine, physical therapy, antidepressant medicines, and transcutaneous electric nerve stimulation (TENS). Side effects of chemotherapy and radiation treatments: Some treatment side effects cause pain. Pain can even make some people stop treatment if it’s not managed. 

Medical Billing Specialist

Full-time, goal-oriented, revenue-driven, highly accurate and motivated billing team member.
Primary duties include, but are not limited to:
Pre insurance work up
Denial management
Insurance follow up
Generating daily, weeks and monthly reports

– Must have minimum 2 years billing experience, preferably in pain management
– Epic EMR experience is preferred but not required
– Coding experience, 2 years
Additional consideration will be given to candidates that demonstrate:
Ability to multitask, prioritize, and manage time efficiently
Self-motivated and self-directed; able to work without supervision
Excellent verbal and written communication skills
Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel); working knowledge of billing software a plus
Strong customer service skills and comfortable answering both patient and insurance company questions
Able to analyze problems and strategize for better solutions
Good salary and comprehensive benefits package for full time employment

Pain and Sleep: A Real Nightmare

Chronic pain can interfere with work, exercise, activities, and general daily life.  At the end of the day, after suffering through pain to complete necessary daily tasks, a good night’s sleep sounds like the perfect cure.  However, for the majority of chronic pain sufferers, laying down for a solid eight hours is unfortunately not that simple. An estimated 90% of chronic pain patients treated at a pain management clinic describe seep issues, and 53% of these patients are diagnosed with moderate to severe insomnia.  

The correlation between pain and sleep trouble can become a vicious cycle.  Being in pain can prevent sleep, and lack of sleep can increase perception of pain, making it even harder to sleep, and so on.  Pain can either make it difficult to fall asleep, or cause frequent nightly wake ups. Chronic pain can be debilitating enough, that a patient cannot work or exercise, and is therefore not capable of using energy stores during the day to be tired enough to sleep.  Additionally, day time activities can keep the mind off of pain, but once the TV is off, the bedroom is dark and quiet, more focus can go on the pain, and making falling asleep more difficult. It is also common for pain to wake a patient up several times a night, due to a change in positions, or having to maintain the same position for too long.  Additionally, if the pain is treated with opioid medication, this too can potentially lead to insomnia, since these medications are known to interfere with the REM sleep, and can lead to respiratory issues while sleeping.  

Unfortunately typical tricks to help with sleep troubles may not be as helpful when the insomnia is secondary to pain.  Increasing mobility during the day can be a difficult, if not impossible feat. Some of the medications used to treat insomnia are dangerous to take with opioids, medications like Ambien and Xanax, and therefore patients are frequently left to choose between pain medication or sleep medication.  

There are, however, therapies that can help with sleep, which include both non-medication and medication based solutions.  First, it is recommended to make sure to practice good sleep hygiene. This includes a consistent bedtime, avoid caffeine in the afternoons, no strenuous activity four hours prior to sleep, and avoid naps.  If this does not improve sleep issues, psychotherapy can be beneficial. This can include deep breathing exercises, meditation, cognitive behavioral therapy, and other therapeutic techniques. If these don’t work, there are medications that can help which are safer to take with opioid medications, such as melatonin, benadryl, or prescription medications.  Additionally, acupuncture is a useful tool that can help with both the pain and the insomnia.  

Chronic pain can lead to difficult days, but unfortunately it frequently also leads to difficult nights.   Insomnia can be equally debilitating. If pain and insomnia are something you are suffering from, you can discuss options with your PCP or your pain management specialist, and they would be happy to help find the right resources to improve your daily, as well as nightly life.  


Bolash, R., & Drerup, M. (2019, November 18). How to Beat Insomnia When You Have Chronic Pain. Retrieved January 16, 2020, from https://health.clevelandclinic.org/managing-insomnia-for-those-with-chronic-pain/

Deardorff, W. (2016, December 12). Psychological Approaches for Insomnia. Retrieved January 16, 2020, from https://www.spine-health.com/wellness/sleep/psychological-approaches-insomnia

Mann, D. (2010, February 17). Pain and Sleep: When Chronic Pain Disrupts Sleep and Causes Insomnia. Retrieved January 16, 2020, from https://www.webmd.com/sleep-disorders/features/pain-sleep

Tang, N. K. Y. (2008, September). Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Retrieved January 16, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589931/

Fibromyalgia – The Ache That Won’t Go Away


Fibromyalgia is a condition that many patients describe as a chronic, dull ache that is persistent all day long. People who have been diagnosed with it have associated fatigue, trouble with sleep patterns, numbness and tingling, and diffuse muscle pain. The theory is that people with fibromyalgia have heightened sensation of pain. Where a normal touch is perceived as mild to moderately painful. These tender areas are not just in one area such as the neck or back but diffuse throughout the body. People, at times, have categorized it like feeling like the flu. This widespread pain can range from mild to debilitating.

There are many treatment options for people with fibromyalgia. First, medications are beneficial and allow people to help manage their pain. These medications are varied and include muscle relaxers, neuromodulators, antidepressants, Low dose Naltrexone and NSAIDS. Opioid medications are not seen as a treatment choice.

Other treatment alternatives to help with this chronic pain include yoga, acupuncture, massage therapy, trigger point injections, and physical therapy. Many people try to avoid these therapies as these require them to use the muscles they perceive as painful. However, numerous studies show that exercise is the most important intervention to help with fibromyalgia.

Exercise helps patients gain strength, improve motion and foster better feeling of long-term health. People should start slow with stretching exercises and gradually increase to walking, water aerobics and even biking. Doing this a few minutes each day can turn into 30 minutes several times per week with the right plan. This will help with spasm, flexibility and endurance. Being active may initially increase the pain level these people experience but in the long term it will be beneficial and reduce pain levels.

The old saying of “no pain, no gain” is true for people with fibromyalgia but the rewards of putting in the work will lead to a better sense of well-being and improved pain scores. Making time for exercise throughout each week is essential for fibromyalgia treatment.

Depression and Pain

It is estimated that up to 85% of chronic pain patients suffer from severe depression.  Sometimes pain is a symptom of pre-existing depression, and sometimes the depression comes as a result of the effects of chronic pain.  With potentially one fifth of the US population suffering from chronic pain, understanding the association between depression and pain, and the subsequent treatment of the two, is becoming more and more important.  

The areas of the brain in charge of mood management include the prefrontal cortex, the amygdala, and the hippocampus.  Evaluation of the brain post-injury shows that body pain is controlled by most of the same regions of the brain. The chemicals in the brain associated with depression, such as serotonin and norepinephrine, play a major role in pain perception.  When the regulation of these chemicals fail, which can be the case with depression, pain perception is intensified. Additionally, autopsies performed on patients who had chronic depression showed a consistently smaller prefrontal cortex. This could potentially mean that depression can cause a physical change in the brain, therefore leading to a chronic, and possibly permanent change in the brain structure.  

Another correlation between chronic depression and pain is due to the similar impacts both can have on someone’s quality of life.  Depression can cause a lack of interest in hobbies, activities, socialization, and can therefore lead to isolation. Without the ability or desire to partake in everyday activities, more focus is paid to pain, which increases the perception of pain.  Pain can cause immobility, loss of ability to work or function, also leading to isolation, and therefore depression. Therefore, regardless of which came first, the onset of chronic pain or depression can either cause or increase the severity of the other.  

Being aware of the correlation between these two debilitating diagnoses can help lead to more effective treatment.  Physical therapy can help increase a patient’s strength and mobility, which is widely known to help with pain, however movement itself produces endorphins, the chemicals which help with happiness and reward, and therefore can decrease depression symptoms as well.  Psychotherapy is widely known to help with depression, however this can also help to alter a patient’s perception and focus on pain, and can either decrease the pain symptoms, or help a patient better cope with chronic pain symptoms. Many antidepressant medications are also used with chronic pain management, regardless of whether or not a patient has been diagnosed with depression as well.  

Overall, chronic pain can be extremely debilitating on its own, but unfortunately it commonly occurs with depression.  Treating one without acknowledging the other can lead to insufficient treatment of both, so understanding their correlation in onset, as well as treatment, can help patients improve their quality of life, both mentally and physically.  


Depression and pain. (2009, June). Retrieved January 14, 2020, from https://www.health.harvard.edu/mind-and-mood/depression-and-pain.

Sansone, R. A., & Sansone, L. A. (2008, December). Pain, pain, go away: antidepressants and pain management. Retrieved January 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729622/.

Sheng, J., Liu, S., Wang, Y., Cui, R., & Zhang, X. (2017). The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Retrieved January 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494581/.

Weight Loss and Improvements in Mental Health

Weight Loss

People today are busy with work, kids, and the normal activities of daily living. Many people do not make time for physical activities, eat on the run, and find little time for themselves due to the demands of life.

America is a country with over 70 million people considered to be obese. This means that 39.6% of our population is at risk for many health issues due to being overweight. Weight loss ads are all over the television as well as on the internet and social media.

Keeping these statistics in mind, we need to realize the importance of weight loss and understand all the benefits that come with losing extra pounds. Weight loss provides many advantages. People who lose weight will typically see lower blood pressures, lower blood sugars, increased physical activity, and improvements in pain as well. People with chronic back and joint pain note that their pain levels improve due to less stress on their body from the loss of excess weight.

People see a big improvements in their mental health. Studies show that losing weight leads to higher self esteem levels, more positive body image and feelings of contentment. After losing even 5-10% of body weight people report less depression, improved relationships, longer sleep duration and lower anxiety levels. Overall, weight loss has shown that people have an improved perception in their quality of life and more self confidence.

The weight loss journey may be tough and hard but the benefits and rewards in a person’s overall health are worth the time and effort. Today there are apps like My Fitness Pal or Lose It to help with this effort to keep track of food intake and exercise. This will help keep people accountable as they make the scales drop.

Set a goal and make a change. Help yourself become a healthier version of you!