Headaches and facial pains are very common and affects nearly everyone at some point in their life. Increasing age, trauma to head or face and conditions like anxiety and depression, over-reliance to pain-killers can contribute to developing headaches. Most of these are self-limiting and last only for a few days or weeks. However, if it is long-lasting, it can be severely disabling and impacts heavily on your quality of life. Most headaches do not signify any major illness and after confirming that there are no underlying medical conditions, a pain consultant would be able to help you control and manage it effectively.
Common Conditions treated at Pain Clinics:
There are very few headaches which need urgent medical attention and possibility of scans and other investigations. These include sudden onset severe headache, associated neurological signs like numbness or weakness in arms and/or leg, drooping of side of face, vertigo, loss of control of bowel and/or waterworks, disturbance in vision or hearing, seizures, signs of infection like fever, chills and history of weight loss, cancer, diabetes, high blood pressure and on blood-thinning medications. We need to rule out stroke, bleeding inside the brain, tumours, meningitis and other serious conditions.
However, the vast majority of headaches are not serious except for the symptoms. Common complaints vary between sharp pain, aches, pulsing or throbbing sensation, pain at the top of the neck, tingling or electric-shock like sensations and burning sensations. Migraine is probably the commonest cause of headache with frequent episodes in some and often it is associated with trigger factors, visual or hearing signs and nausea/vomiting.
There could be several areas that could give rise to pain in the head, face and neck. Primary headaches are conditions where the headache is the medical problem – Migraine, Cluster headache, Tension headaches, SUNCT, hemicrania continua etc are examples. Secondary headaches are those where the headache is due to another underlying medical condition like whip-lash injuries, neck problems, bleed in the brain, stroke, infection, tumours, aneurysms etc. The following are other common causes of headaches and facial pain.
Most patients are seen and managed by the GP; any acute conditions that need referral are promptly dealt and the chronic headaches are usually referred to a neurologist for a diagnosis. Pain consultants offer assessment and advice on managing these conditions after appropriate investigations which may include blood tests and scans. Treatment depend on the diagnosis and various options can be discussed with the patient to suit their preferences. This may include medications, nerve blocks, treatment with Botox, radiofrequency treatments, physiotherapy and psychological rehabilitation. Some patients benefit from holistic approaches including acupuncture, laser therapy, TENS machines and other treatment options including mindfulness, meditation and yoga-based treatments. A small group of patients could benefit from neuromodulation treatment and even fewer patient may require surgical treatment.
Headaches and orofacial pains represent a complex spectrum of conditions and your pain consultant would work with you to make a diagnosis and put together a treatment plan for your condition to give meaningful pain relief and improved quality of life.
Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.
In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.
Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.
There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.
We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.
You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.
You will be reviewed only by MACS clinic senior Pain Consultants for your condition.
If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.
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