Headache and Facial Pain

    • Treatments for migraines, tension headaches and cluster headaches
    • Specialist pain management consultants
    • Rapid access to our pain clinic
    • Call to book an immediate consultation to discuss your options
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The vast majority of headache variants are known as primary headache. This means that the headache itself is the main condition, and that it has not been caused by another condition.

Headache & Facial Pain

Chronic headache is a very common condition that accounts for 4.4% of primary care consultations (6.4% females and 2.5% males). The most common varieties of headache seen on chronic pain clinics include cervicogenic (coming from the neck), tension type headache and chronic migraine.

There are no blood tests or scans that can confirm these conditions and help make the diagnosis. Furthermore, with these headache types, clinical examination is usually normal. This means that the variant of headache is usually diagnosed on the history alone.

Do I Need a Brain Scan?

The vast majority of headache variants are known as primary headache. This means that the headache itself is the main condition, and that it has not been caused by another condition.

The main presentations of primary headache are:

  • Migraine
  • Tension-type headache
  • Cluster headache and other trigeminal autonomic cephalalgias
  • Other primary headaches

These conditions are usually diagnosed from the description of the pain and further scans and investigations are not necessary.

Certain ‘red flags’ can be identified in the history that would suggest that this is a secondary headache (i.e. it is a symptom of another condition) and that a brain scan or blood tests might be necessary.

Potential Secondary Headache Red Flags: “SNOOP-IT”

  • SYSTEMIC SYMPTOMS (fever, weight loss)
  • NEUROLOGIC SYMPTOMS or abnormal signs (confusion, impaired alertness or consciousness)
  • ONSET: sudden, abrupt, or split-second (Thunderclap headache)
  • OLDER: new onset and progressive headache, especially in middle i.e. age over 50 years (giant cell arteritis)
  • PREVIOUS HEADACHE HISTORY: first headache or different (change in attack frequency, severity, or clinical features) i.e. has the pattern of headache changed?
  • Infection i.e. meningitis, encephalitis
  • Trauma

If these features are not present in your description of your headache, your headache is almost certainly one of the primary headaches and further scans are not necessary.

What are the commonest types of headache and facial pain seen at a pain clinic?

The commonest types of headache and facial pain seen at the chronic pain clinic include:

  • Tension type headaches
  • Migraines
  • Occipital neuralgia
  • Cervical pain
  • Trigeminal neuralgia
  • Temporomandibular joint pain
  • Atypical facial pain
  • Facial migraine

What treatments can be offered for my chronic headache / facial pain?

Your chronic pain specialist will take a full history, consider any ‘red flags’ that may be present and decide if any further investigations are necessary.

You will then get a plan for the management of your headache / facial pain, tailored for your own particular needs.

Treatments that may be offered for your headache include:

  • Appropriate pharmacotherapy – using a wide range of drugs including tricyclic antidepressants (TCA’s), anti-epileptic drugs (AED’s), tryptans and NSAID’s (anti-inflammatory drugs)
  • Botulinum Toxin A (Botox) treatment (Approved for the treatment of chronic migraine)
  • Radiofrequency (RF) treatment for trigeminal neuralgia
  • Physiotherapy for cervicogenic headache
  • Cognito-behavioural therapies – can help with coping and acceptance

What is Medication Overuse Headache?

It has long been known that ergotamine, the active ingredient of many of the older migraine medications (Tryptans), can cause headache if taken too frequently. It has also recently emerged that painkillers containing codeine (i.e. cocodamol) can exacerbate headache if taken too frequently. Headache sufferers tend to take this drug up to four times per day. These are the two groups of drugs most strongly linked with medication overuse headache (MOH).

It is likely that the headache is due to a sort of withdrawal syndrome once the positive effects of each dose have worn off.

The natural reaction is to take more medication, to provide short term relief, but this can again lead to further headache after some hours. People taking high dose analgesia usually need to be seen in specialist clinics as sudden and complete withdrawal of medications may lead to a severe withdrawal headache, that can last up to between 2–10 days. This headache may come alongside other symptoms, such as anxiety. During this period, it is important to drink plenty of water to keep well hydrated.

If you would like to book an appointment or require further information on the available options, please do not hesitate to contact our private patient booking team via our online enquiry form.

Alternatively, email Kingsbridge Private Hospital

Treatment Locations

Kingsbridge Private Hospital

811-815 Lisburn Road,

Healthcare Professionals & Consultants

Dr Michael Stafford

Consultant in Anaesthesia and Chronic Pain Medicine

Dr Niranjan Chogle

Consultant in Pain Medicine

Dr Monica Chogle

Consultant in Pain Management

Patient Journey

Find out what your journey will be from diagnosis to treatment

Self Funded Journey

Patient Testimonials

"I was in your facility yesterday for a day procedure (operation on my left arm). I wanted to write and express how impressed I was with the facilities and more importantly the staff on the Ward.

Everyone was excellent, and I mean excellent, i don't normally write congratulatory e-mails so this is high praise in my view. The Senior nurse was excellent, as was the Theatre nurse and the anaesthetist. Even the assistants that helped with catering and other duties. All came together to form a great impression of the establishment." Jason Carpal Tunnel Surgery, Kingsbridge Patient
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Yesterday's was a neck disc replacement operation.  I would highly recommend this hospital like a hotel manner. Thanks again guys." Mr Phillips, Kingsbridge Patient
"As hospitals go this one is pretty amazing! Had surgery with Mr Molloy at the end of October and have another one the end of this month. Mr Molloy is a gentleman who puts you at ease right away and ensured my last procedure went smoothly! From start to finish all the hospital staff go above and beyond to make your stay as comfortable and stress free as possible. The facilities are brilliant with the rooms spacious and modern to recover in. Keep up the good work!" Ms Roulston, Kingsbridge Patient
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