Treatment methods

Getting a handle on the pain

Almost all primary and many secondary headaches can be treated easily. However, the primary headaches in particular cannot be “cured”. But we can reduce the number of your headache episodes (“prophylaxis”) or end the individual headache episodes as quickly and effectively as possible (“attack treatment”).

The majority of headache syndromes can be treated on an outpatient basis, but they should be accompanied by a specialist. A “headache calendar” where you note and describe your headache episodes helps us to plan and monitor your treatment.

With secondary forms of headaches, a quick start to treatment and therefore an inpatient treatment at our headache hospital is often necessary. Once the triggering cause has been eliminated, many patients are then in fact “cured”.
Chronic headaches due to an incorrect use of painkillers require a “withdrawal”. This can also take place for a few days under inpatient supervision.

The specialists at our headache hospital always develop a custom treatment plan just for you. In addition to your illness, this plan also takes your age, comorbidities, your living conditions, your personal expectations and any contraindications into consideration. In most cases, it is advisable to combine drug and non-drug treatments.

Conservative treatment methods

Migraine treatment

There is a difference between attack treatment and migraine prevention when treating migraines.

Treating mild to moderate migraine attacks

Mild migraine attacks are treated with known painkillers, such as aspirin (ASS), Ibuprofen or paracetamol. A sufficient dose of the painkiller is important. The drugs may not be used too frequently, as otherwise they will no longer be effective.

Metoclopramide drops may be taken to counter severe nausea as a side effect. These also improve stomach activity so that the painkillers can be absorbed more quickly.

Treating moderate to severe migraine attacks
So-called triptans are the most effective here. This group of drugs helps exclusively with migraine headaches. Triptans are not suitable for patients with a certain history of heart disease.

Caution: If painkillers and triptans are taken too frequently, there is the risk that the headaches will occur more frequently or even continuously. In these cases, the first priority is to withdraw from the previous pain medication and then sensibly treat the underlying headache disorder, i.e. the migraine or the tension headache.

Migraine prevention with drugs
The aim of using drugs for prevention is to reduce the frequency of migraine attacks by at least 50 per cent. The first choice medication are the beta-blockers metoprolol and propranolol, the calcium channel blocker flunarizine and the antiepileptic drugs topiramate and valproic acid. These drugs must be taken daily. If the attacks have been reduced accordingly and the compatibility is good, the drug treatment should be continued for at least another six months. After that, an attempt can be made to cease taking the drugs.

Migraine prevention without drugs

Cognitive-behavioural approaches have been proven to be successful here. In addition to learning pain and stress management strategies, these also include relaxation exercises (primarily progressive muscle relaxation according to Jacobson) and biofeedback methods. With biofeedback, you get feedback about your body signals via the computer screen (such as muscle tension or blood flow to the temporal arteries). With regular practice, you gradually learn to control them more consciously.

Other treatments for headaches

Non-medical procedures play a major role, because you can make an active contribution on your own here. The focus is on exercises to manage stress as well as relaxation training (muscle relaxation according to Jacobson, autogenic training). Regular endurance training such as jogging, swimming or cycling is also helpful. It sometimes also helps to change your lifestyle habits by, for example, adjusting how long you sleep and your sleep rhythms. If certain foods (such as cheese or alcohol) are identified as triggers, simply remove them from your diet.

Heat applications, massages or stretching have shown to have positive effects, in particular with chronic tension headaches. This can also help with headaches that are triggered by changes in the cervical spine.

Drug treatments for headaches

Not all painkillers are equally suited for every type of headache. Our neurologists will prescribe you exactly the drugs that give you the best chance of getting a handle on your headache attacks.

Acute treatment
In the majority of cases, uncomplicated headaches can be sufficiently treated with simple and accessible painkillers, such as aspirin (ASA), Ibuprofen or paracetamol. It is only necessary to switch to another substance class in the event of incompatibilities or ineffectiveness.

Prophylaxis treatment
If headache attacks are very frequent, it may make sense in some circumstances to start a drug prophylaxis treatment. Taking a drug daily should significantly reduce the number of headache episodes over a period of several months. The drugs used for migraines are, for example, beta-blockers, antiepileptics or antidepressants. They are usually used in low doses and are well-tolerated that way.

Botulinum toxin
Botulinum toxin is a naturally-occurring neurotoxin that is injected in very small doses in the neck or head muscles. It has been proven to be very useful for many neurological disorders. It helps in some cases with headaches.

Surgical treatment methods

Headaches: Surgery can help

With some secondary headache syndromes and a few primary headache disorders as well as neuralgia, surgery is helpful in eliminating headaches. Headache surgery is even necessary in the event of a brain tumour, cranial fluid backup or vascular changes.

Surgeries for trigeminal neuralgia (facial pain) have been the most common to date. Here either the nerve nucleus areas of the pain-inducing trigeminal nerve in the brain are destroyed or, if a oppressive blood vessel has been identified as the pain trigger, the trigeminal nerve is relieved. Recently, it has also been possible to "cut out" pain-sensitive structures with special radiation techniques.

In the event of cluster headaches that do not respond to treatment, electrodes were recently used for deep brain stimulation ("brain pacemaker"). However, this method should only be done at a highly specialised centre.