Headaches are one of the most common medical complaints for which patients seek medical consultation.  Fifty percent of the population experiences a headache in a given year and greater than ninety percent of people experience headaches during their lifetime.  There are many reasons why someone may experience a headache, and accurate diagnosis is essential for appropriate treatment. Headaches are divided into two types: primary and secondary.

Primary headaches account for the vast majority of headache disorders.  Primary headaches include tension type headaches, migraine headaches, and cluster headaches.  These headaches cannot be explained by another obvious condition or disease.  Instead, the primary headache is the condition, which is likely the result of multiple genetic, biological, and environmental factors.  These headaches can be quite painful and disabling with many treatment options available.

Secondary headaches are the result of an underlying medical condition, and they represent a much more concerning situation.  For example, structural abnormalities of the brain such as brain tumors and vascular abnormalities may cause headaches as a secondary symptoms.  Medical conditions such as infections and inflammatory/autoimmune problems can also cause headaches. Prompt diagnosis is crucial for this headache to prevent potentially dangerous problems.


Facial pain represents a unique subset of headache pain.  Facial pain can occur for a number of reasons including sinusitis, ocular problems, and dysfunction of the cranial nerves.  One specific facial pain syndrome is called trigeminal neuralgia.  This debilitating pain condition causes pain along the distribution of the trigeminal nerve in the face.  The pain is often described as electrical, sudden, and brief.  Many episodes occur throughout the day, and the painful episodes may be triggered by chewing, talking, shaving, etc.

Our Office Provides Treatment with the Following:

  • Botox Injections
  • Occipital Nerve Blocks
  • Cervical spine injections
  • Supraorbital and Infraorbital Nerve Blocks
  • Occipital Nerve Stimulation
  • Sphenopalatine Ganglion Blocks
  • Trigeminal/ Gasserian Ganglion Rhizotomy

Some Causes of Primary Headaches:

Migraine Headaches

There are many migraine variants including ocular migraines, hemiplegic migraines, classic migraines, and common migraines.  In the most typical form, patients experience throbbing pain on one or both sides of the head lasting 4-72 hours associated with nausea, light sensitivity, and sound sensitivity.  Some patients have an aura (symptoms preceding the headache onset), which may include visual disturbances, fatigue, and sensory disturbances.

Tension-Type Headaches

Tension Headaches typically cause diffuse head pain, which is mild to moderate in intensity.  These are described as a band like feeling around the head.

Cluster Headaches

These excruciating headaches occur repeatedly during a set period of time, hence the term “cluster.”  The stabbing pain occurs behind and around the eye (ice-pick headache).  Accompanying symptoms include tearing, nasal congestion, and periorbital swelling.

**Some Causes of Secondary Headaches:

Cervicogenic Headache

These headaches occur as a result of referred pain from the neck.  Arthritis and degenerative disc disease of the cervical spine are the common causes.

Spinal Fluid Leak Headaches

An enclosed sac bathes the spinal cord and brain with cerebral spinal fluid (CSF).  A CSF leak can occur as a result of a medical procedure (i.e. Lumbar puncture or epidural injection), trauma, or rarely without cause.  A CSF leak causes pain by producing traction on the tissues around the brain.  Interestingly, the brain itself has no sensation.

Medication Overuse Headaches

As the name suggests, these daily headaches occur as the result of analgesic (pain relievers) medication overuse.  They commonly occur in conjunction with another headache type.

Occipital Neuralgia

The occipital nerve supplies sensation to back of the head.  Occipital nerve irritation may lead to severe, shock like pain in the back of the skull.

**This is a very small sampling of the secondary headache types.  The headaches listed are the common types treated by Delaware Valley Pain and Spine Institute.

Some Causes of Facial Pain:

Trigeminal Neuralgia (TN)

This condition causes sudden, severe, shock-like pain in the distribution of the trigeminal nerve.  The trigeminal nerve has three branches: V1 refers to the branch above the eyebrow, V2 refers to the branch around the maxilla, and V3 refers to the branch just above the jaw line. TN typically causes pain in one or two of these branches.  One widely held view is that TN occurs as the result of a blood vessel compressing the trigeminal nerve in the brain.  Other conditions such as multiple sclerosis and Lyme’s Disease can also cause trigeminal neuralgia.  Medical management alone alleviates symptoms in up to eighty percent of sufferers.  When medications are unsuccessful, interventional approaches are utilized such as Gamma knife therapy, Microvascular Decompression, and minimally invasive trigeminal / Gasserion rhizotomy.

Glossopharyngeal Neuralgia

This rare condition causes pain along the glossopharyngeal nerve.  The severe pain is sudden.  It is described as an electrical pain in the throat, ear, and tongue.

Eagle Syndrome

The styloid process is a bone that normally protrudes from the base of the skull.  In rare situations, enlargement of this bone can compress the carotid artery leading to ear pain, difficulty swallowing, and ringing of the ears.

Atypical Facial Pain

Atypical facial pain is a term used for facial pain along the trigeminal nerve distribution, which does not fulfill the criteria for an alternative diagnosis.  The pain is different from trigeminal neuralgia as it is continuous, and it is described as aching, burning, and throbbing.  The exact cause for atypical facial pain is unknown.