By Ankur Manvar, MD

Headaches are just like opinions. Everyone has them—some are bothersome, some are excruciating, and some come at times when you didn’t ask for them!

Headaches are common, but not everyone knows the right way to treat them. As a pain specialist who trained at the top pain program in Seattle, WA, I can suggest some treatments that will require a pain specialist, but I’m also a proponent of using natural supplements that will bring relief for a lot less money.

First, let’s review the origins of head pain:

  • Extracranial causes (outside the head) such as sinus pain, eyes, ears, orbit, teeth and temporomandibular joint (TMJ)
  • Intracranial sources (inside the head) such as arteries, sinus and membranes covering the brain

These can be classified as primary (a dysfunction of the nervous system) or secondary (sinusitis, TMJ, trauma, substance abuse or medication overuse).

There are three primary types of headaches:

  • Tension
  • Cluster
  • Migraines

Tension headaches cause pressure and tightness that waxes and wanes. There are no symptoms. They can occur on both sides of the head, and the duration of the headache varies. These headaches can be caused by weather, traffic and, like many other health issues, stress.

Cluster headaches come on quickly. They’re deep, continuous, and often excruciating. Symptoms can cause tears, congestion or sweating. The pain settles on one side of the head, behind the eye and can last anywhere from 30 minutes to three or more hours.

Migraines are by far the most difficult to manage. Considered a brain disorder, migraines cause the brain to become hypersensitive and overly responsive. Migraines cause throbbing, pulsing, blurry vision and stabbing pain that can be severe and worsen with exertion. Migraines are associated with nausea and vomiting as well as light sensitivity and can last from 4-72 hours. Most people with migraines are relegated to suffer in a dark quiet room.


When a person feels a headache coming on, they often reach for Tylenol® PM or other medications that decrease blood flow to the brain. But that’s not the right answer. Those medications cause blood vessels to constrict or become smaller, preventing blood flow. When dealing with headache pain, the object is to increase blood flow.

Appropriate migraine and headache medications focus on prevention such as beta blockers like timolol and propranolol as well as anti-depressants. However, you will need to see your pain specialist or Primary Care Provider to initiate these medications.

If migraines are lasting more than ten days a month, the best way to treat this is with Botox. Yes, that Botox. So who doesn’t want to look a little younger while their headaches are under control? Aside from wrinkles, Botox releases desensitizes nerves that cause the excruciating pain of migraines. Botox currently is the only proven, evidenced-based treatment for chronic migraines.

For people with more than ten headache days per month, Botox treatment includes 31 injections using very small needles on the neck, upper back and scalp.

Our patients find pain relief from migraines with Botox.

However, Botox is not effective with other medications like opioids or medications over the counter. Often my patients overuse pain medicines, so the first thing is to wean them off other medications while adding other non-drug treatments like good sleep hygiene (no cell phones or TV in the bedroom).

In addition to good sleep hygiene, I recommend patients avoid headache triggers such as certain foods, drugs, smoking and stress. Psychotherapy and biofeedback for relaxation are good options, as well as an all-natural supplement called Boswellia.

If you’d like more information about managing chronic headaches, feel free to call our office at St. Luke’s Hospital Pain Center in Columbus, NC. Call 828-894-0978 for an appointment.