# Chronic Headaches and Migraine in Barcelona

> Treatment of chronic headaches and refractory migraine. Comprehensive differential diagnosis and advanced options: nerve blocks, neuromodulation. Treatment for national and international patients with remote second opinion.

URL: https://brainandspine-bcn.com/en/neurology/chronic-headaches-migraine/
Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com

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# Chronic headaches and refractory migraine

Comprehensive differential diagnosis and personalised plan for headaches that do not respond to standard medical treatment. From ultrasound-guided injections to neuromodulation.

## Classify first, then treat

Not all chronic headaches respond to the same treatment. Our first step is a **thorough differential diagnosis** to identify the exact type of headache and rule out secondary causes.

### Types we treat

- **Migraine** episodic and chronic.
- **Chronic tension headache.**
- **Cervicogenic headache** (cervical origin).
- **Cluster headache.**
- **Post-traumatic headaches**, whiplash, after cervical surgery.
- **Occipital neuralgia.**
- **Trigeminal neuralgia** (typical or atypical facial pain).

### Therapeutic options

- **Pharmacological treatment:** personalised preventive and rescue therapy according to headache type.
- **[Greater occipital nerve block](https://brainandspine-bcn.com/en/neurology/occipital-nerve-block/)** ultrasound-guided in clinic.
- **Botulinum toxin injection** for chronic migraine according to PREEMPT criteria.
- **Vascular micodecompression** in refractory trigeminal neuralgia.
- **Neuromodulation** in highly selected cases that do not respond to any prior option.

30% of chronic migraines
do not receive a precise diagnosis after years of evolution. A comprehensive approach (neurologist + neurosurgeon) broadens the range of options when oral medication is not enough.

## Symptoms of chronic headaches

Recognising the pain pattern is key to classifying the headache and guiding treatment. Each type has characteristic symptoms.

### Chronic migraine

- **Pulsating pain** of moderate to severe intensity, often unilateral.
- **15 or more headache days per month** for more than 3 months (8 of them with migraine features).
- **Nausea or vomiting** accompanying the headache.
- **Photo and phonophobia** (sensitivity to light and noise).
- **Worsening with routine physical activity.**
- **Aura** (visual or sensory) preceding the headache in some patients.

### Tension headache

- **Pressing or tightening pain** "band-like" or helmet-like, bilateral.
- **Mild to moderate intensity**, non-pulsating.
- **Not aggravated by physical activity.**
- **Tension and tightness** of pericranial and cervical muscles.
- **No nausea**; at most mild photo or phonophobia.

### Cluster headache

- **Very severe, strictly unilateral pain**, orbital or periorbital.
- **Attacks lasting 15 to 180 minutes** recurring in clusters over weeks.
- **Tearing, conjunctival redness and nasal congestion** on the same side.
- **Ptosis or miosis** (drooping eyelid, small pupil).
- **Agitation and restlessness** during the attack.

### Cervicogenic headache

- **Pain of cervical origin** radiating from the nape to the forehead.
- **Unilateral and always on the same side** in each episode.
- **Triggered by neck movements or postures.**
- **Restricted cervical range of motion.**
- **Tenderness on pressure** over the occipital and upper cervical region.

Red flags: when to seek urgent assessment:
sudden, extremely severe headache ("the worst of your life"), new headache onset after age 50, progressive worsening, fever with neck stiffness, neurological deficit (weakness, speech or vision disturbance), seizures or behavioural changes. These signs require urgent evaluation to exclude a secondary cause.

## What our patients say

5,0
Average rating on Doctoralia · testimonials anonymised with consent
"I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well."

"For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away."

"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."

_**A multidisciplinary team by your side.** Neurosurgeons, neurologists and nursing staff working together on every case. [Meet the whole team →](https://brainandspine-bcn.com/en/team/)_