Headache management in an interventional pain practice.

More than 20 million people in the United States suffer from severe headaches. Most have been diagnosed as "migraines," which have been assumed to be an intracranial process. Recognition of the extracranial sources of headaches (such as supraorbital neuralgia, infraorbital neuralgia, auriculotemporal neuralgia, facial neuralgia, posterior auricular neuralgia, occipital neuralgia, cervical facet pathology, masseter spasm, sternocleidomastoid muscle spasm, trapezius spasm, and interspinous ligament pathology) has led to an expansion of the treatment options available for practitioners skilled in interventional pain procedures. However, unless the clinical presentation is recognized, treatment cannot be offered. Clinical presentation, diagnostic injections, differential diagnosis, and advanced neurolytic techniques are discussed in this article.