Ultrasound for evaluation and treatment of headaches

Headaches are a common pain complaint, affecting millions of people in the US alone. These pains have been attributed to intracranial processes, such as dilated blood vessels and the trigeminal ganglion, and therefore only amenable to medication therapies. However, many of these headaches, including “migraines”, may be caused by extracranial conditions that can be diagnosed and treated with interventional pain techniques. Using “pattern recognition”, many headache etiologies can be quickly identified, and then treated with ultrasound-guided injections that diagnose and treat the underlying condition. The topics in this article include the diagnosis and ultrasound-guided treatment of supraorbital neuralgia, auriculotemporal neuralgia, and greater occipital neuralgia, and their role in headache management.