A clear differentiation must be made between the different types of headaches.


In cases of headache and facial pain, exhaustive examinations should be carried out by the patient's GP, and, if applicable, by a neurologist, an ENT specialist, an ophthalmologist (eye doctor), a dentist, a jaw bone surgeon, an anaesthesiologist, a psychologist and/or a psychiatrist. The treatment dispensed by a pain team in an outpatient pain clinic in cases of headaches or facial pain is to a large extent aimed at the symptoms rather than the direct cause of the pain. This is why it is necessary to carry out in-depth examinations in order to make or rule out a specific diagnosis. We advise against treating headache patients primarily for their pain symptoms. Doctors working in pain clinics should refer headache patients who are insufficiently monitored for evaluation and proper diagnosis. Besides paracetamol and/or various NSAIDs, the antiepileptic drug carbamazepine has a special place in the treatment of head and face pain.

Cluster headaches

Cluster headaches are experienced on one side of the head, usually in and around one eye , but the pain can radiate to the forehead, the side of the head, the face, ear and neck. The pain ranges from piercing to stabbing and is reported as being severe. Possible cluster headache symptoms are tearing of the eyes, reddening of the whites of the eyes, swelling of the nasal mucosae, runny nose, perspiration on the forehead, narrowed pupils or a hanging eyelid. Treatment can include therapy with carbamazepine (Tegretol), ergotamine, sumatriptan (Imigran), corticosteroids, methysergide (Deseril), calcium blockers (e.g. Adalat or Isoptin), lithium carbonate, TENS, oxygen therapy and, potentially, nerve blocking. Good results have been obtained with the sphenopalatine ganglion block. In this procedure, an electrode is introduced via the side of the cheek into the nerve centre, and, once in place, is heated for a short period of time by means of radiofrequency current.

Images of Cluster headaches

De typische klachten bij cluster hoofdpijn zijn, éénzijdige hevige hoofdpijn, meestal rond het oog en dit samen met neusloop aan die kant en zelfs een dichtvallend ooglid. De verdeling van typische cluster hoofdpijn, met de meeste pijn in en rond het oog. Op deze magnetische beeldvorming van de hersenen zien we de zones die actief zijn bij cluster hoofdpijn. Een nieuwe behandelings-techniek bestaat erin deze hersenzones via een elektrode te stimuleren om de pijn te doen verdwijnen.