INSTANTANEOUS CURE OF ACUTE FRONTAL CEPHALALGIA

C.X McCALLA III, M.D.; DABFP

While personally in the throes of an attack of a migraine headache - an intense unilateralfronto-templar unrelenting, suffering pain with associated photophobia and nausea - I recognized that there was a discreet point in the temple from which radiated most of the rest of the wide area of continual throbbing pain. And it was at this point that I was applying an ice pack constantly in attempt to get some relief. The point seemed small localized and felt as if all the intensity of the terribly unpleasant sensation was concentrated upon it, as if there were a burning hot wire applied continually to my temple without interruption. And it occured to me that if I could do something to eradicate that point of intensity the rest of my headache would not be so bad.

Reflecting on that idea I began wondering if I were to anesthatize that spot with Lidocaine would that answer relief? Also remembering that migraine type headaches have also been considered by researchers to have had a neuro-vascular origin, often described as an arterial dilation, I wondered too if something to relieve swelling(inflammation) might not also be helpful?

From those ideas I devised an injectible combination of the anticipated agents consisting of Lidocaine, Sarapin and Triamcinolone Acetonide(Kenalog) layered in a syringe(but without effort to prevent some mixing) of the proportion of 0.10cc Triamcinolone (4mg), 0.75cc Sarapin and 0.15cc of Lidocaine 2% with Adrenalin, Drawn into the syringe in that order. I used a one ml diabetic syringe with 5/8 inch 28 gauge needle. And at the onset of next attack of migraine experience I was astonished to feel almost instantaneous, complete relief of all of the headache symptoms- NO pain!, no nausea!, no photophobia -- and they did not recur! That headache was gone! Although in future weeks another onset did return that I similarly treated. Since that time of some 5 years previous I have had fewer and fewer onsets of attack but have never failed to abolish it nor suffered any disability from an acute migraine.

In time I began to offer it to patients that presented to the office in the throes of an acute attack. I have such treated dozens and dozens of individuals, each time with amazing, rapid results of complete symptom relief. I estimate a series of more than 450 treatment (perhaps 200+ patients) in a 3 year period and have had only 2 treatment failures. Those were individuals that had suffered for years almost daily with intense, debilitating headache, had sought help from multiple physicians and treatment centers, and whom I suspected as having headache of mixed and multiple origin. They admitted some lessening of discomfort but little effective relief.

In my injections experience I've found that in the majority of cases that even though a patient subjectively identifies a headache as on one side or the other--i.e. unilateral-- it is necessary to inject both the temples to achieve complete relief. I suspect a neurological croos over effect from the trigger points.

The trigger points are always symmetrucally bilateral on the patients, usually just into the hair line, and always at the same location for a given individual(Fig. 1);although the exact location may vary a bit from person to person. And the trigger points are almost always tender, if palpated, even when no attack is occuring. This the individual doesn't recognize until it's pointed out to him or her by palpation. Also mostly it hasn't been previously recognized by the patient as being a point of such painful intensity during an acute attack until it is touched by the therapist.

To find the points, have patient sitting with head extended back to a rest. With one-finger palpation feel repeatedly about the area till the point is touched. The patient's reaction to the painful stimulation is apparent and obvious. Insert the needle directly in, check for blood and inject completely. A pressure holding and slight massaging movement for a time facilitates spreading ingredients and prevents any possible hematoma formation. To miss the trigger point by a centimeter or more may be a cause of treatment failure. Also there may be more than one tender spot on the temple, but experience and patient reaction when touched will indicate the precise point which is more intense than any others.

The injection procedure is not markedly with discomfort to the patient. One subjectively feels kind of "crunching" as needle progresses through soft tissue to the cranial bone surface(but it's not felt by the therapist); "needle pain" is minimal, and relief is rapid after injection. And although the idea of a "shot in the head" carries some trepidation to many folk, most sufferers of any acute migraine attack will fairly readily submit with resignation but without anticipation of much relief until it has once been experienced. A first time patient when suffering may say, "You can do anything you want, Doctor, but it won't help much". A few moments later after treatment is applied that opnion is forever removed.

The rationale for use of the different components and their believed reactions are: the Lidocaine provides immediate local anesthesia of the neurological focus of pain onset; the corticosteroid relieves any local inflammation involved with the neurological stimulation; Sarapin supposedly having a long time anesthetic action on "C-fibers" only facilitates a prolonged relief of pain. Thus a given headache attack is quickly aborted and completely abolished.

Another interesting feature of this mode of treatment is that it will be successful for any frontal headache etiology. Frontal headaches due sinus engorgement, those associated with TMJ or acute otitis, those of apparent allergy origin, etc. will all respond with relief when the temple trigger points are injected! This suggests that although frontal headaches may be onset by different etiological states the mechanism of experiencing the head-ache discomfort is likely the same. Patients with URI and fever and headaches are also pleased to note that with relief of headache pain their earaches may also be stopped. I guess it's like: no matter what causes a COLD, a runny nose is a runny nose is a runny nose!

August 1995 C.X McCalla III, M.D P.O.Box 151 Paoli, IN 47454

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