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21 Jul 2011

Chronic Daily Headache - Surgery or Other options
Thank you for taking the time to read my question.

Seven months ago I (very, very foolishly and to my eternal regret) took a BZP-based, so-called ''party pill''. 1-Benzylpiperazine (BZP) has a peripheral sympathomimetic action and a complex central action, On top of a central and probably peripheral amphetamine-like action, BZP is thought to be an agonist of the 5-HT2B receptor. Mild ''hangover'' headaches are certainly reported in the limited literature on this drug, but nothing more. I briefly developed a severe headache that night, which passed. A few days later, however, I began to experience an unremitting, tension/pressure-headache that is bilateral, non-pulstating, and ever-present. A dull, constant ache. There is pronounced tenderness on palpitation at the occipital region of my skull. Seven months later this headache is still there: unremitting, chronic pain. It can vary in intensity but never goes away. One must conclude it was induced by the BZP.

I am a 35-year old man with no history of headaches and am otherwise healthy. An MRI showed no structural abnormalities. Greater occipital nerve blocks were performed but had absolutely no effect.

My neurologist has diagnosed a migraine-type headache and, as is standard, recommended that all OTC medication cease (I was not taking too many in any case). He is, again as protocol dictates, moving through the standard array of prophylactics. None of the preventers have worked, and my doctor tells me that, seven months on, I have intractable migraine that is unlikely to respond to any treatment.

I have heard about surgery for headache (nerve decompression being one type). Given my rather atypical symptoms, would I be a candidate for same? Is surgery even an appropriate avenue to explore? My doctor claims that surgery should not even be considered.

Thank you again for your time and efforts. It is much appreciated.

Answer 738 views
Headache expert
Headache expert

01 Jan 0001

Dear Bill,

There are different surgical procedures available, and some of them are effective while others are not. It depends on the source of your pain – for your doctor to say that surgery should not even be considered demonstrates appalling ignorance. You are welcome to e-mail me on for more information on the surgical options available. To get to the root of the problem, you need what is called a “multidisciplinary assessment”, which should include a neurological examination to rule out any serious underlying condition. There are so many different structures in the head and neck, all of which can be involved in the headache process, that no single specialist can have all the knowledge necessary to make a comprehensive assessment and diagnosis. For instance, a neurologist will examine the brain and nervous system, a physiotherapist will look at the muscles, a dentist will examine the teeth etc. For this reason, the “multidisciplinary assessment” combines and integrates the expertise of different specialists who would normally treat headache patients in isolation, into a single more comprehensive body of knowledge. This enables the different members of the team to provide a co-ordinated treatment plan, so that all the contributing factors are addressed.

This assessment must include a thorough examination of the head and neck muscles to determine the presence of abnormal tension, and of the external carotid vasculature to determine whether there is an arterial element to the pain.

Headache sufferers often have a poor Quality of Life due to the constant pain and associated symptoms. For a free assessment of how your headaches are affecting your Quality of Life, click on

This information has been supplied and checked by the multidisciplinary team of specialists at The Headache Clinic, in association with The International Headache Society and the South African Institute of Headache and Migraine Science. For consultation with these specialists, call The Headache Clinic (Cape Town, Durban, Johannesburg) on 0861 678 911.
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