The comprehensive services offered at the Headache Center include education about headache disorders, the identification of headache triggers, and the development of a headache treatment plan for managing the headache problem.
At your first appointment, our headache specialists will ask about your headache history and symptoms, focusing on the frequency, intensity, duration, location, and any known triggers. Your doctor also conducts a comprehensive review of your medical history and family history of headache and performs a physical exam to obtain a complete picture of your health. To help the doctor make a more accurate diagnosis, bring to your appointment past medical records, including imaging scans and reports, and any lab studies you might have had.
Depending on your symptoms and the results of your medical examination, your physician may recommend further diagnostic testing. Your doctor may use one or more of the following tests to arrive at the most accurate diagnosis.
A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. Your doctor may also assess the function of the nerves connected to the brainstem—the cranial nerves—by testing for sensation in the face, checking your hearing and eye movements, asking you to swallow or say “ahh,” and observing your ability to move your head, neck, and shoulders.
Your doctor may test your vision and look for any signs of increased pressure in your head. Your reflexes may also be checked to see whether the headaches are caused by a rarer problem, such as a brain tumor or blood clot in the brain, or to rule out the possibility that another condition may be causing your symptoms.
These tests are used to determine other medical conditions — including diabetes, thyroid problems and infections — that can cause headaches.
X-rays and computers are used to produce images of a cross-section of the body. A CT scan of the head might be recommended if you are getting daily or almost daily headaches to help rule out other causes of headaches.
MRI uses magnetic waves and computers to create two- or three-dimensional images. Your doctor may order an MRI scan if you are getting daily or almost daily headaches to view the inside of the head and neck. This can reveal the presence of other conditions that can cause headaches, such as a tumor or abscess, which is a collection of pus that has formed in response to an infection. Sometimes, MRI scans of the neck are used to identify problems with the cervical spine—the bones in the neck—that may be triggering headaches.
An eye pressure test performed by an eye doctor (ophthalmologist) can help rule out glaucoma or pressure on the optic nerve as causes of headaches.
We believe in a comprehensive approach to headache pain. This means we utilize any and every resource in a concrete, long-term plan for treating your condition and symptoms. Rather than combatting your pain with just one method, we combine strategies in order to maximize effectiveness. Our multidisciplinary approach can include a wide range of treatments, such as:
Behavioral therapy such as biofeedback, cognitive behavioral therapy, relaxation training and stress management can be as effective as medication in the treatment of headaches. They can also make medication work more effectively.
With this treatment approach, patients learn how to manage stress by focusing on their heart rate, blood pressure, circulation, muscle tension and breathing to avoid headaches and reduce headache pain. Some approaches such as relaxation practice and stress management can be learned and practiced independently. Others, including biofeedback and cognitive behavioral therapy, require assistance from trained professionals—including doctors, physical therapists, occupational therapists, social workers or other experienced allied health professionals.
Behavioral therapy treatments are especially important for patients who cannot take certain medications, like pregnant women or women who want to become pregnant.
Botox injections are performed by our trained clinicians and is an approved therapy for the treatment of chronic migraine.
Many people with primary headaches—those not caused by an underlying health condition—can control their symptoms with medication. Our experts at the Headache Center can develop a personalized medication plan to address and prevent headache attacks.
Medication prescribed for headaches may be preventive (taken on a daily basis to decrease the frequency of headaches), acute (taken only during the onset of a headache attack to shorten the attack by relieving the pain and associated symptoms) or intravenous (IV medications given if acute headaches fail to respond to oral medication).
Nerve blocks help temporarily stop the pain of an acute headache attack or break an ongoing cycle of pain. They are best used in the treatment of severe cluster headaches or chronic migraines, among other types of headaches. It is often recommended when other medications do not relieve symptoms.
This quick, outpatient procedure works by targeting several nerves that are involved in the production of headache pain. Your doctor injects small amounts of numbing medicine into the area around the affected nerve to block pain signals. Pain will be relieved within minutes and the benefits can last days to weeks.
Nerve blocks are performed on an as-needed basis. Your doctor can determine whether this is an appropriate treatment for your symptoms.
A trigger point is a tight band of muscle, or knot, that occurs when the muscle fails to relax. It develops as a result of injury, inflammation or trauma to the muscle. The trigger point can irritate the surrounding nerves, causing pain and tenderness not only in the affected muscle, but also in other parts of the body, including the head. Trigger points can be found in patients suffering from migraine, tension, post-traumatic and other headache disorders, and may cause or worsen headache pain.
This quick, outpatient procedure works by injecting a local anesthetic (possibly mixed with a corticosteroid) into the area of the muscle where the trigger point has formed. The injection renders the trigger point inactive, returning the muscle to its relaxed state, alleviating pain and providing long-term relief. Several trigger points may be treated in a single visit.