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12/19/19

Headache and migraine treatments

Right at the outset, we should be honest: what we don’t know about chronic headaches far exceeds what we do know. Classifications of headaches come and go, but one thing remains: nearly one in four households in the United States has at least one migraine sufferer. Migraine is more common than asthma and diabetes, combined!

There is no question that migraine is underdiagnosed and undertreated. 2 out of 3 migraine sufferers only receive care from their primary care physician. Only 16% of migraine sufferers see a specialist.

In my clinic, the first step in treating headache is to identify if there are neck spinal structures that cause the headache. These are very commonly overlooked, even by other headache specialists. Sometimes, identifying cervical spinal structures as sources of headache can lead to rapid and efficient treatment.

Once secondary causes for headaches are ruled out, primary chronic headaches such as tension headache and migraine can be treated with medication. There are many medications on the market, some aimed directly at headache treatment, some general pain medications. Again, I have to be honest here: we don’t really specialize in medication management – we think that sometimes the price to pay for taking pain medication for a long time is too high.

So, if not medication, or when medication fails, what can a migraine sufferer do?

I would like to tell you about 2 relatively new options we have used for the past 1-2 years with good success in treating even the most complicated of the chronic headache patients. The first is Botox. Most of you may be familiar with Botox being used for cosmetic procedures. In fact, Botox has been used for a long time to relax arm or leg muscles in patients who have had strokes or spinal cord injuries with chronic muscle contractures, called spasticity. We use Botox successfully for chronic migraines. Botox is injected in the muscles of the face, scalp, neck and shoulder girdles leading to muscle relaxation and peripheral nerve temporary inactivation. Botox injections are repeated 3 times per year when successful.

The second option for chronic headaches that have not responded to medication or Botox is peripheral nerve stimulation. The nerves of the scalp and the face represent the final pathway for generation and spread of migraines. These nerves can be stimulated by small leads implanted under the skin. When stimulated, these nerves cannot spread the migraine, which is subsequently aborted. Best of all, pain relief is achieved without pain medication and with virtually no risks. Also, these leads can be implanted and left in place as long as it’s necessary, without the need for continuous doctor visits, emergency room treatments, etc.

Please contact us and make an appointment to discuss your options for treatment of chronic headaches and migraines. Thank you!

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