Director: I. Khelemsky, M.D.
Diagnosis and management of migraines and other persistent headaches.
EEG, neurosonography, injections, counseling, and physical therapy are available on the premises.
Headache management includes:
Approximately 28 million Americans suffer from migraine headaches. This is approximately 12% of the entire population. Migraine headaches are most common among people 20-40 years old. Women are affected 3 times more often than men. Many researchers believe that migraine headaches occur in people who have a genetic predisposition to it. The most common symptoms of migraine headache include throbbing pain, usually on one side of the head, which nay be associated with nausea, increased sensitivity to light, noise or odors, preceded by visual disturbances ("aura"). For migraine headaches, so called "prodrome" is quite typical. This may consist of loss of appetite, paleness, generalized fatigue, dizziness, sensation of being warm or cold, craving for chocolate or other foods, prodrome precedes headaches by days or hours.
Diagnosis of migraine headaches involves complete medical and neurological evaluation. Frequently, we use brain MRI, encephalogram, other neurological testing to rule out other more serious conditions and make an accurate diagnosis.
Once a migraine diagnosis has been made, we implement a multiple modality approach depending on each individual case. Migraine is not a uniform disorder. There are different types of migraines, such as chronic daily headaches, status migranosus, and so on.
There are other conditions similar to migraines or which at least have a common mechanism, such as tension headaches and cluster headaches. Each of these entities has its own etiology, physiological and pathological mechanism, diagnostic approach and individual treatment.
In our facility, we widely use prophylactic migraine medications. This is a group of agents that is used prophylactically, on a daily basis, to prevent migraine headaches from occurring. These medications include ÃŸ-blockers, Tricyclics, Topamax, Depakote and others. Medications to abort an individual attack of headaches are non-steroidal anti-inflammatory medications, such as Advil or Tylenol, triptans, such as Imitrex or Relpax, Ergotamine, DHE, and occasionally narcotics. In addition to pharmacologic treatment, we widely utilise injections, such as IV magnesium infusions, Botox injections in the specific areas of the scalp, trigger point injections, occipital nerve blocks. For a select group of patients we order a course of physical therapy, an aerobic exercise program, a special diet, etc. The diet should not contain migraine-triggering foods: chocolate, red wine, or aged cheeses. We modify lifestyle, reducing stress and normalizing sleep.
We treat comorbidities that are frequently associated with migraines or other headaches: anxiety, depression, insomnia, generalized fatigue, caffeine or smoking dependency, analgesic dependency, obesity and many other. To improve compliance, we frequently monitor our patients by carrying out counseling sessions with the doctor, physician assistant or licensed physical therapist on a regular basis.
In most cases, patients receive complete relief or great improvement of their migraine headache symptoms and it takes much less effort to maintain the response in the future.
All Neurological Services, P.C.