FAQs

Why should I use a headache clinic?

• To get a specific diagnosis or to confirm diagnosis. Some will also want to know if there are potential causes or triggers to their headaches.
• For headaches that are frequent or not responding to treatment.
• For headaches that are interfering with one's life or activities.
• If you feel that are you taking too many prescribed or over-the-counter medications.

A headache clinic is not for everyone.  If you have a new type or a change in your headache, then this may be an emergency situation and a visit to the emergency department is warranted. Other signs that you may be having a life threatening emergency or a serious medical condition may be headache associated with:

• Fever
• Stiff neck
• Changes in mental status
• Weakness or numbness
• Malaise
• Difficulty speaking, difficulty for others to understand
• Changes in blood pressure or pulse
• New headaches over the age of 50 years old
• To get the right diagnosis.  Headache is, without question, one of the most common symptoms that neurologists evaluate. Not surprisingly, there are over 300 different headache types. Understanding headache and associated symptoms are essential for achieving the correct diagnosis and prescribing the correct treatment plan.

If I know my diagnosis would I still benefit from the Headache Clinic?

Yes. New advances and treatment options are frequently in development. For example, Botox has recently been approved by the F.D.A. for the treatment of chronic migraine.

Are there any other treatments available for headaches? What kind of treatments will help?

Acute treatments are taken when a headache is experienced. Patients may also take preventative medications. Preventatives are taken on a daily basis and reduce the frequency and intensity of attacks. Some patients will also benefit from nerve blocks, trigger point injections, and other procedures. Some individuals will also be helped with biofeedback, physical therapy, and intravenous medications. 

What are some other advantages of a Headache Clinic?

The Middletown Medical Headache Clinic offers patients several advantages.  If needed, our facility offers the services of an in-house MRI and CT scan machine.  We also work in conjunction with several physicians, including those specializing in pain management, rheumatology, pulmonologist, cardiologist, and ophthalmologist. 

Certain individuals with frequent headaches often have potential triggers that are making headaches more frequent.  By focusing on these triggers, one can potentially decrease the frequency and the burden of the headaches.  For example, untreated chronic neck pain and jaw pain can make headaches more frequent and unresponsive to treatments. 

What are some examples of preventative medications?

Preventatives are medications that are taken daily or injected every 3 months in order to prevent headaches from occurring. Preventatives also decreased the intensity of each headache attack and may make headaches easier to treat.  None of the current preventative medications available were originally designed with headaches in mind. They were developed for the treatment of high blood pressure, anxiety, depression, seizures, and other conditions.  Preventative medications are not meant to be taken life-long. Usually, patients can be weaned off preventative medications after headaches have improved. However, some patients will require long-term treatment with preventative medications.   

What are nerve blocks?

Many patients report that their headaches start or are located in the neck region or base of the skull. The occipital nerves typically reside in that area. Some patients also have pain in the frontal regions and in the temples where the auriculotemporal and supraorbital/supratrochlear nerves are located. These nerves serve as a gateway to the parts of the brain where headache pain starts and are generated.

Nerve blocks may stop the flow of pain and relieve the pain. Nerve blocks are usually done with a local anesthetic. Sometimes steroids are used. There can be some pain during needle insertion and during the infusion of the medications. Pain relief can be felt within 15 minutes and may last several hours to several days. Sometimes relief can last several weeks. Nerve blocks can be especially helpful for those patients who are using medications very frequently and for those whose medications are not working. Side effects are rare but exist and will be discussed prior to the procedure [we need to insert a link here to some educational material on nerve blocks – from the American Headache Society Patient Education]. Some will experience dizziness or lightheadeness after the procedures. Other side effects are possible. Please discuss them with your physician. In addition, caution should be used if steroids are used repetitively.

Nerve blocks do not require any preparation. We advise patients not to use makeup. Patients can usually resume their activities afterwards. We only require that patients do not drive after the procedure.  Nerve blocks can be often repeated depending on your response. 

Remember, your doctor cannot predict with confidence whether the nerve blocks will be effective.