Headache & Migraine Care

Common conditions treated at the Lahey Headache Center include:

• Migraine headache – Severe head pain on one or both sides of the head often accompanied by nausea, vomiting, sensitivity to light or sound, and sometimes heralded by neurological symptoms such as disturbed vision or a tingling sensation in your body
• Cervicogenic headache – Headaches triggered by neck pain or degenerative disease of the cervical spine
• Whiplash injury – Chronic headaches and neck pain caused by sudden neck strain, sometimes the result of accidents
• Occipital and other neuralgias – Sharp pain often shooting up from the neck, around your head and sometimes behind the eye, caused by irritation of scalp nerves
• Cluster headache – Intense, piercing pain on one side of the head associated with eye tearing/swelling or a stuffy nose
• Tension-type headache – Like a rubber band or vise-grip around your head often associated with muscle tension and stress
• Trigeminal neuralgia – Severe pain attacks on one side of the face caused by irritation or compression of the trigeminal nerve
• Spinal fluid (CSF) leak – this can happen after a lumbar puncture, an accident or spontaneously, and it causes severe headaches typically in the sitting or standing position. Often neuroradiology and interventional radiology colleagues are involved in diagnosis and treatment.

Headache, neck and facial pain belong to the most common and most disabling diseases worldwide, and successful treatment has many challenges. Sometimes lifestyle changes and identifying pain triggers can be a helpful first step.

A wide variety of medications for both the prevention of headaches as well as the acute treatment is available, but has to be chosen based on a patients preference, other medical conditions and potential side effects.

More recently, the availability of so called CGRP antagonists, which can be administered orally (as a self administered monthly injection or as an infusion every three months) has significantly increased the treatment options especially for migraine headaches.

Interventional Treatment Options

Interventional treatments can often be used in combination with or instead of pharmacological treatments, especially for patients who experience side effects, are worried about interaction with other medications or have an incomplete response to medications.

Interventional treatments offered at Lahey include these procedures:

• Botulinum toxin (Botox) – An FDA-approved prevention treatment for chronic migraines. Injections of small amounts of botulinum toxin around the head and neck every three months can results in significant reduction of headache frequency and intensity.
• Nerve blocks – Injections of local anesthetic can block the nerve causing or contributing to your pain.
• Trigger point injections – A procedure in which a local anesthetic is injected into tight muscles to break up muscle spasms in the neck and provide pain relief
• X-ray-guided neck injections/cervical facet blocks – The use of X-ray imaging in an OR setting helps us to precisely guide an injection to nerves and joints in your cervical spine. This helps us understand where your pain is coming from, but also helps treat some types of headache and neck pain.
• Radiofrequency ablation – Once we have identified a specific pain source in your neck using targeted nerve blocks, we can “heat shock” these nerves under X-ray guidance to provide longer-lasting pain relief.
• Trigeminal nerve block – X-ray guided injections of the trigeminal nerve to help treat trigeminal neuralgia and other facial pain
• Sphenopalatine ganglion block (SPG) – Injection of a nerve structure (ganglion), which can contribute to some headache types, using either a catheter through your nose or an X-ray-guided injection
• Blood patch – X-ray-guided injection in the lower back to stop spinal fluid (CSF) leakage, which can cause severe positional headaches
• Occipital nerve stimulation (ONS), peripheral nerve stimulation (PNS) – An outpatient procedure for the most refractory cases, where a small programmable, electric lead is inserted over the affected nerve to disrupt or modify pain signals