MIGRAINES + HEADACHES
A migraine headache can cause intense throbbing, or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.
A migraine headache can cause intense throbbing, or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.
Although much about the cause of migraines isn't understood, genetics and environmental factors seem to both play a role. Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway. Imbalances in brain chemicals, including serotonin- which helps travel to your brain's outer covering (meninges). The result is headache pain.
When to See a Pain Management Doctor
Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your pain mangement doctor about trying different migraine treatment including invasive procedures to relieve the pain or even undergo required surgery.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems: An abrupt, severe headache like a thunderclap. Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking. Headache after a head injury, especially if the headache gets worse. A chronic headache that is worse after coughing, exertion, straining
Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your pain mangement doctor about trying different migraine treatment including invasive procedures to relieve the pain or even undergo required surgery.
See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems: An abrupt, severe headache like a thunderclap. Headache with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or trouble speaking. Headache after a head injury, especially if the headache gets worse. A chronic headache that is worse after coughing, exertion, straining
Commonly Asked Questions
How can I make an appointment with one of your migraine specialists?
Prior to meeting with Dr. Elena Ocher and Dr. Kaveh Alizadeh, we have our patients fill out a detailed migraine questionnaire (provided below) to help determine if you are a surgical candidate and to help us create a treatment program specific for you.
Who is a good candidate for migraine surgical treatment?
New York Migraine Association Group surgeons will consider surgical treatment for migraine patients who respond well to injectable treatments. Injectable treatments are used to temporarily ‘freeze’ the muscles with migraine-causing nerve constriction helping to identify trigger sites. If trigger sites are successfully pinpointed, a patient may move forward with surgery to permanently release the compression of those muscles to provide long-term relief of symptoms.
How is the migraine surgery performed?
Migraine surgical solutions vary from patient to patient depending on the offending muscles identified through injectable treatment methods. The muscles that are most likely correlated with migraine headaches are the forehead, temple, back of head or deviated septum. In the case of forehead muscles, a small segment of facial muscle over the nerves is removed through small hidden incisions near hair bearing skin. This procedure will also smooth the forehead. In the case of temple muscles, the nerves are detached but not removed. In the back of the head, muscles that encapsulate the nerves may also be removed. When a deviated septum contributes to migraine pain, a septoplasty, or straightening of the septum, is performed along with removal of the turbinates in the nose.
What are the risks and side effects of migraine surgical treatment?
Although uncommon, some complications may include: discomfort, mild bruising and swelling. There can be a temporary hollowing of the temple, numbness in the forehead and scalp as well as infection and bleeding. Phlebitis may also occur causing a deep vein thrombosis or pulmonary embolus (a blood clot to the lungs). There may be a shift in brow appearance and movement and localized hair loss in the temporal areas. With septoplasty and turbinectomy, a dryness and a whistling sound from the nose can occur after surgery. Lastly, migraines may continue as there is no guarantee that a surgical treatment will be 100% effective.
Does insurance cover migraine treatment?
In some cases, insurance companies will cover injectable treatments for migraines such as Botox which was FDA approved in 2010 for the treatment of migraines. Migraine surgery may be covered by insurance. Our team of experts will help you through the insurance process. For more information please visit: newyorkmigraineassociation.com
Prior to meeting with Dr. Elena Ocher and Dr. Kaveh Alizadeh, we have our patients fill out a detailed migraine questionnaire (provided below) to help determine if you are a surgical candidate and to help us create a treatment program specific for you.
Who is a good candidate for migraine surgical treatment?
New York Migraine Association Group surgeons will consider surgical treatment for migraine patients who respond well to injectable treatments. Injectable treatments are used to temporarily ‘freeze’ the muscles with migraine-causing nerve constriction helping to identify trigger sites. If trigger sites are successfully pinpointed, a patient may move forward with surgery to permanently release the compression of those muscles to provide long-term relief of symptoms.
How is the migraine surgery performed?
Migraine surgical solutions vary from patient to patient depending on the offending muscles identified through injectable treatment methods. The muscles that are most likely correlated with migraine headaches are the forehead, temple, back of head or deviated septum. In the case of forehead muscles, a small segment of facial muscle over the nerves is removed through small hidden incisions near hair bearing skin. This procedure will also smooth the forehead. In the case of temple muscles, the nerves are detached but not removed. In the back of the head, muscles that encapsulate the nerves may also be removed. When a deviated septum contributes to migraine pain, a septoplasty, or straightening of the septum, is performed along with removal of the turbinates in the nose.
What are the risks and side effects of migraine surgical treatment?
Although uncommon, some complications may include: discomfort, mild bruising and swelling. There can be a temporary hollowing of the temple, numbness in the forehead and scalp as well as infection and bleeding. Phlebitis may also occur causing a deep vein thrombosis or pulmonary embolus (a blood clot to the lungs). There may be a shift in brow appearance and movement and localized hair loss in the temporal areas. With septoplasty and turbinectomy, a dryness and a whistling sound from the nose can occur after surgery. Lastly, migraines may continue as there is no guarantee that a surgical treatment will be 100% effective.
Does insurance cover migraine treatment?
In some cases, insurance companies will cover injectable treatments for migraines such as Botox which was FDA approved in 2010 for the treatment of migraines. Migraine surgery may be covered by insurance. Our team of experts will help you through the insurance process. For more information please visit: newyorkmigraineassociation.com
Migraine headache triggersWhatever the exact mechanism of the headaches, a number of things may trigger them. Common migraine triggers include:
Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women with known migraines. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen. Others have an increased tendency to develop migraines during pregnancy or menopause. Hormonal medications- such as oral contraceptives and hormone replacement therapy- also may worsen migraines, though some women find it's beneficial to take them. Food. Some migraines appear to be triggered by certain foods. Common offenders include alcohol, especially beer and red wine; aged cheeses; chocolate; aspartame; overuse of Stress. Stress at work or home can instigate migraines. Post-Traumatic Headache. Triggered by significant head trauma or injury to the head or neck. The accompanying muscle contraction and vascular changes compounded by emotional reactions may rise to a vascular headache that can pulsate. Sensory Stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells- including pleasant scents, such as perfume, and unpleasant odors, such as paint thinner and secondhand smoke- can also trigger migraines. Changes in wake-sleep pattern. Either missing sleep or getting too much sleep may serve as a trigger for migraines in some individuals, as can jet lag. Physical Factors. Intense physical exertion, including sexual activity, may provoke migraines. Changes in the environment. A change of weather or barometric pressure can prompt a migraine. Medications. Certain medications can aggravate migraines, especially oral contraceptives and vasodilators, such as nitroglycerin. |
SymptomsMigraine headaches often begin in childhood, adolescence or early adulthood. Migraines may progress through four stages- Prodrome, Aura, Attack and Postdrome- though you may not experience all the stages.
Prodrome. One or two days before migraine, you may notice subtle changes that may signify an oncoming migraine, including: - Hyperactivity, Irritability and Neck Stiffness. - Depression - Food Cravings - Constipation - Diarrhea Aura. Most people experience migraine headaches without aura. Auras are usually visual but can also be sensory, motor and verbal disturbances. Each of these symptoms typically begins gradually, builds up over several minutes, then commonly lasts for 10 to 30 minutes. Examples of aura include: -Visual phenomena, such as seeing various shapes, bright spots or flashes of lights. -Vision loss. -Pins and needles sensations in an arm or leg. -Speech or language problems. Less commonly, an aura may be associated with aphasia or limb weakness (hemiplegic migraine). Attack. When untreated, a migraine typically lasts from 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less frequently. During a migraine, you may experience some of the following symptoms: -Pain on one side of your head. Pain that has a pulsating, throbbing quality. -Sensitivity to light, sounds and sometimes smells. -Nausea and vomiting. -Blurred vision. -Diarrhea. -Lightheadedness, sometimes followed by fainting. Postdrome. The final phase- known as postdrome- occurs after a migraine attack, when you may feel drained and washed out, though some people report feeling mildly euphoric. |
MANHATTAN
1111 Park Ave., Suite 1G New York, NY 10128 Phone: 646-678-3676 Fax: 646-669-9953 BROOKLYN 7401 4th avenue Brooklyn, NY 11209 Phone: 718-836-6100 Fax: 718-836-6111 |
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