Services and Treatments
We offer our patients the tools and support to manage their headaches successfully and permanently. Our services include drug therapy (including both acute and preventive medications), biofeedback, cognitive behavioral therapy, and lifestyle modifications to help people identify and avoid triggers. We also offer Botox injections as treatment for migraines.
Outpatient Evaluation and Treatment
At the Montefiore Headache Center, we are dedicated to a comprehensive approach to diagnosing and treating patients with headache. During your initial visit to our clinic, you will then be seen by one of our neurologist physicians and a neurology medical fellow, who will conduct your comprehensive headache evaluation, which combines your interview, and the physician's exam to develop a treatment and management plan specifically for you.
Patients will also have the opportunity to receive a psychological evaluation and meet with the clinical health psychologist on staff if they and their physician choose to do so. Patients with severe headaches are often faced with stress, depression, and anxiety. Therefore, a psychological evaluation, support, and treatment may be a key component of your care. You may also choose to work with the psychologist if you are not able to take medications for any reason, for example, if you are trying to become or are already pregnant.
If you are a new patient and will be attending your first visit at the Montefiore Headache Center in the coming weeks, please see the directions for your first visit.
Inpatient Evaluation and Treatment
The goal of inpatient treatment is to stop your headache cycle. To do this, you will be given intravenous medications along with continuous IV fluids. You will also receive a low-caffeine diet. We use a multidisciplinary team approach to treatment. Your treatment team includes your attending physician, the nurse coordinator, a neurology fellow, the clinical health psychologist, and the unit nurses. Other team members may include a physical therapist, dietitian, and medical residents and students. These professionals work together to ensure that you receive comprehensive treatment according to your care needs.
"Biobehavioral treatment" refers to biofeedback, cognitive behavioral therapy (CBT), relaxation training, and stress management. Research has shown that these techniques can be as effective as medication and can make medication work more effectively when practiced correctly. These techniques are especially important for patients who can not take certain medications such as women who are pregnant or want to become pregnant. Some approaches can be learned and practiced on your own (e.g., relaxation practice and stress management) and some such as "biofeedback" and CBT are taught by our psychologist.
Biofeedback is a process where you learn to control the stress any activation in your body (i.e., the sympathetic nervous system) by controlling functions as your heart rate, blood pressure, circulation, muscle tension, and breathing. By learning to control these functions you can help avoid having a headache or reduce the pain of a headache that has already started. During the sessions, physiological functions like your rate of breathing and heart rate will be displayed on a computer monitor. Training typically requires between four to six sessions, and patients must practice techniques outside of sessions as well. Sessions may be covered by your insurance under your mental health benefits. We also offer low cost or free services through the Ferkauf Graduate School of Psychology at The Max and Celia Parnes Family Psychological and Psychoeducational Services Clinic.
To learn more about biofeedback click on the link below to download further reading.
"What is Biofeedback?" —National Institute of Mental Health article
Botulinum toxin (Botox)
Botulinum toxin is a novel therapy for the treatment of various pain disorders. More investigations need to be completed to prove efficacy in treating conditions such as migraine, tension-type headache, and temporomandibular disorders. The Montefiore Headache Center is currently conducting clinical trials examining the efficacy of this treatment for these conditions. You may be eligible to participate in this study.
Trigger Point Injections
A trigger point injection (TPI) is used to treat extremely painful areas of muscle. Normal muscles contract and relax when used. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily when touched. The trigger point can trap or irritate surrounding nerves and cause referred pain (which is pain that is felt in another parts of the body such as the neck, back, or temple areas of head). TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method.
Occipital Nerve Blocks
Occipital headaches are usually located in the back of the head. Occipital nerve blocks are injections that involve using an anti-inflammatory medication with a local anesthetic. These injections can be performed in the clinic, and the patient, after a few minutes of observation, can return to their daily routine afterwards.