Our Headache Treatment Philosophy

With rare exceptions, we use non-addictive methods of pain treatment in the headache clinic. Using opiates and opioid therapies in your long-term migraine treatment plan puts you at risk for physical and psychological addiction. In addition, these medications can contribute to medication overuse headache, also known as "rebound" headache,  which can occur as frequently as every day in migraineurs.

When possible, we incorporate natural therapies into a patient's overall treatment plan that often includes the following:

Nutrition and Hydration Program

Trigger Avoidance

Exercise Plan

Weight Loss Plan (if needed)

Stress Reduction Program

Cognitive Behavioral Therapy

Relaxation Techniques

Vitamin Replacement

Massage or Physical Therapy


Medications to abort a headache or migraine are also important to take as early as possible in the headache cycle. If headaches are frequent or particularly debilitating, we plan ahead by utilizing preventive medications and other strategies. Sometimes, this includes procedures such as Botox, chronic migraine protocol, peripheral nerve blocks, or sphenopalatine ganglion blocks, as well.  

We measure success as improved quality of life through

  • Complete resolution of headaches if possible
  • Fewer headaches that are easier to treat
  • No hospitalizations/ER visits for headaches

Q. What is the difference between a regular headache and a migraine?

A. A migraine is different because it typically lasts for several hours or even days and can be accompanied by nausea, light and sound sensitivity, and blurry vision. Individuals often try to find a dark, quiet place to lie down to get relief. Sleep can make a migraine better. Not infrequently, migraines can be preceded by 30 minutes of visual changes called "aura." Medications for migraine work best when taken very early in the migraine cycle, as soon as you recognize the headache as a migraine.

Q. What is the best way to understand my migraine triggers?
A.  The easiest way to understand your triggers is to keep a migraine diary. After a migraine, document the foods (especially processed foods), the amount of hydration, activities, and any stressors that led up to that event. Document sleep patterns and alcohol intake. Over time, you may begin to see a pattern. Be sure to keep track of any correlation with your menstrual cycle if you are a woman.

Q. Are there proven natural preventive migraine therapies?

A.  Yes! There is excellent data to support using  B2 (riboflavin), low dose magnesium, feverfew, and coenzyme Q10 for migraine prevention.

Q. Are there ways to increase B2 in my diet?

A. B2 is found in milk, cheese, yogurt, and leafy green vegetables. Taking a B2 supplement is also generally safe. However, be careful not to take a "B complex supplement." Large amounts of B6 can be toxic to nerves and cause a painful peripheral neuropathy that is sometimes irreversible.

Q. When should I consider Botox for my migraines?

A.  Botox is an FDA approved therapy for chronic migraine, migraines occurring 15 days or more per month, lasting at least 4 hours daily.  We inject Botox into seven muscle groups (31 injections) every three months to reduce the number of headache days monthly and ask patients to keep a migraine and headache diary to be sure the medication is working well. In the headache clinic, our experience has been that this therapy works best for individuals who also have some component of posterior head and chronic neck pain.

Q. Are there any new therapies coming for migraine?

A. Yes! The anti-CGRP (calcitonin gene related peptide) therapies are here! CGRP is thought to be an important factor in the inflammatory cascade that causes pain transmission for migraineurs. These therapies are changing how we treat migraine in 2018!

FAQ about Migraine