Outpatient Evaluation: 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, a licensed fellow will conduct your interview and document your detailed and comprehensive medical history. Patients will also have the opportunity to receive a psychological evaluation and meet with a licensed psychologist associated with the center. Patients with severe headaches often must cope with unusual amounts of stress, depression, and anxiety. Therefore, the evaluation is a key component to the proper diagnosis, treatment, and management of headache. (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). You will then be seen by one of our physicians, who will conduct your comprehensive headache evaluation, which combines your interview, psychological evaluation and the physician's exam to develop a treatment and management plan specifically for you.
Inpatient Evaluation: 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 team approach to treatment. Your treatment team includes your attending physician, the nurse coordinator, a neurology fellow, a psychologist, and the unit nurses. Other team members may include a physical therapist, dietitian, and medical students. These professionals work together to ensure that you receive comprehensive treatment according to your care needs.
Biobehavioral Treatments: "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 when practiced correctly and can make medication work more effectively. Some approaches can be learned and practiced on your own (relaxation practice and stress management) and some such as "biofeedback" and CBT can be taught by a professional (doctor, physical therapist, occupational therapist, social worker or other experienced allied health professional.
Biofeedback is a process where you learn to control the stress in your body through 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, end a headache, or reduce the pain of a headache that has already started. You should find a licensed professional with biofeedback equipment and training in biofeedback for headache. The equipment is usually used with a computer. Physiological functions like your rate of breathing and heart rate will be displayed on a computer monitor, similar to a video game. Training typically requires between four to six sessions, and patients must practice the techniques outside of sessions as well. Techniques learned through the biofeedback can help you avoid a headache attack or manage the pain once it starts.
*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) Treatments: Botulinum toxin is a novel therapy for the treatment of pain. 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 looking into the efficacy of this treatment for these conditions.
Trigger Point Injections: Trigger point injections (TPI) are used to treat extremely painful areas of muscle. A trigger point is a "knot" or tight band of muscle that forms when a 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 felt in another parts of the body (i.e. neck, back, or temple areas of head). TPI are used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment. Trigger point injections are helpful in trating headaches by relaxing the muscles that may cotnribue to pain. At the Montefiore Headache Center, we concentrate on muscles in the neck, shoulders, and upper back, as we find that these muscles can contribue significantly to certain types of headache.
Occipital Nerve Blocks: Occipital nerve blocks are injections that involve an anti-inflammatory medication with a local anesthetic for patients that suffer from occipital headaches. Occipital headaches are observed at the distribution of the greater occipital nerve and are usually located in the back of the head. These injections can be performed in the clinic, and the patient, after a few minutes of observation, can return to their daily routine afterwards.