headache

The NeuroCenter has been in the forefront of treatment and research of headaches for many years. The NeuroCenter’s founder and head neurologist, Dr. José L. Medina, has published extensively in the area of headache treatment.

Headaches are a biochemical disorder, in other words, they are produced by chemical reactions in the body. A clear understanding of the nature of the headaches and its trigger factors results in the successful treatment of these headaches.

When a person has a headache, several areas of the head can hurt, including a network of nerves that extends over the scalp and certain nerves in the face, mouth, and throat. The muscles of the head and the blood vessels found along the surface and at the base of the brain are also sensitive to pain because they contain delicate nerve fibers. The ends of these pain-sensitive nerves, called nociceptors, can be stimulated by stress, muscular tension, dilated blood vessels, and other headache triggers. The bones of the skull and the tissues of the brain itself never hurt because they lack pain-sensitive nerve fibers.

Vascular headaches (migraines are a kind of vascular headache) are thought to involve abnormal function of the brain's blood vessels or vascular system; muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles. Traction and inflammatory headaches are symptoms of other disorders, ranging from brain tumor to stroke to sinus infection. Some types of headaches are signals of more serious disorders. Headaches that are associated with convulsions, confusion or loss of consciousness need to be taken very seriously and treated by a physician.

Our physician will obtain a full medical history and may order a blood test to screen for thyroid disease and anemia. MRIs and blood tests may be recommended. An eye exam is usually performed to check for weakness in the eye muscle or unequal pupil size. Some scientists believe that fatigue, glaring or flickering lights, the weather, and certain foods may trigger migraine headaches.

Our specialized headache neurologist put together a comprehensive management plan according to each patient’s unique needs to eliminate headaches.

We understand that chronic headaches may give rise to anxiety, frustration and, sometimes, depression. It is important to take the time to get to know the patient and understand how your pain is affecting your life.

We specialize in headaches that are difficult to treat, but if your headaches are easy, we can help too! Here are some case studies exemplifying how we diagnose and treat headaches. Please click on CASE STUDY.

Migraine

It is a moderate to severe headache that it is intermittent, lasts 4-72 hours, and is throbbing in quality. Migraines usually occur on one side and shift from side to side during different attacks. Those who suffer from migraines experience nausea and become sensitive to lights and noise.

The mechanism of a migraine involves chemical substances such as serotonin, increased stickiness of blood platelets, alterations in cerebral blood flow and increased irritability of the nerve cells in the brain.

The migraine condition is frequently inherited. However, trauma, use of birth control pills or estrogen for postmenopausal changes may create a migraine condition even if there is not an inherited predisposition. These “artificial migraines” may be temporary and disappear in a few months or can become permanent.

Many environmental factors trigger migraine attacks. Some of these triggers include stress, dietary factors, hormones, weather changes, certain medications, sleep abnormalities, fumes and many other factors can bring on the migraine attack.

During a migraine attack, the patient may experience other symptoms such as seeing flashing lights, losing part of their vision, numbness or weakness on one side or double vision.

It is very important that migraines are diagnosed and treated by a physician since other conditions such as brain tumors, congenital malformation of blood vessels in the brain (arterio-venous malformations), or inflammation of blood vessels in the brain (vasculitis) may mimic migraine symptoms.

The most important part of migraine treatment is its prevention. Many things can cause changes in serotonin levels. You may be taking medication that is causing you to suffer from migraines. If prevention is unsuccessful or migraines are so infrequent that no preventative medication is needed, symptomatic treatment of the headache can be accomplished with the use of triptan medications.

Intractable Headaches

Intractable headaches are those headaches that are unresponsive to the standard medications and therapies utilized in the treatment of headaches. These are the patients who require special care and customized management. A thorough knowledge of headaches, neurology, and borderland areas of medicine must be applied to theses headaches to reach a happy and sometimes almost miraculous end.

To read two example of the how we helped patients with these very difficult headaches, please click on CASE STUDY.

Cluster Headaches

A cluster headache is excruciating, strictly one-sided, localized mainly in the eye and temple, lasting 15-180 minutes and occurring 1-8 times a day usually during a period of few weeks. The headaches, during each period, are usually on the same side. These periods may occur once or twice a year and sometimes may not return in several years. At times, these headaches may start to occur more frequently and become daily and chronic.

In contrast to migraines, which occur more frequently in women, cluster headaches occur more often in men but a small percentage of women also have this type of headache. Sometimes both migraine and cluster headaches may be present in the same patient.

Tension Type Headache

Tension type headaches occur on both sides of the head and range from mild to moderate in severity. They usually have a pressure-like quality. When they occur sporadically, they are considered the typical occasional headache that most people experience during their lifetime. However when the headache occurs everyday, week after week, month after month and sometimes, year after year, it is called chronic tension headache. A patient with chronic tension headaches is usually a patient who has also experienced migraines for some time and for various reasons, the headache has changed from a intermittent headache that occurred few times a month to a daily, chronic headache (transformed migraine.) A number of factors including depression, trauma, analgesic abuse, drug abuse, certain medications and increased prolactin hormone can cause this transformation. Treatment of tension type headaches is similar to that of migraines.

Cervicogenic Headaches

Some headaches originate in your neck as a result of osteoarthritic changes, disc problems and mechanical changes. These things may cause pain that radiates to the back of the head and often behind the ears. These headaches are unilateral or bilateral and most of the time worsens with the movements of the neck. Some of these headaches have a vascular component– the blood vessels in the area contribute to the headaches behaving similarly to migraine.

Sinus Headache

Although inflammation of sinuses can cause headaches, most “sinus headaches” are actually migraines or tension headaches.

Ocular Headaches

These uncommon headaches are characterized by localized pain in the eye due to eye abnormalities or visual strain.

Cranial Neuralgia (Facial Pain)

Cranial Neuralgia is described by those who suffer from it as a sharp, piercing pain located in the upper or lower part of the face or both. It lasts seconds or minutes and is brought on by eating, speaking or touching certain areas of the face. They are practically always on one side and in between attacks, the individual is totally free of any pain in the area or it remains only a very mild, dull ache. This facial pain is due to the irritation of the nerve.