At the Headache Clinic of San Antonio, we provide the following services:
Botox is a preventive treatment, which means it prevents headaches and migraines before they even start. The medication is injected into the muscles of the head and neck. Botox prevents on average 8 to 9 headache days and migraines. Although Botox induces muscle relaxation, it also blocks pain in ways that are not completely understood. The procedure takes about ten to twenty minutes, and only minor pain typically occurs. The advantage of Botox is that it has fewer side effects than other medications. Also, it is a good alternative for patients who have tried multiple preventative medications without relief.
The occiptal nerve is located in the back of the head behind the ear and provides sensory innervation to this head area. Many migraine patients suffer from posterior head and neck pain. Occipital nerve blocks can offer almost immediate relief. The procedure involves injecting an anesthetic medication under the skin, which overlies the occipital nerve. The relief gained from an occipital nerve block, however, is unpredictable and may last for weeks in some patients and only hours in others.
Medications including oral and injectables
Treatment for many patients is not only to stop headache pain as soon as it occurs, but to prevent headaches from occurring. General speaking, if patients have four headaches per month, or if their headaches interfere with work or school, they are candidates for preventive medications, or “prophylaxis.” The three most commonly used categories of preventive medications are certain blood pressure medications, antidepressant medications, and antiepileptic medications. There are no medications in use for headache prevention originally invented for this purpose. As these medications were used for other causes, however, their anti-headache properties were discovered. A specific medication is tailored to the individual patient’s needs and tolerance to side effects.
Calcitonin gene-related peptides (CGRPs) are the first drugs to specifically target migraine, as opposed to previous “migraine” medications that were actually formulated to treat other conditions, such as high blood pressure or depression. CGRPs might also be useful to those with cluster headaches or post-traumatic headaches. These medications are administered monthly or quarterly via subcutaneous injection.