Overview
Chronic headache disorders — including chronic migraine, cluster headache, occipital neuralgia, cervicogenic headache, and facial pain syndromes — affect tens of millions of Americans and can be profoundly disabling. When preventive medications, lifestyle modifications, and acute treatments provide insufficient relief, interventional pain medicine offers a range of targeted options that address the neural pathways driving these conditions. Dr. Migdale evaluates and treats headache disorders using procedures including nerve blocks, Botox for chronic migraine, peripheral nerve stimulation, and medical acupuncture — including Battlefield Acupuncture, in which she holds VA certification.
Types of Headache and Facial Pain Treated
Dr. Migdale treats a broad spectrum of headache and facial pain conditions including: chronic migraine (15 or more headache days per month); occipital neuralgia (nerve pain from the occipital nerves at the base of the skull, radiating over the scalp); cervicogenic headache (headache originating from the cervical spine); cluster headache; trigeminal neuralgia and other facial pain syndromes; and post-traumatic headache following head or neck injury.
Occipital Neuralgia
Occipital neuralgia is a condition in which the occipital nerves — which run from the top of the spinal cord through the scalp — become inflamed or irritated, producing stabbing, throbbing, or electric shock-like pain in the upper neck, back of the head, and behind the ears. It is often misdiagnosed as migraine. Greater and lesser occipital nerve blocks can provide dramatic, rapid relief and also serve as a diagnostic tool.
Interventional Options for Chronic Headache
Occipital nerve blocks are a highly effective and well-tolerated treatment for both occipital neuralgia and refractory migraine. For longer-term relief, pulsed radiofrequency or peripheral nerve stimulation of the occipital nerves can provide sustained benefit. Botox injections for chronic migraine are FDA-approved and highly effective. Medical acupuncture and Battlefield Acupuncture (auricular acupuncture) have strong evidence for headache management and are part of Dr. Migdale's integrative approach.