FAQs on Migraine Headache Treatment in Philadelphia

Migraine headaches are intense, throbbing pain of one or both side of the head. With this medical condition, the person often has association visual symptoms, nausea/vomiting, and sensitivity to sound and light.

When do migraine headaches occur?

The patient can experience migraines at any time of the day, but they often begin in the morning. The pain associated with migraine headaches can last anywhere from a few hours to days. Migraine headaches threaten overall health, and often interfere with daily life.

Who has migraine headaches?

Migraine is more common among women, people ages 15 to 55 years, and those who have a family history of these types of headaches. With age, migraine episodes become less frequent and less severe.

How common are migraines?

Migraine headaches affect approximately 29.5 million people in the United States. This is one of the most common types of disabling headache, and it often sends patients to the emergency room.

What is the cause of migraine headaches?

Experts do not fully understand what causes migraines. However, many researchers believe that these headaches are the result of abnormal changes in substances produced in the brain. When the levels of certain chemicals increase, it results in inflammation, which causes blood vessels to swell and press on nerves of the brain.

What brings on a migraine headache?

Certain substances, events, and situations that bring on a migraine headache are called triggers. These include: bright lights, loud noises, strong odors, missing means, lack of sleep, hormone changes, stress, anxiety, alcohol, caffeine, foods with nitrates (lunch meats and hot dogs), and weather changes.

What are the symptoms of migraines?

Migraine with aura is also called classic migraine. Aura is visual disturbances and other symptoms that occur 15-30 minutes before the onset of pain. This involves numbness or tingling of the hands and/or face, seeing zigzag lines, blind spots, and flashing lights, a disturbed sense of taste, smell, or touch, and feeling mentally sluggish.

How are migraine headaches treated?

The pain management specialist may use a combination of treatment approaches. These include:

  • Sphenopalatine ganglion block – This procedure involve inserting a small catheter through the nostril to reach the sphenopalatine ganglion nerves (located at the base of the brain and back of throat). Once the catheter is in place, the doctor injects a long-acting anesthetic onto the nerves, which blocks pain signals. In a study of 22 patients, this procedure offered significant pain relief for patients, which lasted for more than 30 days.
  • Medications – The first therapy for migraine headaches is abortive agents, like Maxalt of Imitrex. Preventive medicines include tricyclic antidepressants (nortriptyline and amitriptyline). These drugs affect levels of serotonin and other brain chemicals. In addition, serotonin norepinephrine reuptake inhibitors are used, such as vanlafaxine. Anti-seizure medicines are used also, such as topiramate.
  • Occipital nerve block (ONB) – This block is used to relieve pain at the posterior region of the head. A long-acting anesthetic is injected into the scalp near the occipital nerves. Clinical studies show that ONB reduces 50% or more pain intensity and frequency.
  • Botox – Botulinum toxin A is used to prevent migraine headaches by paralyzing and blocking acetylcholine release from nerve cells. The injections are given in the forehead and temples, as well as the upper neck region. According to one clinical study, these injections reduced the severity and intensity of migraine pain.
  • Radiofrequency denervation – The doctor may use radiofrequency energy to destroy a portion of the nerve root located at the top of the neck (cervical spine). The needle and probe are inserted to the site using x-ray guidance. Based on studies, this procedure is 75% effective.


Lee, JB, Park, JY, Park, J, Lim DJ, et al. (2007). Clinical efficacy of radiofrequency cervical zygapophyseal neurotomy in patients with chronic cervicogenic headache. J Korean Med Sci, 22(2), 326-239. doi:  10.3346/jkms.2007.22.2.326

Palmisani, S, Al-Kaisy, A, Arcioni, R et al. (2013). A six year retrospective review of occipital nerve stimulation practice – controversies and challenges of an emerging technique for treating refractory headache syndromes. The Journal of Headache and Pain, 14 (67). doi:10.1186/1129-2377-14-67.

Siberstein, S, Mathew, N, Saper, J, & Jenkins, S (2000). Botulinum toxin type A as a migraine preventive treatment. BOTOX Migraine Clinical Research Group. Headache, 40(6), 445-450.

Varghese BT & Koshy RC (2001). Endoscopic transnasal neurolytic sphenopalatine ganglion block for head and neck cancer pain. J Laryngol Otology, 115(5):385-7.