Questions patients ask before the first visit.

A normal MRI rules out a mass or a stroke. It does not rule out a spinal fluid pressure problem, a venous outflow restriction, a CSF leak, or a dural fistula — several of those require MRV, venography, or an actual pressure measurement, and some are visible on a standard MRI only if someone is specifically looking for the signs. A normal report is a starting point, not an answer.

Most patients leave the first visit with an acute plan that works better than what they arrived with. Preventive medications are judged at 8 to 12 weeks. Botox is assessed after two cycles — roughly six months — because the second cycle is usually better than the first. If a pressure or flow problem is found and treated, improvement can be much faster.

For chronic migraine — 15 or more headache days a month — Botox has strong trial evidence and is FDA-approved. It is given as 31 small injections across the forehead, temples, back of the head, neck, and shoulders using the PREEMPT protocol, takes about 15 minutes, and needs no numbing or sedation. Most patients describe brief pinpricks. It is repeated every 12 weeks.

Often, yes. Two common reasons for apparent failure are an incomplete injection pattern and stopping after one cycle. Protocol compliance matters, and response typically improves on the second and third rounds. It is worth reviewing exactly what was injected, where, and how many times.

Most patients do not. It is considered when the history suggests a pressure problem — headache clearly worse lying down or standing, pulsatile whooshing in one ear, transient vision loss, papilledema, or a headache that began abruptly and never left. The workup may include an eye exam with visual fields, MRI/MRV, a lumbar puncture with opening-pressure measurement, or catheter venography with pressure gradients. Because the center is within an interventional neurology practice, the study and the treatment are planned and coordinated by the same practice.

Yes, and this is a specific focus of the practice. There are effective options at every stage — nerve blocks, magnesium, selected acute medications, and non-drug approaches — and we coordinate directly with your obstetrician, maternal-fetal medicine specialist, or reproductive endocrinologist.

It can be. Frequent use of triptans, butalbital, opioids, or combination analgesics can convert episodic headache into daily headache that no preventive will fix while the overuse continues. Withdrawal is managed with a bridge — in-office infusions, nerve blocks, sometimes a steroid taper — started at the same time as a preventive, so you are not left without anything.

Yes. Occipital and trigeminal branch blocks, sphenopalatine ganglion blocks, trigger point injections, Botox, and infusion protocols are all performed in the office, with no sedation and no hospital visit.

That is a large part of the practice. Bring your records, your imaging, and the list of what has been tried. We start by reviewing the diagnosis together, because a headache that has resisted many treatments is often a headache whose cause has not yet been identified.

Go immediately for a sudden severe headache that peaks within seconds, headache with fever and a stiff neck, new weakness or numbness, trouble speaking, loss of vision, or headache after a significant head injury. Call 911 rather than waiting for an appointment.