Migraine

Migraine is more than a bad headache. Attacks can bring throbbing pain, light or sound sensitivity, nausea, and days that get rearranged around the next flare.

What it feels like

Pain is often one-sided or shifts sides, with a pulsing or pounding quality. Some people feel it across the whole head.

Light, sound, smell, or movement can make it worse. Nausea is common. Aura (visual changes, tingling, or speech trouble) happens for some, not everyone.

Episodes may last hours to a few days. Between attacks, many people feel fine. When attacks stack up month after month, we start talking about chronic migraine.

What is going on

Migraine is a brain and nerve-processing condition. Sensory pathways become hypersensitive, and blood vessels and pain networks join the cascade.

Episodic migraine means fewer headache days each month. Chronic migraine usually means 15 or more headache days a month for more than three months, with migraine features on at least eight of those days.

Neck tightness can ride along with migraine, and sometimes a cervicogenic or occipital pattern overlaps. Sorting that out changes which treatments we reach for first.

How we evaluate

We map attack frequency, severity, triggers, aura, and what you have already tried for acute and preventive care.

A focused neurologic and cervical exam looks for red flags and for neck or occipital findings that might be feeding the picture.

Imaging is not routine for classic migraine. We order it when the story is atypical, new and severe, or when exam findings push us there.

What we may offer

Medication management comes first for most people: a clear acute plan for attacks, and prevention when attacks are frequent, long, or keep cutting into work and family life.

For chronic migraine, onabotulinumtoxinA (Botox) can be part of prevention when the day-count and migraine features fit, and after we have worked through an appropriate medication plan. The PREEMPT trials showed fewer headache days versus placebo in that setting.

An occipital nerve block may help selected patterns with occipital tenderness or mixed headache features. If the neck facets seem to drive a cervicogenic overlap, we may discuss medial branch blocks. Coordinated physical therapy helps when posture and neck mechanics keep priming attacks.

We do not use regenerative injectables such as BMAC as a migraine treatment.

What is the difference between episodic and chronic migraine?

Episodic migraine means fewer headache days each month. Chronic migraine usually means 15 or more headache days a month for more than three months, with migraine features on at least eight of those days.

When does Botox make sense?

We consider Botox when chronic migraine criteria are met and prevention is needed after appropriate medication options. It is not a first step for occasional episodic attacks.

Can my neck be part of my migraine?

Yes. Neck muscle load, occipital nerves, or cervical facets can overlap with migraine. We examine for that so treatment is not one-size-fits-all.

References

Short list of sources behind the clinical framing on this page.

Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1-211. Used for migraine features and the chronic migraine day-count framework.
Dodick DW, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-936. Core evidence for Botox in chronic migraine prevention.
Bendtsen L, et al. Guideline on the use of onabotulinumtoxinA in chronic migraine: a consensus statement from the European Headache Federation. J Headache Pain. 2018;19(1):91. Practical framing for when Botox fits after other prevention options.