Treatments & Procedures

The specialists at Houston Methodist offer a wide range of treatments for headache and migraine, from simple lifestyle changes to more advanced therapies depending on the severity of headache and how chronic is the condition.

Lifestyle and Dietary Counseling
Sometimes simple lifestyle or dietary changes are sufficient to reduce the frequency and severity of headaches and migraines. Our doctors work with patients to help them identify and eliminate specific triggers that tend to precede the onset of a headache or migraine. Some general recommendations might include the following:
  • Stay nourished and hydrated: Many people find that skipping meals or not drinking enough water tends to trigger headaches and migraines. Make sure to have plenty of water and healthy snacks available throughout the day.
  • Watch for food triggers: Some people with headaches and migraines notice they tend to be triggered by certain foods. Keeping a food diary can help identify possible culprits.
  • Exercise regularly: A daily exercise routine has been shown to be helpful in alleviating headaches and migraines; however, exercise that is too intense may actually trigger them. Aim for a moderate exertion level and be sure to stay hydrated before and after exercising.

Stress Management

Stress is the lifestyle factor most commonly linked to headaches and migraines. While it is impossible to eliminate stress completely, doctors may recommend some simple stress management techniques, such as the following:
  • Deep breathing and meditation
  • Calming physical practices such as yoga or tai chi
  • Massage therapy
  • Making time for hobbies or leisure activities
  • Avoiding stressful situations when possible

Medication Management

Some over-the-counter medications such as aspirin, naproxen, ibuprofen or acetaminophen can be effective to treat headaches and some migraines. For more severe migraines, the following prescription medications can provide relief:
  • Triptans, such as sumatriptan (Imitrex), constrict blood vessels and block pain pathways in the brain.
  • Ergots, such as dihydroergotamine (Migranal), also constrict the brain's blood vessels.
  • Medications with narcotics, such as codeine, may be effective for patients unable to take triptans or ergots.

 Our doctors work with each patient to prescribe a medication regimen customized to his or her specific diagnosis and symptoms.

Infusion Therapy
With infusion therapy, medications are administered intravenously. This approach is usually reserved for patients with severe cases of chronic headache or migraine who require more aggressive treatment. Infusion therapy is administered on an outpatient basis, usually involving several hours of infusion over three to four consecutive days.

Treatment with Botulinum Toxin (Botox®)
For patients suffering from chronic migraines, Botox® (botulinum toxin or onabotulinum toxin A) therapy may be an option for treatment. Botox is one of the many trade names for the neurotoxic protein that is produced by the bacterium Clostridium botulinum and is the only botulinum toxin approved by the U.S. Food and Drug Administration (FDA) for the prevention of chronic migraine in adults 18 years and older. 

Chronic migraine is defined as 15 or more headaches each month with a headache lasting 4 or more hours each day. Clinical studies have shown that chronic migraine patients treated with Botox average eight to nine fewer headache days per month compared with their original baseline. 

Botox works to relax the contraction of muscles by blocking nerve impulses. It is injected into the muscle using a fine needle to minimize discomfort and maximize accuracy. The procedure can be performed in a physician’s office, does not require anesthesia and typically takes only a few minutes to perform.

It is very important for patients to have an informed discussion with a practitioner experienced in the diagnosis and management of headaches before a decision to use Botox is made. A board-certified neurologist or pain-management specialist is the best physician to help decide whether Botox is appropriate. Our specialists are experienced in providing Botox therapy as a treatment option for adult patients 18 years and older suffering from chronic migraine.  

Patent Foramen Ovale (PFO) Assessment for Migraine Patients
Migraines are common in patients with patent foramen ovale (PFO), a condition involving a small hole in the wall between the two upper chambers of the heart (the atrial septum). The hole (the foramen ovale) develops naturally while a baby is in the womb and usually closes on its own at birth, but sometimes it fails to do so.

Because PFO is usually asymptomatic (shows no symptoms), patients with migraines may undergo an echocardiogram to check for this condition. If a PFO is found, the doctor may recommend a course of treatment involving medication and/or surgery.