Acute and Chronic Headaches/Migraine

Diagnosing headaches begins with a review of your medical history and a conversation about your symptoms. Headache symptoms vary depending on your diagnosis. In some cases, patients have visual changes or more severe symptoms caused by light, sound or certain foods. Learn more. 

Next, we conduct a physical exam to determine the type of headaches you are experiencing and how to treat them. There are two major types of headaches:

• Primary headaches include cluster headaches, migraines and tension headaches. These are caused by triggers such as stress, diet or allergies. In the case of migraine headaches, there can be a genetic link.  
• Secondary headaches are a symptom of an underlying medical condition, such as sinusitis or more serious conditions such as stroke, aneurysm, a sudden blood pressure spike, blood sugar issues or a brain tumor.  

Your doctor may order a variety of tests to better understand your symptoms and eliminate underlying causes of headaches. Testing can include: 

• CT or MRI 
• Lumbar puncture (spinal tap) 
• Blood tests  
• Neurological tests

Always seek emergency care if you have a severe headache that gets worse over a few days, or if pain occurs in combination with other serious symptoms, such as: 

• A sudden, very severe burst of pain with no known cause (thunderclap headache) 
• Difficulty speaking, seeing or moving  
• Fever, nausea or vomiting, neck stiffness, confusion, seizures, fainting spells, numbness  
• Head injury 

The specialists at Houston Methodist offer a wide range of treatments for headaches and migraines, customized to your unique symptoms.

When it comes to headaches and migraines, what works for one person may not work for another. Our board-certified neurologists and pain-management specialists can help you decide what treatment combinations might work best for you. 

Lifestyle and Dietary Counseling – Our headache experts work with you to identify and eliminate specific triggers that can lead to headaches or migraines. General recommendations include eating a nourishing diet, getting moderate exercise and drinking plenty of water.  

Stress Management – Stress is the lifestyle factor most linked to headaches and migraines. While it’s impossible to eliminate stress completely, we can recommend simple techniques, such as: 

• Avoiding stressful situations when possible 
• Calming physical practices, such as yoga or tai chi 
• Deep breathing and meditation 
• Making time for hobbies or leisure activities 
• Massage therapy

Medication – Some over-the-counter medications like aspirin, naproxen, ibuprofen or acetaminophen can treat mild to moderate symptoms. For severe migraines, certain prescription medications can provide relief, including:

• Ergots, such as dihydroergotamine (Migranal), which constrict blood vessels and block pain pathways in the brain 
• Narcotics, such as codeine, can help reduce pain and improve sleep 
• Triptans, such as sumatriptan (Imitrex), which also control blood flow and pain pathways in the brain

Infusion Therapy – Powerful medications given through an IV can reduce severe headache or migraine pain. Infusion therapy is administered on an outpatient basis, usually involving several hours of infusion over three to four days. 

Botulinum Toxin (Botox®) Injections – For people suffering from chronic migraines, Botox® (botulinum toxin or onabotulinum toxin A) therapy can relax the contraction of muscles by blocking nerve impulses. It is injected using a fine needle to minimize discomfort and maximize accuracy. The procedure can be performed in a doctor’s office, does not require anesthesia and typically takes only a few minutes. 

For severe cases that do not respond to other therapies, we offer advanced surgical treatment options including:

• Brain surgery for underlying conditions  
• Neurostimulation devices and procedures  
• Patent foramen ovale (PFO) assessment  
• Personalized medication combinations