Articles
Plain-language articles on migraine, cluster headache, medication-overuse headache, nerve blocks and prevention — each written from the primary literature and the ICHD-3 diagnostic criteria rather than summarized from other websites.
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When a headache actually needs a scan
Most headaches do not need imaging, and that is the guideline position rather than a shortcut. The features that do warrant a scan, the three types people never think to mention, and what a normal MRI does and does not rule out.
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Greater and lesser occipital nerve: the anatomy that decides the injection
Which nerve is carrying your pain determines where the needle goes, and the two supply different parts of the head. A plain-language map of the greater, lesser and third occipital nerves, and why the occipital artery changes the technique.
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Can an occipital nerve block make a headache worse?
A headache in the days after the injection is common enough to be worth expecting. What is normal, what a steroid flare looks like, and the small number of patterns that mean you should call rather than wait.
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Steroid or anesthetic: what actually goes into an occipital nerve block
People often assume the steroid is the active ingredient. The randomized evidence points the other way — the local anesthetic is doing the work, and adding a steroid has not reliably improved outcomes in migraine.
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Occipital nerve block: side effects and risks
What the randomized trials found about adverse events, what is expected rather than a complication, the rare serious risks worth knowing, and why the occipital artery is the reason image guidance matters.
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How long does an occipital nerve block last?
The anesthetic wears off in hours, but relief often lasts weeks — longer than the pharmacology explains. What the trials measured, what a short response means, and why there is no fixed schedule.
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Supraorbital neuralgia after an injury to the eyebrow
A blow to the brow can trap or damage the supraorbital nerve and leave a one-sided forehead headache behind for years. The diagnostic triad, why it is mistaken for migraine and sinus headache, and why the nerve block is both the test and the treatment.
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TMJ as a missed cause of headache
Jaw and chewing-muscle problems are among the most commonly missed contributors to headache, and the most easily checked. What temporomandibular disorder is, why a normal joint X-ray does not rule it out, and how often it is found when headaches become frequent.
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Same-day headache treatment in St. Louis: what to expect
What actually happens when you contact Headache Express mid-attack — how the visit runs, what we can do in one appointment, and when we will send you to an emergency department instead.
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Magnesium, riboflavin and vitamin D for migraine: what the evidence supports
Three inexpensive supplements have a longer track record in migraine than most. None is dramatic, all take weeks to months, and vitamin D is worth measuring rather than assuming.
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Sleep and migraine: why regularity beats duration
The intervention with the best evidence is not more sleep — it is more regular sleep. A consistent wake time held on weekends does more than an extra hour on a Sunday.
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The SPG block explained: a nerve block with no needle
The sphenopalatine ganglion sits just behind the nasal cavity, so it can be reached topically through the nostril. No needle, no sedation, about fifteen minutes.
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What to expect from an occipital nerve block
It takes seconds, needs no sedation, and you drive yourself home. Scalp numbness afterwards is expected. Relief often outlasts the anesthetic by weeks.
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Headache red flags: when to go to the emergency room
A headache that peaks within seconds, one with fever and a stiff neck, or one with any neurological change needs emergency assessment — not an outpatient headache clinic.
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Why image guidance matters for headache injections
A block placed by landmarks alone goes where anatomy usually is. Ultrasound and fluoroscopy make it accurate, safer around the vessels of the head and neck, and — critically — make a negative result trustworthy.
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Do nerve blocks for headache actually work?
For cluster headache the randomized evidence is reasonable: a meta-analysis found 50% of patients pain-free at one month after a greater occipital nerve block. For other headaches the case is more mixed — and diagnostic.
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When a migraine will not break: what IV therapy does
Migraine slows gastric emptying, so a tablet taken hours into an attack may never be absorbed. Intravenous treatment removes absorption from the equation.
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Chronic or episodic migraine? Why 15 days is the line
Chronic migraine means headache on 15 or more days a month for over three months, with at least eight days having migraine features. The threshold changes which treatments are available to you.
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Botox for chronic migraine: who it is for and what to expect
Botox is evidenced for chronic migraine — 15 or more headache days a month — not episodic. The PREEMPT protocol is 155 units across 31 fixed sites every 12 weeks, and the benefit builds over cycles.
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Cluster headache and the years it takes to get diagnosed
A 2025 meta-analysis of eleven studies put the average delay to a cluster headache diagnosis at 10.4 years. Knowing the three features that identify it is how you shorten that.