Our headache treatments fall into two groups. The first group stops an attack in one visit: IV migraine therapy, high-flow oxygen and the no-needle sphenopalatine ganglion block. The second group treats headache that keeps coming back: occipital, C1-C2, trigeminal and stellate ganglion blocks.
EVERY INJECTION
Placed under ultrasound or fluoroscopic guidance
Not an upgrade and not on request — the default. Guidance is why a block reaches its target. It is why a block is safe around the vessels of the head and neck. And it is why a block that doesn’t relieve your pain is trustworthy diagnostic information rather than a possible miss.
Below is what we can do in a single visit to stop an attack that is happening now. After that come the targeted procedures for headache that keeps coming back. Which one fits depends on the headache, not on preference.
How do you stop a headache attack that is happening now?
IV migraine therapy
This is for a migraine attack that has not responded to oral medication, or one where vomiting makes swallowing anything pointless. You get hydration plus an anti-nausea medicine, magnesium and an anti-inflammatory. All of it is given intravenously (into a vein), so absorption is not a variable.
Oxygen therapy
High-flow oxygen through a non-rebreather mask is a first-line abortive for cluster headache. An abortive is a treatment that stops an attack. It is one of the few treatments in headache medicine that is both highly effective and essentially free of side effects. We also offer hyperbaric oxygen. The evidence base for that is narrower, and we say so on the page.
Sphenopalatine ganglion block
The sphenopalatine ganglion sits just behind the nasal cavity. It carries much of the autonomic signaling that produces the watering eye and blocked nose of a cluster attack. Anesthetic is applied through the nostril. No needle, no sedation.
What treats a headache that keeps coming back?
Occipital nerve block
Local anesthetic is placed where the greater and lesser occipital nerves come out at the base of the skull. The strongest fit is occipital neuralgia and cervicogenic headache (headache that comes from the neck). It is also used as an add-on in cluster bouts. It is ultrasound guided, because the occipital artery runs with the nerve.
Atlanto-axial (C1–C2) injection
The joint at the very top of the neck is a recognized and frequently missed source of cervicogenic headache. It is missed because it sits above the levels that most cervical imaging and most injections address. The injection is performed under fluoroscopy (live X-ray) with contrast confirmation — never blind.
Trigeminal nerve block
The trigeminal nerve is the sensory supply to the face. It is also the pathway through which migraine and cluster headache generate pain. Which branch is blocked depends on where the pain actually is.
Stellate ganglion block
This is a block of the cervical sympathetic chain in the neck. It is used for cluster headache, sympathetically maintained facial pain and upper-limb complex regional pain syndrome. It is ultrasound guided — the target sits among the carotid, the jugular and the vertebral artery.
When should you go to the ER instead?
Go to an emergency department or call 911 instead of coming here if you have any of these. A headache that reached maximum intensity within seconds. A headache with fever or a stiff neck. Any weakness, numbness, trouble speaking, vision loss or confusion. Or a headache following a head injury.
Frequently asked questions
What is the best treatment for a severe headache?
It depends on the headache, not on preference. A migraine that oral medication has not broken responds to IV migraine therapy. Cluster headache has high-flow oxygen as a first-line abortive. Some headache keeps coming back from a nerve or joint in the upper neck. That headache is treated with a targeted block, such as an occipital nerve block or a C1-C2 injection.
How are cluster headaches treated here?
High-flow oxygen through a non-rebreather mask is a first-line abortive for cluster headache. It is essentially free of side effects. A sphenopalatine ganglion block targets the relay behind the watering eye and blocked nose of an attack. An occipital nerve block is used as an add-on during a cluster bout. A stellate ganglion block is another option.
Are headache injections done with image guidance?
Yes, every injection. Ultrasound or fluoroscopic guidance is the default, not an upgrade and not on request. Guidance is why a block reaches its target. It is why a block is safe around the blood vessels of the head and neck. And it is why a block that does not relieve your pain still gives trustworthy information about where the pain is coming from.
Is there a headache treatment without a needle?
Yes. For a sphenopalatine ganglion block, anesthetic is applied through the nostril. It goes to a nerve bundle just behind the nasal cavity, with no needle and no sedation. High-flow oxygen for cluster headache is also needle-free. IV migraine therapy needs an IV line. The nerve and joint blocks are injections placed under guidance.
Booking online shows our scheduled openings. Call or text for hours that are not listed. Please contact us before coming in rather than arriving unannounced — we need to know what is happening to have the right treatment ready.
A note on coverage, and on timing. Same-day treatment and prior authorization do not run on the same clock. Many insurers take days to weeks to decide. Some acute headache treatments are not covered at all. Your headache will not wait for that process.
We will verify your benefits. Where a treatment needs prior authorization, we will attempt to obtain it. An authorization confirms that a service meets criteria for review — it is not a guarantee of payment. No clinic can make that promise on your insurer’s behalf. Sometimes a treatment is unlikely to be covered, or it cannot be certified in time to treat you today. If so, we will tell you before we treat rather than after, so the decision is yours. Payment is due at the time of service.