Headache Center at Puget Sound Neurology

Migraine & Headache Specialists in Tacoma, WA

As a Headache Center, our mission at Puget Sound Neurology is to empower you to take control of your headaches, so they no longer control you. We take a comprehensive approach to headache management, working together to find what works best for your particular condition. Instead of simply surviving with migraine, we want you to thrive!

Discover the comprehensive care available at the Integrative Headache Center, located at Puget Sound Neurology in Tacoma, WA. Our specialized center is dedicated to providing expert care for individuals suffering from debilitating headaches and migraines. Don’t let chronic headaches hold you back any longer—schedule your consultation today by calling (253) 284-4488. Trust our team at the Integrative Headache Center to provide the comprehensive care you need to find relief and regain control over your life.

We treat all forms of headache conditions including (but not limited to) Episodic and Chronic Migraine, Menstrual Headaches, Cluster Headaches, Post Traumatic Headaches, New Daily Persistent Headache, Tension-type headaches, and Trigeminal Neuralgia.

Headache Specialists

Samuel Urkov, DNP, FNP-C, AQH

Headache Specialist

My interest in headache medicine comes from a place of personal understanding, as I’ve experienced migraine attacks since I was young. This firsthand experience has given me a deep well of empathy for others who suffer from migraines and a strong desire to help those facing similar challenges.

Kelsi Tsukayama MSN, ARNP

Headache Specialist

I am dedicated to helping patients find lasting relief from headaches and migraine. My background in the ICU has given me a strong foundation in caring for patients with complex medical conditions while emphasizing compassion, education, and individualized care.

Treatments

Neurotoxin therapy is one of the core treatments we provide — not a side offering. Using purified neurotoxin injections (including Botox®, Dysport®, Xeomin®, Myobloc®, and Daxxify ®)

Botox works by temporarily relaxing the muscles responsible for much of the strain on the jaw joint.

Our approach includes:

Detailed Health History

Evaluation in our office will include a complete history, including all previous medications tried and currently being used, as well as a thorough neurological examination. Additional tests, such as radiological scans of the brain (including CT or MRI) are often included as part of the evaluation when necessary.

You should bring or have your doctor send old records, including previous head scans and all medications tried, for our review.

Trigger Identification and Management

Each person’s migraine condition is unique, so learning to identify your specific triggers is important to gaining control and reducing the disability caused by migraine. Common triggers include changes in hormones, changes in weather, stress, sleep, illness, neck pain, medication overuse and many more. We will encourage you to keep a migraine diary to gain a better understanding of what triggers your migraine. Certain foods, and chemicals in foods can also be migraine triggers. With the help of a registered dietician, we perform Chemical Sensitivity Testing (called MRT) to help you identify and eliminate your food triggers from your diet. Knowledge is power, so the more you understand your particular headaches, the better chance you have of conquering them.

Preventative therapies

If you have frequent, or chronic migraines, taking a preventative medication on a daily basis may be needed to raise your migraine threshold. These include:

Natural supplements: Including Magnesium, Riboflavin and Co-Q 10 (such as found in Ribo-Mag forte)
Seizure medications: Examples are Topiramate, Valproate, Zonisamide
Cardiac type medications: Examples are beta-blockers, calcium channel blockers and angiotensin receptor blockers
Anti-depressant medications: Examples include tricyclics and SSNI/SSRI combinations Depression and sleep disturbances are very common with migraine so these medications can help with migraine prevention as well as these issues. These medications can also be helpful in individuals without depression.
Anti-CGRP therapies: Examples are Ajovy, Emgality, Aimovig, and Vyepti. CGRP is a protein released in the brain that is now known to contribute to migraine symptoms and pain.

Abortive Therapies

Abortive treatments are used when you have an active headache on an as-needed basis. The goal of our clinic is to find the treatment plan to control your disorder, rather than cover it over with simple pain medications. Migraine specific abortive treatments include:

Triptans and Ditans: Examples are sumatriptan, naratriptan, rizatriptan, Reyvow among others. These medications, if taken early in the migraine, can help to turn off the inflammatory process in the brain before the migraine gets worse. Very often a person will not have a good response to one triptan or have side effects but have a miraculous benefit to another to get the person back into life.

NSAID: Examples are Naproxen or Diclofenac. These may be used in combination with other medications to treat the attack.

DHE: Examples Trudhesa, Migranal. These treat the vascular component of migraine.

CGRP antagonists: Ubrelvy and Nurtec. These directly target the protein CGRP, which plays a role in the migraine process.

The overuse of any of these medications can cause a new type of headache, called Medication Overuse Headache (MOH). MOH can transform the migraine disorder into a daily headache syndrome which will not respond to any treatment until the medication that is causing the headache cycle is stopped. We have methods of breaking that cycle and getting off these medications without excessive stress on the system or rebound headaches.

Procedures

We perform all common procedures for headache. Your provider will work to determine which is right for you. All procedures are performed in office, eliminating the need for pricey facility fees.

BOTOX injections: BOTOX can be used to prevent migraines in patients with chronic migraine. These injections are administered with a small needle, similar to what is used in acupuncture, to a patient’s head, neck and shoulders. The treatment is given every 3 months. It is safe, well tolerated and a good alternative to oral medications that may have intolerable side effects.
Peripheral Nerve Blocks: These procedures block the pain signals travelling along the peripheral nerves of the head (occipital and trigeminal nerves) or above the eyebrows (supraorbital and supratrochlear nerves). This can help provide relief during a migraine attack if other forms of treatment aren’t working or can help people with Chronic migraine as a bridge treatment to reduce the number of attacks while they are waiting for the long-term prevention treatment to begin working.

Non-medication Devices

In addition to medications and procedures, there are multiple non-invasive FDA approved devices that can assist with migraines. All of these devices work through a process called neuromodulation. Our providers will match you with the device that is best suited for you, if deemed appropriate. Examples include:

Cefaly: The Cefaly device electrically activates forehead nerves and creates a buzzing sensation. The signal goes into the rain turning headache pathways down slowly over time. This results in fewer headache days.

Nerivio (Remote electrical neuromodulation): Nerivio is approved for the acute treatment of migraine with or without aura. This prescription device is self- applied to the upper arm at the onset of migraine or aura and is controlled via a smartphone app. It works by stimulating small skin nerves to induce conditioned pain modulation (CPM) for a treatment lasting 45 minutes. Studies show similar results as many of the oral migraine medications without side effects.

Help with Breakthrough Headaches

To prevent unnecessary visits to the Emergency Room, we offer injections of medications used to treat severe headaches. We also offer phone and telehealth visits with your provider to provide you the relief you need in a timely fashion.

Lifestyle Alterations (Nutrition and Exercise)

What’s good for the body is good for the brain. We believe that the healthier your overall lifestyle habits, the better chance you have in controlling your migraine. We have a certified Exercise Physiologist and a Registered Dietician in office available to help you live your best life. These professionals can help you identify food triggers through chemical sensitivity testing and help you establish an exercise program that works for you. This is all part of our comprehensive approach to headache treatment.

Migraine and Headache Resources

The American Headache Society
The American Migraine Foundation
The National Headache Foundation
The International Headache Society
JAMA Archives of Neurology (Journal of the American Medical Association)

The Migraine Association of Canada
Migraine news and information provided by the Doctor’s Guide Website
The Migraine Action Association (formerly the British Migraine Association)
DiscoveryHealth.com
HealthlinkUSA

Schedule a Migraines & Headaches consultation in Tacoma, WA

At Puget Sound Neurology’s Integrative Headache Center in Tacoma, WA, our dedicated team of neurologists specializes in providing migraine & headache care for individuals suffering from chronic headaches and migraines. Through a comprehensive and integrative approach, we aim to address the underlying causes of your headaches and develop personalized treatment plans tailored to your unique needs. Experience the difference in headache care at our state-of-the-art facility. Schedule your consultation today by calling (253) 284-4488 and take the first step towards a headache-free life.