Integrative 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!
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.
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.
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 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.
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.
- Sphenopalatine Ganglion Block (SPG block): The SPG is a group of nerve cells linked to the trigeminal nerve, the main nerve involved in headache. We use two different devices, the TX360 and Sphenocath to deliver numbing medications to block or partially block the SPG, which can be helpful in reducing head and facial pain.
- 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.
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 same day 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
- National Migraine Association MAGNUM (Migraine Awareness Group: A National Understanding for Migraineurs)
- The International Headache Society
- JAMA Archives of Neurology (Journal of the American Medical Association)