Chronic Headache Specialists

Headache specialists are neurologists who have completed an additional year of training (called a fellowship) specifically in headache medicine and have been certified by the United Council for Neurologic Subspecialties. They stay up to date on headache research and new treatment options.

A headache specialist may be able to help if you:

• Have tried two or more headache medications that haven’t worked
• Have unusual symptoms with your headaches
• Want to know whether new treatment options could be right for you

Determining what type of headache you have is essential to finding the right treatment. There are many different types of headaches that are grouped as either primary or secondary. Headaches are considered chronic if you have at least 15 headache days a month for three or more months.

Primary headaches do not have any other known cause.

• Migraines are the most common type of primary headache and are more common in women. They can last from hours to days and are characterized by throbbing pain on one side or both sides of the head, nausea, and/or sensitivity to light, sound, or smells. Less commonly, you might see spots or wavy lines (auras).
• Tension headaches are dull, non-throbbing headaches that can last from hours to days.
• Trigeminal neuralgia can be caused by compression of the trigeminal nerve near the brain. These headaches cause severe shooting or electric-shock-like pain on one side of the face, lasting for seconds to minutes each time. They can happen many times a day and can be triggered by eating, talking, drinking, brushing your teeth, or washing your face.
• Cluster headaches are more common in men and are characterized by severe pain around one eye; they do not switch from one side to the other. They last for less than three hours and may happen several times a day. Months or years may pass between cluster headache attacks, but then they may occur daily for weeks.
• Rare headache disorders include very severe types of headaches -- such as paroxysmal hemicrania, idiopathic stabbing headache (can cause intense and jabbing head pain), and new daily persistent headache.

Secondary headaches have known causes that can range from mild (like sinus or allergy problems) to more serious (like blocked or narrowed blood vessels, a tumor, cerebrospinal fluid leak, or infection). Although rare, some can be severe and cause concerning symptoms like loss of consciousness, double vision, or stroke-like symptoms.

Patient History and Physical Exam
Before any testing, our headache specialists will spend time talking with you about your headaches -- when they started, how often you have them, what kind of pain you have and where, and how you have treated them in the past. In fact, it’s helpful if you can track your headaches with a headache diary before your appointment. Next, your doctor will perform a basic physical exam and may order current blood work to get a sense of your overall health.

Neurological Exam
A series of simple, in-office tests will help your doctor learn more about the function of your brain, nerves, eyes, facial expressions, muscular strength, and reflexes.

CT or MRI Scans
These scans create high-quality images of the brain and detect abnormalities. They may be recommended to rule out major causes of headaches, such as tumors, strokes, or multiple sclerosis. These tests take about 30 to 60 minutes and are virtually painless.

We offer a wide range of treatment options for headaches and migraines. Headache treatment is definitely not one-size-fits-all. It may take several tries to find the solution that works best for you. 

Preventive Headache Treatment 
Preventive options range from over-the-counter products like melatonin or B2 supplements for migraines to a variety of prescription medications. Monthly injections are a newer option. They target a protein thought to play a role in migraines. Botulinum toxin (Botox) injections are also FDA-approved for migraine prevention in people who meet certain criteria. 

Abortive Headache Treatment
Abortive treatment stops headaches from getting worse. In addition to prescription medications, other options include nerve blocks (numbing medication given through a shot into a specific part of the body), which can stop pain within minutes. Intravenous (IV) infusions of medication can be given over one or two hours, or periodically over several days. Also, oxygen therapy can stop cluster headaches within 15 minutes of onset.

Comprehensive, Expert Care
Providers at our headache clinic at Duke Neurology Morreene Road specialize in treating headaches, head pain, and face pain, which means they have a lot of experience dealing with these specific conditions. Our neurologists collaborate with and can refer you to experts in neurosurgery, psychology, and pain management to ensure you receive thorough care.

Easy Access
We have a dedicated phone line and email access for patients who need assistance with or have questions about medications, treatment plans, and medication authorizations with insurance companies.

Training the Next Generation
Our neurologists are experts in headache treatment and teach the next generation of headache specialists through our accredited fellowship training program.