25.10.2014

Neurology headache and pain relief center

An occipital nerve block is used to treat certain types of headaches by the injection of a steroid solution into the tissues around the occipital nerves located over the back of the head. Several injections will be made into the soft tissue on the back of the head just above the neck area using a very small needle. KCA Neurology is a full service neurology practice with two locations (Franklin and Clarksville, TN).
As someone who has managed his own migraines for years, Stanford headache expert Robert Cowan offers advice to those who experience chronic headaches.
Women who suffer from migraines may notice changes in their headache patterns when they're pregnant, experts say. Migraines and other forms of headache disorders can cause debilitating pain, disrupt lives and lead to large economic and societal costs.
Headache is the most common neurological disorder seen in neurology outpatient clinics and in an emergency setting.
Migraine is among the most common neurological disorders affecting humans, which is ranked 7th most disabling by the WHO.
The trigeminovascular system originates in the dense plexus of nociceptors which innervate the cranial vasculature and dura matter, the central projections of which travel via the trigeminal ganglion (TG) and synapse on second order neurons in the dorsal horn giving rise to the trigeminal cervical complex (TCC).
A combination of seminal preclinical and brain imaging studies have highlighted the importance of key pontine, brainstem and diencephalic structures involved in the pain neuroaxis in migraine.
The trigeminothalamic tract terminates in multiple thalamic nuclei, which are activated in migraine, SUNCT and cluster headache, and are involved in the parallel processing of nociceptive information, en route to cortical areas.4 Trigeminovascular activation in experimental models activates specific nuclei which have been shown to be possible sites of action for anti-migraine therapeutics including the triptans.
It is now widely accepted that disruption of normal pain modulatory tone plays a critical role in primary headaches (Figure 1 above). While we have not discussed the role of cortical spreading depression (CSD) here, we refer the reader to an excellent recent review15 and imaging data below regarding the occurrence of CSD like events in humans, thought to underlie the aura of migraine.
In a BOLD fMRI study signal intensities increased in the red nucleus, substantia nigra and occipital cortex when aura was triggered using a checker-board stimulus.10  The onset of headache or visual change was preceded by suppression of initial activation. The first PET study detailing regional activation during migraine without aura involved nine subjects scanned within six hours of onset of migraine. Brainstem activation was also demonstrated in a study of five subjects with spontaneous migraine.20 Two had typical migraine aura prior to the onset of the headache. The demonstration of key brainstem and diencephalic involvement in migraine and its experimental models, which form integral parts of the descending pain modulatory networks (Fig 1), highlights their critical role in primary headache disorders. Mia chose to focus her life on health care because she loved the challenge of the ever-evolving field of medicine. When she’s not working, she enjoys spending time with her family, running, watching sports and traveling.
A migraine is a vascular headache that occurs when blood vessels on the surface of the brain are irritated and swollen.
Although scientists have not identified a single cause of migraines, they continue to make key discoveries. While stress may be a trigger, a study in the journal Neurology suggests it’s the moments of relaxation following a particularly stressful time that increases onset.
Since migraine pain can be felt in the sinus area, it’s often misdiagnosed as a sinus or tension headache.
For example, the American Heart Association found that older migraine sufferers may also experience silent brain injury.
Excedrin, Advil, and Motrin—each available over-the-counter (OTC)—are recommended by the Food and Drug Administration to treat migraine pain.
Flex your green thumb.Feverfew is one of the oldest herbal remedies thought to mitigate migraines. Chronic migraine sufferers are defined as having as many as 15 headaches a month; eight of those are full-on migraines.
Some scientists are skeptical of the use of OTC drugs for chronic conditions, meaning natural pain relief methods may be even more important. Interestingly, BMJ also found that when patients take a passive role in their disorder, they don’t feel in control.
The bottom line: There are options for migraine sufferers that may include natural pain relievers. In addition, Dr Feldman participates in investigational clinical research in aspects of headache management, Alzheimera€™s disease, diabetic neuropathy, and multiple sclerosis. His professional interests lie in treating patients with complicated headaches, balance disorders, neuropathic pain, restless legs syndrome, memory loss.A  He has over 10 years of experience in treatment with Botox and electro-diagnostic and interventional treatment of pain. In his free time he enjoys skiing, fishing, picking mushrooms, playing tennis, and traveling.A  He is married. Svetlana is a Licensed Professional Counselor, National Certified Counselor, Psychotherapist, and founder of Oak Leaf Counseling. Svetlana holds two Masters degrees: a Master of Arts in Counseling (Diploma with Honors) from Regis University, Denver, CO and a Master of Science in Applied Math and Computer Science (Diploma with Honors) from National University of Radio Electronics, Kharkov, Ukraine.
Besides her academic education and degrees, Svetlana has studied in several spiritual and metaphysical schools and attended numerous trainings, seminars, and workshops. Svetlana has also spent numerous years in profound self-education, reading, researching, and learning about various philosophical, psychological, metaphysical, and spiritual subjects. In her practice Svetlana offers multiple relaxation and spiritual techniques, including meditations, contemplations, guided imageries, and visualizations to those patients who are open to such knowledge.
My professional background involves research and neuropsychological assessment of individuals with a variety of neurological impairments, including traumatic brain injury, strokes, and dementia.
I am proud to be part of the team working to improve the lives of patients with mild to moderate traumatic brain injury at Uptown Brain Injury and Pain Management.
We are driven by a sincere dedication to exemplary medical treatment.A We work together as a team to bring each patient the highest quality of care in a warm, friendly and professional environment.
We help people of the Denver Metro Area in the diagnosis and treatment of strokes, epilepsy, headaches, dementia, multiple sclerosis, Parkinson disease, and other neurological disorders. Lyme Disease Action: Striving for the prevention and treatment of Lyme disease and associated tick borne diseases. Immediately after an attached tick has been removed from the skin, the site of the bite will continue to be a little red, perhaps for a couple of days – this is not in itself an indication of Lyme disease.


This is an uncommon, bluish-red discolouration and swelling, on the surfaces of legs and arms, that develops several years after infection.
Giant cell arteritis (GCA) is a systemic necrotizing vasculitis characterized by inflammatory lesions of the arteries, primarily those that originate from the aortic arch.
Neuro-ophthalmic manifestations of GCA include vision loss, seen in over 80% of patients with GCA.
25-50% of patients with GCA-associated vision loss in one eye will become bilaterally blind if untreated. GCA can occur in family members, including pairs of twins, suggesting a genetic predisposition.
Clearly, either immune changes or environmental triggers associated with aging underlie the disease process. The inflammatory reaction in GCA is initiated by dendritic cells positioned at the border between the external elastic media and adventitia.
These lines of evidence suggest that bacterial antigens may be involved in the initial steps that lead to the development of GCA.
The diagnosis of GCA is based upon clinical signs and symptoms, laboratory data, and temporal artery biopsy.
Although there are risks to the procedure, including bleeding, infection, and facial nerve damage, the overall morbidity and mortality of temporal artery biopsy is small compared to the potential side effects of treatment.
As many as 58% of treated GCA patients suffer complications of treatment including fractures and infections.
This Interventional Pain clinic was recently accredited by the American Academy of Pain Management, meaning the pain-management clinic meets the academy’s standards of accountability and commitment to continuous quality improvement.
The clinic manages a variety of pain conditions and is staffed by four or more disciplines all operating in the same organization. Great River Pain Clinic is in the Center for Rehab and Clinics on Great River Medical Center’s campus in West Burlington, Iowa. Headache is associated with low mortality but high morbidity, largely affecting the working population.
Activation of these sensory afferents results in the release of a number of neuropeptides, in both humans and animals, which have actions on the cerebrovasculature and spinal cord. The hypothalamus has a critical role in the pain neuroaxis and a multitude of functions, which may underlie certain migraine premonitory symptoms. The authors postulate that hypothalamic and ventral tegmental involvement would explain yawning related to dopaminergic mechanisms; frequent urination and thirst may relate to reduced vasopressin and mood changes through hypothalamic connections with the limbic system. The spreading phenomenon did not cross prominent sulci and were restricted to the hemisphere corresponding to the aura.
Brainstem activation was revealed during the migraine and persisted after sumatriptan administration had relieved the pain.13  The resolution of the PET camera used was not high enough to identify specific nuclei, but the dorsal midbrain, which contains the dorsal raphe nucleus and PAG, was thought to be involved. Activation was seen in the dorsal pons and thalamus (Figure 3) but also in areas which form part of the pain matrix: right anterior cingulate, posterior cingulate, cerebellum, insula, prefrontal cortex and temporal lobes. They are ideally located to modulate the trigeminovascular system, cerebro-vasculature, cortical activity, and the integration of external stimuli. When these blood vessels are impaired and unable to pulsate properly, they send pain signals to the brain, says the National Headache Foundation (NHF). In the 2010 Global Burden of Disease Survey, migraines were listed as the seventh biggest disabler. In 2013, researchers from King’s College London discovered 12 genetic regions in or near the parts of the brain responsible for maintaining healthy brain tissue. Unfortunately, a misdiagnosis can steer attention away from other underlying health problems.
The injury involves a blood clot disrupting blood flow to the brain, which could lead to a future stroke. Per the NFH, these pills are most effective when taken as early as possible while pain is still mild.
According to the New York Headache Center, it contains an anti-inflammatory called parthenolide that helps to protect the blood vessels on the brain’s surface. According to a small study published in the Annals of Behavioral Medicine, migraine sufferers had fewer attacks following weekly massages. A study published in the International Journal of Preventative Medicine found yoga can improve vascular function in migraine sufferers.
Lavender, peppermint, and basil oil can help to relieve migraine pain, says Everyday Health.
During the Chinese technique of acupuncture, small needles are inserted at nerve points in a person’s in an effort to better their qi, or energy. It’s a common neurological disorder, says the NHF, and affects two percent of the population. Additional factors that may contribute to chronic migraines include major life changes, such as divorce and employment status, snoring, sleep disorders, psychiatric disease, frequent use of OTC migraine drugs, lower socioeconomic status, comorbid pain disorders, and history of head or neck injury, according to a study review published in the journal BMJ. But the brain is difficult to study, and information from one study may not be universally applicable to all migraine sufferers.
Since there are no special tests for migraines, a nerve and brain specialist may be able to help if routine examinations are inconclusive.
His daughter finished a medical school and is currently doing neurology residency at Colorado University. Among them are the School of Advanced Energy-Informational Development and Integrated Energy Therapy. These techniques are very powerful and effective tools for obtaining balance and harmony, getting a deep insight, understanding, and self-awareness as well as purification of body, mind, and spirit of an individual.
Her personal life experience, background, professional knowledge as well as significant knowledge of many European cultures, traditions, and history allowed her to relate better to her patientsa€™ needs offering her services in multiple languages with an appropriate multicultural touch.
All mentioned above helps Svetlana form a bond with her patients and offer a genuine, warm, and highly intuitive counseling and psychotherapy. The best known is a roughly circular red rash, without itching or pain, that slowly spreads outwards. It takes a chronically progressive course and finally leads to a widespread atrophy of the skin.
It is a bluish-red, solitary swelling, with a diameter of up to a few centimetres, most often seen on ear lobes or nipples.


In this video, Robert Cowan, MD, migraine researcher and director of our Headache Clinic, shares his insights on how to manage your migraines – a condition that he and the more than 10,000 patients he has cared for suffer from.
Yet medical attention and with it resources are instinctively driven towards the few with fatal outcome. The TCC has direct ascending connections with areas of the brainstem (locus coeruleus (LC) and periaqueductal grey (PAG)), thalamus and hypothalamus via the trigeminothalamic and trigeminohypothalamic tracts en route to cortical structures. The hypothalamus (and the associated A11 nuclei) has clear projections to the TCC and is activated during headache disorders6 and trigeminovascular stimulation. MRA has revealed an absence of extracranial artery dilatation during spontaneous migraine attacks in 19 subjects with unilateral headache.16 There was slight intracranial dilatation (10%) on the pain side but this was not altered by sumatriptan administration. Hypothalamic activation has been noted in only one previous study during migraine (within four hours of onset) although this study did not look at the premonitory phase specifically6. Brainstem activation was seen in the dorsal pons during the migraine state versus the pain-free state when comparing migraineurs to controls. Thus it is likely that dysregulation of these central nervous system networks underlie not just the migraine attack, but also the array of associated symptoms. Oxygen inhibits neuronal activation in the trigeminocervical complex after stimulation of trigeminal autonomic reflex, but not during direct dural activation of trigeminal afferents.
Migraine pathophysiology: Anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain.
A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate.
Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study. As a member of the Neurology & Pain Specialty Center, Mia focuses on general neurology specializing in neuromuscular disorders and epilepsy, specifically the use of VNS therapy. Migraines may be hereditary, too: 70 to 80 percent of sufferers say migraines run in their families. If it’s a migraine with aura, the sufferer may temporarily see spots or lose vision altogether, experience numbness, and have difficulty with speech before the actual pain kicks in. According to lead study author Richard Lipton, MD, the first six hours after a stress decline translated into a nearly five-fold increased risk of migraine onset. A small study in Neurology finds if a person is exposed to a trigger for months at a time without any effect, they may not have to avoid it. Similarly, researchers from Washington University’s School of Medicine found female migraine sufferers are nearly two times more likely to have cardiovascular disease. Aspartame, artificial sweeteners, and caffeine have also been problematic for migraine sufferers.
There are also at-home massage techniques that you can practice; try these from Women’s Health’s book for an awesome, DIY massage.
A whiff of peppermint oil can help control blood flow, and a whiff of basil oil can work to relax muscles. Acupuncture has been found as an effective way to prevent tension headaches and migraines, in addition to relieving back pain and indigestion. She has numerous certifications in the area of spirituality, energy work, and energy healing. She took several spiritual trips and journeys to different countries including India, Mexico, and Costa Rica. She deeply respects cultural sensitivity and importance of cultural heredity with her patients.
In 2013, ACNR published the first part of this Headache series addressing these very issues – Secondary Headache (Bahra) and at the other end of the spectrum, Chronic Daily Headache (Katsarava and Obermann), where the burden of economic disability lies. In addition to the ascending projections there is also a reflex connection from the TCC to the parasympathetic system via the superior salivatory nucleus (SuS) and sphenopalantine ganglion (SPG). Recently the hypothalamic orexinergic7 and dopaminergic8 pathways have gained attention for their role in trigeminovascular modulation and associated symptoms, with a dual orexin receptor antagonist currently undergoing phase 2 clinical trials. When each group was analysed separately to investigate laterality it was found that the dorsal pontine activation was ipsilateral in the right-sided and left-sided groups and bilateral in the bilateral headache group with a left-sided preponderance. This backs up previous research that associates reduced physical activity with an increase in migraines.
That may be related to the levels of the hormone cortisol: It increases during stress in order to combat pain levels.
News & World Report, alcohol—including red wine, beer, whiskey, and champagne—increases blood flow to the brain, and that in turn can cause a migraine. And, at the American Academy of Neurology’s 64th Annual Meeting in 2012, researchers presented a study that found female migraine sufferers were also at an increased risk for depression. Tyramine is found in alcohol and aged foods such and meats and cheeses, like brie, may be a trigger, as is  phenylethylamine, which shows up in soy foods, nuts, citrus fruits, and vinegar. It has been a profound spiritual experience and powerful self-educational curve leading her to immense personal growth and development. She also teaches at her School of Light, a school of advanced spiritual growth and development.
In 2014 the series will move on to look at the less common headache disorders, such as the Trigeminal Autonomic Cephalalgias, the prevalent but under-diagnosed Migraine with Vestibular aura, management of Headache in Pregnancy and Current Advances in Treatment options.
This connection results in cranial autonomic features, which are seen in approximately 30-40% of migraineurs, are diagnostic for cluster headache and, currently a target of neurostimulation and proposed action of oxygen,4 and efferent connections from the facial and cervical dermatomes (via cervical ganglia, CG). Key to insightful management is a progressive understanding of central nervous system mechanisms in generating headache disorders. In the current issue Phil Holland and Shazia Afridi explain the complexities of an inherently dysfunctional pain network as demonstrated from both pre-clincial and clinical studies.



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