Types of Headaches, Migraines & Facial Nerve Pain | MedStar Health

Headache, Migraines, and Facial Pain

At MedStar Health, our surgeons are experts in diagnosing and surgically treating various headache disorders, including:
  • Migraine headaches

  • Cluster headaches

  • Post traumatic headache conditions

  • Occipital neuralgia

The causes of such conditions can be very complex, and many patients spend years chasing treatments. Our surgeons receive additional training focusing specifically on nerves, to ensure that you receive the best possible care from top experts in the field, and often use treatments such as the following: 

  • Pharmacological: Patients often benefit from both a preventive and abortive medication treatment plan. A daily preventive medication will help make headaches less severe when they do occur. These include antidepressant, anti-seizure, and antihypertensive medications. An abortive medication is a single medication or a combination of medications that is taken during an attack. These include NSAIDS, triptans, ergotamines, antiemetics, and antipsychotics. 
  • Nerve blocks: In this procedure, anesthetic agents (a mixture of lidocaine and bupivacaine) are injected near the occipital nerve on the back of the head near the base of the skull. Most patients have no side effects; some patients experience pain at the injection site and/or dizziness. 
  • Botox: These injections are used primarily on patients who experience chronic daily headaches. 

Our Approach to Care

At MedStar Health, our surgeons are experts in diagnosing and surgically treating various headache disorders. When approaching migraine care, there are two categories of treatment: abortive and preventive. Abortive treatments are designed to stop migraine symptoms after they start, while preventive treatments aim to reduce the frequency or severity of migraines.

Typically, we try to treat migraines first with abortive treatments. Any abortive treatments we provide should be taken as soon as you notice migraine symptoms. If severe, frequent, and long-lasting migraines persist, we’ll look at preventive treatments.


 Abortive and preventive treatments for migraines at MedStar Health include:

Botox® therapy: Botulinum toxin injections can prevent the muscle contractions that lead to migraines. It’s generally reserved for patients with at least 14 headaches a month.

External nerve stimulation (CEFALY): An egg-sized device placed on the forehead stimulates the trigeminal nerve using precise micro-impulses, producing a sedative effect that can help relieve pain or reduce the frequency of migraines.

Medications: A variety of prescriptions, such as antidepressants, anti-seizure medications, and painkillers, can improve migraine symptoms.

Nerve blocks: Anesthetic agents are injected near the occipital nerve in the back of the head to reduce migraine pain.

Nerve decompression surgery: People with migraines who also have chronic daily headaches may benefit from surgery to reduce pressure on certain nerves. The area of the head where the surgery is performed depends on where your migraines are typically located.

Transcranial magnetic stimulation (TMS): A special device held against the back of the head delivers a magnetic pulse to reduce or stop migraine pain. It induces mild electrical currents in the brain that are thought to interrupt abnormal electrical activity caused by migraines.

Choosing MedStar Health

When you choose MedStar Health, you benefit by seeing a multidisciplinary team of providers who specialize in the diagnosis and treatment of patients with various headache disorders. We partner with our patients to create a safe and effective management plan. You can conveniently find our Headache Centers at various locations throughout Maryland and DC where you’ll have access to other medical specialties and advanced levels of care should you need it. 

Frequently asked questions

  • Does TMS hurt?

    To most patients, TMS feels like tapping on the skull and is not painful. You may feel uncomfortable with the tapping sensation and you may have mild head soreness during the first week of treatment.
  • Is surgery for migraines covered by insurance?

    More insurance providers are recognizing the benefits of migraine surgery. Your migraine surgery may be covered by insurance if it is deemed medically necessary. Please contact your insurance company to determine your coverage.
  • How should I prepare for migraine surgery?

    Before surgery, you may be asked to get blood tests and take or adjust medications. If you smoke, quitting will help you heal faster and avoid possible complications. You’ll also need to arrange for transportation to and from the hospital and for someone to stay with you the night you return home.

    For more information, visit Patient Resources or Preparing for Surgery.