Migraine & Headache Care in Syracuse, NY — CNY Neurological Consulting

Understanding Migraine

Migraine is more than a headache. It is a neurological condition that can cause moderate to severe head pain — typically throbbing or pulsating, often on one side — along with nausea, vomiting, and sensitivity to light and sound. Episodes can last from a few hours to several days.

Migraine is classified as episodic when attacks occur fewer than 15 days per month, and chronic when headache is present 15 or more days per month for at least three months, with migraine features on at least eight of those days.

Many patients experience a prodrome phase before the headache begins, and some experience aura — transient neurological symptoms such as visual disturbances, sensory changes, or speech difficulty — that precede or accompany the headache.

Common Symptoms

• Moderate to severe head pain, often unilateral and throbbing
• Nausea or vomiting
• Sensitivity to light (photophobia) and sound (phonophobia)
• Visual aura — flickering lights, blind spots, or zigzag patterns
• Sensory aura — tingling or numbness
• Worsening with routine physical activity
• Postdrome fatigue or cognitive difficulty following the headache

When Headaches Should Be Evaluated

Not all headaches require neurological evaluation, but certain patterns warrant assessment. These include headaches that are new or different from prior headaches, headaches that are progressively worsening, headaches associated with neurological symptoms such as weakness, vision changes, or speech difficulty, and headaches that are significantly impacting daily function or quality of life.

A sudden severe headache — sometimes described as the worst headache of one's life — requires urgent medical evaluation to rule out serious causes.

Neurological Evaluation

A neurological evaluation for headache begins with a thorough history — including headache frequency, duration, severity, associated symptoms, triggers, and prior treatments. A neurological examination is performed to assess for any focal findings that might suggest a secondary cause.

Neuroimaging may be ordered when the history or examination raises concern for a structural cause. Most patients with a classic migraine history and normal examination do not require imaging.

Treatment Approaches

Migraine management is individualized based on attack frequency, severity, impact on function, and prior treatment response. Management typically includes both acute treatment — medications taken at the onset of an attack — and preventive treatment for patients with frequent or disabling migraines.

Preventive approaches may include daily oral medications, injectable therapies, or procedural interventions. The appropriate approach depends on the individual patient's clinical profile.

Procedural Options

For eligible patients, procedural treatments may be incorporated into the management plan. These include therapeutic Botox injections for chronic migraine, occipital nerve blocks for headache syndromes with occipital involvement, and trigger point injections for patients with a significant myofascial component.

Frequently Asked Questions