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Migraine Center

migraine headache centerThere is no need to suffer from chronic headaches and migraines any longer.

There is relief from migraine suffering. At the Blackhawk Migraine Center we have several treatment options available to end your migraine pain permanently.

Please call to schedule an evaluation to see if you are a candidate.

If all other traditional migraine treatments have failed you, we may have the procedure and treatments you’ve been looking for to eliminate migraines forever.

More than 39 million Americans are afflicted by chronic migraines. By determining if there are nerves in the head and neck area causing the migraines, we can offer treatment solutions including surgical and non-surgical options. Schedule your consultation today.

Blackhawk Migraine Clinic Treatment Options:

  • Consultation to evaluate and treat all types of headaches such as chronic/episodic migraine, cluster headaches, trigeminal neuralgia, NDPH, hypnic headaches etc.
  • Routine Follow up visits to ensure effective, adequate and up to date treatment for your headaches. May include recommendations for diet, physical therapy, acupuncture and more.
  • In office occipital, trigeminal and muscular nerve blocks to treat an acute migraine for quick noninvasive pain relief.
  • In office Intramuscular injections for acute headaches including: Sumatriptan IM, Toradol, Phenergan
  • Botox treatment for chronic migraine using the PREEMPT protocol. Courtesy prior authorization done in our office for commercial insurance.
  • Botox or Dysport to alleviate TMJ discomfort
  • Migraine Surgery ​

Per the international headache society, a migraine headache is defined as:
At least five attacks meeting items below
Headaches lasting 4-72 hours (untreated or unsuccessfully treated)
Headaches have at least two of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity (for example walking or climbing stairs)
At least one of the following: nausea and/or vomiting, photophobia and phonophobia
Not attributable to any other disorder

What causes migraine headaches?

There a few different pathophysiological processes believed to cause migraine headaches. These include Interictal cortical derangement, Dysfunctional Periaquaductal gray matter, cortical spreading depression, and irritation of the

trigeminal or occipital nerves.

Surgery is aimed at addressing the latter. Irritation of these nerves causes release of substance P, calcitonin gene related peptide and Neurokinin A. All of these neurotransmitters result in a local meningitis and vasodilation. The irritation of these nerves can be caused by either muscle, connective tissue that is too tight and local arteries that contact these nerves.

Surgically amenable migraine headaches can be treated with Botox or surgery.


Botox is FDA approved for the treatment of migraine headaches. It can also be used as a way to diagnose those patients that may be responsive to surgery. Patients that have a positive response to Botox will have a 50% reduction in the intensity or frequency of migraine headaches for at least 4 weeks. Up to 3 trigger sites can be treated with Botox, typically with 1 trigger site/ a month receiving treatment.

Those patients that have successful reduction in their migraine frequency or pain are likely to also benefit from migraine surgery.

Migraine headaches caused by irritation of trigeminal and occipital nerves can occur at 5 different locations about the head.

    1. Frontal (supraorbital, supratrochlear)
    2. Temporal trigger site (zygomaticotemporal)
    3. Rhinogenic
    4. Occiput (Greater occipital nerve)
    5. Auriculotemporal

Dysport in Jaw

For some, a Dysport injection in the jaw may help to address pain from tight jaw and teeth clenching.

Trigger Sites

Frontal Trigger

Constellation of symptoms:

  1. Pain starts above the eyebrows
  2. Pain starts in the afternoon
  3. There is strong corrugator muscle activity causing deep frown lines on animation and repose.
  4. The points of emergence of the supraorbital and supratrochlear nerves from the corrugator muscle or the foramen are tender to the touch.
  5. Patients commonly have eyelid ptosis on the affected side at the time of active pain. Pressure on these sites may abort the MH during the initial stages.
  6. Application of cold or warm compresses on these sites often reduces or stops the pain.
  7. The pain is usually imploding in nature.
  8. Stress often can result in triggering the MH

Temporal Trigger

Constellation of symptoms:

  1. The pain starts in the temple area approximately 17 mm lateral and 6 mm cephalad to the lateral canthus.
  2. Patients usually wake up in the morning with pain after clenching or grinding their teeth all night.
  3. Often, the pain is associated with tenderness of the temporalis or masseteric muscle.
  4. One may see wearing of the dental facets.
  5. Rubbing or pressing the exit point of the zygomaticotemporal branch of the trigeminal nerve from the deep temporal fascia can stop or reduce the pain in the beginning.
  6. Application of cold or warm compresses to this point may reduce or stop the pain.
  7. The pain is characterized as imploding.
  8. Stress can trigger MH in this site.

Occipital Trigger

Constellation of symptoms:

  1. The pain starts at the point of exit of the greater occipital nerve from the semispinalis capitis muscle (3.5 cm caudal to the occipital tuberosity and 1.5 cm off the midline).
  2. There is no specific starting time for the pain.
  3. The patients may have a history of whip-lash.
  4. The neck muscles are usually tight.
  5. Heavy exercise can trigger the MH.
  6. Compression of this site can stop the pain in the early stage, whereas at the later stage, the point is tender
  7. Application of cold or heat at this site may result in some improvement in the pain.
  8. Stress can be a trigger for occipital MH.

Rhinogenic Trigger

Constellation of symptoms:

  1. The pain starts behind the eye.
  2. Patient commonly wakes up with the pain in the morning or at night.
  3. Commonly, the MH is triggered by weather changes.
  4. Rhinorrhea (Runny nose) can accompany the pain on the affected side.
  5. This type of MH can be related to the nasal allergy episodes.
  6. Menstrual cycles can trigger MH.
  7. The pain is usually described as exploding.
  8. Concha bullosa (abnormal air cell within the bone in your nose), septal deviation with contact between the turbinates and the septum, septa bullosa, and Haller’s cell (abnormal air cell within the medial orbital rim) can be seen on the CT scan.

Auriculotemporal Trigger

Constellation of symptoms:

  1. Pain typically starts on the side of the head just above and anterior to the ear.
  2. Pain may be mistaken for tempormandibular joint (Jaw joint) dysfunction
  3. May present as multiple tender areas on the side of the head

Lesser occipital Trigger

Constellation of symptoms:

  1. Pain typically starts in the neck or back or back of the head behind the ears.
  • Possible causes
    • Trauma
    • Prior surgery
    • C-Spine abnormalities

Numular Trigger

Sites show rare trigger sites that are found in less than 0.1% of migraine patients.

Constellation of symptoms:

  1. These can occur anywhere on the head that does not coincide with another defined trigger point but is usually located over the parietal region.
  2. Very responsive to local anesthesia
  3. Pain is always localized to a specific location.

Click here to read more about insurance options for Migraine Treatments at Blackhawk Plastic Surgery.

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Blackhawk Plastic Surgery

3600 Blackhawk Plaza Circle, Danville, CA 94506

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3600 Blackhawk Plaza Circle, Danville, CA 94506

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