Our Approach to Headache Disorders & Facial Pain
The Montefiore Einstein Headache Center is the first center in the world and an international leader in the field focused exclusively on the diagnosis and treatment of headache disorders and facial pain in adults and children. Our Center has more than 70 years of experience advancing clinical excellence and knowledge of headache disorders while our research has informed the development of the classification system for migraine and other headache syndromes, leading to their precision treatments.
Our interdisciplinary team of renowned experts treats the full spectrum of pediatric and adult headache disorders—including migraine, tension-type headache, hypnic headache and cluster headache, as well as those secondary to other medical and neurological conditions—to help minimize pain, optimize function and improve quality of life.
We are ranked in the top 1% of all hospitals in the nation for neurology, according to U.S. News & World Report, and an international referral site for complex headache cases.
Advanced Treatments
We provide the full range of treatments for migraine and other headache disorders, including both acute and preventive medications, neuromodulation devices, botulinum toxin (Botox) injections, peripheral nerve blocks, trigger point injections, biobehavioral treatments including biofeedback, cognitive behavioral therapies, occupational and physical therapy, as well as personalized lifestyle modifications.
Research & Clinical Trials
During your initial visit, you will also be evaluated for clinical trial eligibility. As an established patient, this evaluation is ongoing as new clinical trials emerge on a yearly basis. Clinical trial participation occurs only after patient interest is established, inclusion criteria are met, and patient consent is obtained.
Our innovative research in headache disorders has led to the development of some of the earliest medications for migraines, which are still widely used today. Our researchers have been involved in studies of the latest acute treatments for migraines, along with the new class of monoclonal antibodies for prevention and a medical device study on transcranial magnetic stimulation to treat acute migraines. Our patients also have access to groundbreaking treatments through clinical trials.
Your Headache Center Team
Cynthia E. Armand, MD
Daniel N. Lax, MD
Richard B. Lipton, MD
Kristina M. Maselli, MD
Jelena Pavlovic, MD, PhD
Elizabeth K. Seng, Ph.D.
About Headaches
Headache disorders originate in the nervous system. They are one of the most common disorders and are sometimes associated with other conditions.
Headaches are often a secondary symptom of a sleep disorder. For example, tension-type headache is regularly seen in persons with insomnia or sleep-wake cycle disorders. Nearly 75 percent of individuals who suffer from narcolepsy complain of either migraine or cluster headache. Migraines and cluster headaches appear to be related to the number of transitions between rapid eye movement (REM) and other sleep periods an individual has during sleep. Hypnic headache awakens individuals mainly at night but may also interrupt daytime naps. Reduced oxygen levels in people with sleep apnea may trigger early morning headaches.
Types of Headache Disorders
Migraine is a type of headache characterized by recurrent attacks of moderate to severe throbbing and pulsating pain on one side of the head. The pain is caused by the activation of nerve fibers within the wall of brain blood vessels traveling inside the meninges (the three layers of membranes protecting the brain and spinal cord).
Recurrent headaches are a sign of a headache disorder. Types of disorders besides migraine include tension headaches and trigeminal autonomic cephalgias (cluster headaches).
Headaches affect people of all ages, races and socioeconomic status and are more common in women. Some headaches are extremely debilitating and have a significant impact on an individual’s quality of life, imposing huge costs to healthcare and indirectly to the economy in general. Only a small proportion of headache disorders require specialist input. The vast majority can be effectively treated by a primary care physician or generalist with a correct clinical diagnosis that requires no special investigation.
Tension-type headache is the most common type of headache. Its name indicates the role of stress and mental or emotional conflict in triggering the pain and contracting muscles in the neck, face, scalp and jaw.
The most severe form of primary headache involves sudden, extremely painful headaches that occur in "clusters", usually at the same time of the day and night for several weeks.They strike one side of the head, often behind or around one eye, and may be preceded by a migraine-like aura and nausea. The pain usually peaks five to 10 minutes after onset and continues at that intensity for up to three hours. The nose and the eye on the affected side of the face may get red, swollen and teary. Some people will experience restlessness and agitation, changes in heart rate and blood pressure, and sensitivity to light, sound or smell. These headaches often wake people from sleep.
Chronic daily headache refers to a group of headache disorders that occur at least 15 days a month during a three-month period. In addition to chronic tension-type headache, chronic migraine and medication-overuse headache all include Hemicrania continua and new daily persistent headaches. Individuals feel constant, mostly moderate pain throughout the day on the sides or top of the head. They may also experience other types of headache. Adolescents and adults may experience chronic daily headaches. In children, stress from school and family activities may contribute to these headaches.