Our Program

The USC Headache and Neuralgia Center at Keck Medicine of USC in Los Angeles is an advanced care center that provides comprehensive treatment of headache and facial pain disorders, particularly those that are unmanageable and challenging. The center’s multidisciplinary program incorporates multiple subspecialties for the comprehensive management of complex headache disorders. These specialties include anesthesiology/pain medicine, neuro-radiology, neurology, neuro surgery, occupational therapy, oral and facial dentistry, pain psychology, physical therapy and medicine, and complementary/alternative medicine. We offer the full range of headache and neuralgia related services and treatment options that include nerve blocks, injections, infusions, treatment of TMJ-related pain, radiofrequency ablation, neurosurgical decompression surgery and Gamma Knife® radiosurgery to fit the needs of every patient.

The center also features the only Lifestyle Redesign® program in the United States for chronic headaches, an evidence-based approach that examines a patient’s entire lifestyle (including stress, food, ergonomics and time management) to find effective treatments for headache pain and allow patients to live a pain-free, normal life.

Our Approach

The USC Headache and Neuralgia Center takes an interdisciplinary approach toward headache pain. Depending upon your specific condition and needs, your team may consist of physical therapists, occupational therapists, pain physicians, psychologists, neurosurgeons, neurologists or complementary/alternative medicine specialists.

The country’s only Lifestyle Redesign® program is managed by occupational therapists, and consists of weekly sessions during which key parts of a patient’s daily life – diet, stresses, posture and ergonomics and “pacing” – are reviewed. Lifestyle Redesign® (LRD) for chronic headaches draws from a variety of preventive treatment strategies and was developed collaboratively with neurologists and occupational therapists. Our physicaltherapists are specialized in headache management and review all aspects of a patient’s daily routines to search for factors and habits that might contribute to headaches. Once a possible cause is identified (from diet, stress, posture or time management), a plan is set in place to reduce the possibilities of future severe headaches.

For established patients in need of immediate rescue from extreme pain, the center’s Headache Rescue Program can provide specialized, rapid response evaluation.

Conditions

Nearly everyone will experience headaches during their lifetime; however, most are not severe. The major types of headache are migraine, tension(tension),medication overuse and inflammatory. The most common type of headache is a migraine, which affects 30 million Americans. Chronic daily headaches occur on more than 15 days a month and are one of the top 10 disabling neurological conditions according to the World Health Organization. While “neuralgia” literally means “nerve pain,” headache, face and neck pain also can be caused by occipital neuralgia. Often, patients have a combination of pain disorders, migraine and occipital neuralgia, for example.

Anyone can have a headache severe enough that it is not treatable with over-the-counter medicines or prescription medications at home. Conditions that are treated at the USC Headache and Neuralgia Center at Keck Medicine of USC in Los Angeles include:

Headache – Nearly all of us have had a headache at some time, marked by pain somewhere in our faces, heads and scalps, perhaps extending down into the neck.

Migraine – An inherited neurological disorder that is characterized by over excitability of specific areas of the brain. Although we do not clearly understand how a migraine brain is different or what happens in the brain to start a migraine, we know that individuals with migraines are more susceptible to the influence of transient factors, termed “triggers,” that raise the risk for having a migraine attack. These triggers include hormonal fluctuations; environmental stimuli such as weather or bright lights, certain smells, alcohol, certain foods, poor sleep and high stress.

Post-concussion headache – One of a number of symptoms that can arise after a concussion that resulted from a head injury. Headaches, dizziness and other symptoms often arise about a week after an injury and can last for weeks or even months after the injury. The risk of having a post-concussion headache does not appear related to the severity of the original injury.

Occipital neuralgia – Two nerves are responsible for transmitting most of the feeling we get on the top and back of the head. Called the occipital nerves, they reach out from the spinal cord through muscles in the neck and back of the head, extending over toward the forehead. When irritated, the nerves can generate a shooting, zapping, electric or tingling pain. Neuralgia (nerve pain) can be spontaneous or can be caused by a pinched nerve brought about by arthritis, injury or surgery to the scalp. “Tight” muscles in the neck have also been associated with occipital neuralgia.

Tension headache – The most common type of headache, this variety usually is not severe enough to require extended medical attention. Despite the name, stress or “tight” muscles do not cause “tension” headaches. In fact, their cause is largely unknown. While usually mild in nature, tension headaches that are severe enough are treated by a number of strategies at the USC Headache and Neuralgia Center at Keck Medicine of USC.

Sinus headache and allergy-related headaches – While most people with “sinus” headaches probably have a migraine or some other form of head and neck pain, sinus infections and pressure on internal nasal and sinus structures can cause significant pain. Allergic reactions also can cause pain in the sinus areas.

Medication-overuse headache – Also called “rebound” headache, this type of pain is caused by the overuse of headache medication. Typically, medication can provide relief for short-term headaches, but the pain can return or “rebound” as your body adjusts to the long-term presence of pain drugs. Medication-overuse headache is the third most-common form of headache, after tension headaches and migraines.

Cluster Headache – Cluster headaches are rare, with a prevalence of less than one percent (one in 1,000). In recent years, some exciting new discoveries have been made with regard to the pathophysiology and treatment of this unusual and mysterious headache. More commonly seen in men than women, this type of headache occurs in clusters in a repetitive manner at the same time of day, year or season.

For more detailed information about headache, click here to view our online health library.

Treatments and Services

The USC Headache and Neuralgia Center at Keck Medicine of USC in Los Angeles offers the latest techniques to break stubborn headaches and migraines when usual medications fail. The center’s treatments include advanced acute headache and facial pain infusion and procedures.

Headache Rescue Program
Chronic migraines and other headaches can alter how the brain functions, often making headache systems worse. Neuromodulation is the positive change in brain and nerve signaling that brings about pain relief and can be accomplished through medications and non-medicational methods. Infusions of various medications can, over time, halt these alterations and return brain function back to normal. Often, a combination of medications are used, to determine which ones are the most effective. This procedure is performed on an outpatient basis at the USC Headache and Neuralgia Center. Infusions include intravenous, intramuscular or subcutaneous medications, specially used to break severe headache cycles. Some examples of medications used on an acute basis:

  • Oxygen therapy
  • Intravenous (IV) magnesium
  • IV ketorolac tromethamine (Toradol)
  • IV valproate sodium (Depacon)
  • IV steroids
  • IV anti-nausea medication

Physical Therapy for Headaches
Our specialists have extensive experience in pain and headaches and will evaluate and treat with the following goals:

  1. Develop an exercise program
  2. Help patient identify musculoskeletal triggers
  3. Improve muscle strength
  4. Improve posture
  5. Improve spine mobility
  6. Improve tolerance for work, home and recreational activities
  7. Reduce headache frequency and severity

Lifestyle Redesign® Program for Chronic Headaches:
Sessions are held for one hour once a week for eight weeks by occupational therapy specialists. This program helps patients regain or develop function in activities of daily living and self-care and improves self-management of chronic conditions. Some of the topics addressed include the following:

  1. Dietary triggers
  2. Energy conservation & fatigue management
  3. Ergonomics and body mechanics
  4. Exercise
  5. Pacing
  6. Sensory processing
  7. Sleep Hygiene
  8. Stress management & relaxation training
  9. Time management & organization

Pain Psychology
Our pain psychologists specialize in comprehensive biofeedback training and neuromodulation of pain based on teaching mind- body techniques. In combination with other modalities of treatment, these therapeutic methods can provide long-term improvement in pain reduction and headache management.

Procedures
Sometimes, injections of medicines or chemicals that “block” the transmission of pain signals can alleviate headache pain. For any nerve block, a chemical is injected in or near a key nerve. Nerve blocks will not work for all patients. In addition, some nerve blocks may not immediately halt headache pain, but could prevent future headaches.

Occipital nerve block – The most common nerve block procedure, involving an injection in or around the nerves in the scalp over the back of the head.

Supra-orbital nerve block – A nerve block includes injections of nerve-blocking chemicals in the face, just over the eye.

Trigger point Injections:
An injection is performed on and around painful “trigger points” characterized by muscles in constant tight knots either resulting from headaches or causing headaches.

OnabotulinumtoxinA (Botox) injection – The same medicine used to treat wrinkles was also recently approved to treat chronic migraines. For headache treatment, onabotulinumtoxinA is injected into several sites on the face and neck every 12 weeks.

Sphenopalatine ganglion block:
The sphenopalatine ganglion (SPG) is a collection of nerve cells that is closely associated with the trigeminal nerve, which is the main nerve involved in headache disorders. A nerve block is a procedure to stop pain transmission through anesthesia to the nerve. In a SPG block, an anesthetic agent is administered through the nose. The procedure is done in the office or clinic.

Intravenous ketamine infusion: Our team pain specialist provides this special outpatient infusion to patients who have unmanageable headache and pain and who qualify for this treatment.

Radiofrequency nerve ablation – A technique useful for reducing pain caused by specific nerves, specialized needles are injected into a nerve to deliver a microwave (or other electric signal) that inactivates the targeted nerve.

Peripheral nerve stimulators – Electrical stimulation of small sensory nerves on the scalp can result in pain relief. This is another technique for treating headaches brought about by a single nerve, usually the occipital nerve in the back of the head. In this case, an electrode is inserted just under the skin to deliver a current that replaces occipital nerve pain with a tingling sensation.

Brain surgery for Headaches and neuralgias
Microvascular decompression – This minimally invasive surgical procedure has been shown to be effective against headaches brought about by the trigeminal nerve. The trigeminal nerve is found in the side of the face. With this procedure, a neurosurgeon removes any arteries or blood vessels that may be touching and putting pressure on the trigeminal nerve.

GammaKnife® – This advanced surgical tool focuses radiation on very specific areas of the brain to treat a number of disorders, including headache. It is often used to treat trigeminal neuralgia, as an alternative to microvascular decompression.

Patient Information

What to expect
On your first visit to the USC Headache and Neuralgia Center, one of our specialists will obtain a comprehensive and detailed history, confirm the diagnosis of headache and enroll you in some of our multidisciplinary programs including the Lifestyle Redesign® program and physical therapy, for example. Then, a course of treatment will be determined, depending on your individual case and needs. You should provide detailed information about your headaches (severity, number of headaches, apparent location and duration) to both your doctor and the center specialists.

Most treatments are done on an outpatient basis. Our team will follow up closely with you after every procedure to determine how well treatments are working. In addition, you will be able to email or telephone our nurses, physicians and other staff between your visits to us.

For established patients who are suffering from headache and are frequently visiting the emergency room or have difficult-to-treat headaches, we can provide same-day treatments through our Headache Rescue Program.

For surgical procedures, including microvascular decompression or GammaKnife® surgery, you will need to be admitted to Keck Hospital of USC. You will meet with the USC Headache and Neuralgia Center’s surgeons, as well as with other specialists who will help decide on a course of treatment.

Resources

Patient Support
American Headache Society
americanheadachesociety.org
The nation’s largest society of headache specialists.

American Headache and Migraine Association
easeheadachemigraine.org
An association that focuses on migraine headaches, and provides educational, professional and patient advocacy services.

ACHE (Headache Education)
achenet.org
The American Headache Society’s Committee for Headache Education, providing materials for patients, families and providers.

Headache Cooperative of the Pacific
hcop.com
An organization in the western United States dedicated to better communication and education of advances in headache medicine for patients and healthcare providers.

American Migraine Foundation
americanmigrainefoundation.org
Founded by the American Headache Society, this foundation supports innovative migraine research.

Clinical Trials
Patients have the option of taking part in clinical trials being conducted at Keck Medical Center of USC and elsewhere. While clinical trial participation does not ensure that an effective treatment will be received, participation does help provide invaluable information for future treatments, and possibly a cure in the future.

Current studies:
Placebo-controlled Safety and Efficacy Study of Pregabalin (Lyrica) in Subjects With Post-traumatic Peripheral Neuropathic Pain. This study is designed to investigate if pregabalin is effective in treating neuropathic (nerve) pain resulting from peripheral nerve trauma due to a traumatic or surgical event.

Our Team

Our team consists of a number of physicians, therapists, social workers and other specialists, in a multidisciplinary structure tailored toward each’s patients’ unique conditions and needs. Our physicians can be contacted by your primary care physician/health-care provider or directly by our patients.

Our Physicians

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Practicing Locations

Keck Hospital of USC
Keck Medicine of USC - Downtown Los Angeles
LAC+USC Medical Center
USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital
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Practicing Locations

USC Healthcare Center 2

Specializing In

Cerebrovascular Disease of the Brain and Spinal Cord, Surgical Approaches to the Cranial Base, Stereotactic Radiosurgery, Microvascular Decompression for Bell’s Palsy, Lateral Skull Base Surgery for Facial Nerve Tumors

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Practicing Locations

USC Healthcare Center 2
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Practicing Locations

USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital
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Practicing Locations

Keck Hospital of USC
LAC+USC Medical Center
USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital
view profile

Practicing Locations

Keck Hospital of USC
USC Healthcare Center 2
USC Norris Comprehensive Cancer Center and Hospital

Additional Faculty

Susan Axtell, PhD
Kecia Watari, PhD
Faye Weinstein, PhD

Additional Team Members

Glenn Clark, DDS, MS
Dawn Fishback, PA-C
Lori Ginoza, DPT, NCS
Olive Nworie, NP
Saravanan Ram, DDS, MS
Erica Sigman DPT, MA, BS
Ashley Uyeshiro, OTD, OTR/L