As a member of the American Interventional Headache Society, Ayman Tarabishy, MD, at Enhance Center uses his training and expertise to provide lasting headache relief. The practice’s multimodal approach to treatment includes:
- Treatment starts by identifying and treating reversible causes of headache,
- Natural and herbal supplementations
- Oral, sublingual, nasal, and injectable medications
- Topical ointments and creams
- Botox® botulinum toxin
- sphenocath®
- IV infusions are available for intractable attacks
- Radiofrequency nerve ablation
- Psychotherapy
- CSF drainage for pseudotumor cerebri sufferers with failed shunts
- Some intractable cases may benefit from certain nerve stimulators
- In some intractable cases even intrathecal ziconotide can be considered
- Interventional nerve blocks, pulsed or thermal ablations: Dr. Tarabishy uses Ultrasound, Fluoroscopy, nerve stimulator and sometimes CT guidance to perform the interventions
- Occipital (greater, lesser and least)
- TON (third occipital nerve)
- Diagnostic occipital nerve ultrasound guided block, along with ultrasound guided inferior obliquus muscle (IOM) and semispinalis capitis muscles (SSC) in cases of muscle tension impingement occipital neuralgia
- Supraorbital
- Supratrochlear
- Infraorbital
- Mental
- Inferior alveolar
- Temporoauricular
- Greater auricular
- Sphenopalatine (trans-nasal and lateral infra-zygomatic approaches)
- Superficial cervical plexus
- Trigeminal or any of its branches (ophthalmic V1, Maxillary V2, Mandibular V3)
- Gasserian ganglion
- Buccal
- External nasal
- Zygomaticotemporal
- Zygomaticofacial
- Ascending cervical
- EMG and Ultrasound guided specific facial muscles and/or glands botulinum toxin injections
- Strong affiliation with the best MRI facilities and direct contact with neuroradiologists to ensure the best imaging studies and advanced MRI sequences.
- Strong affiliation with the best neurosurgeons when surgical intervention is warranted (Arnold Chiari, microvascular decompression, CSF shunts, nerve harvesting, vagal nerve stimulators, retrograde C0-C4 spinal cord stimulating paddle…)
As with most experienced headache specialists, we do not recommend implantable occipital nerve stimulators anymore because of their high rate of migration, high rate of complications and a low percentage of long-lasting relief.
