Headaches and Migraines: When to Seek Help and What Treatment Can Do

Headaches are one of the most common pain complaints, but they are not all the same. Some feel like pressure around the forehead. Others cause throbbing pain, light sensitivity, nausea, neck tension, or pain that lasts for hours or days. When headaches become frequent, severe, or difficult to control with over-the-counter medication, it may be time to look deeper.

At Palm Beach Pain Institute in Delray Beach, Florida, Marcie A. Merson, MD, evaluates and treats headaches and migraines using an individualized, patient-centered approach.

Common types of headaches

There are many types of headaches, and treatment depends on the underlying cause. Some of the most common include:

Tension headaches

Tension headaches often feel like a tight band around the head. They may be linked to stress, poor posture, muscle tension, jaw clenching, or neck strain.

Migraine headaches

Migraines are more than “bad headaches.” They can cause throbbing or pulsing pain, often on one side of the head. Many people also experience nausea, vomiting, light sensitivity, sound sensitivity, visual changes, or worsening pain with activity.

Cervicogenic headaches

These headaches begin in the neck and refer pain into the head. They may be related to arthritis, muscle tightness, disc problems, posture, whiplash, or other neck conditions.

Occipital neuralgia

Occipital neuralgia can cause sharp, burning, or electric pain that begins near the base of the skull and travels upward. The scalp may feel tender or sensitive.

Chronic headaches

Headaches are considered chronic when they occur 15 or more days per month. Chronic headaches may develop from migraines, neck pain, medication overuse, stress, sleep issues, or other medical factors.

Symptoms that should not be ignored

Most headaches are not emergencies, but certain symptoms require prompt medical attention. Seek urgent care if you have a sudden “worst headache of your life,” headache after head trauma, headache with confusion or fainting, fever with stiff neck, new weakness, vision loss, trouble speaking, or a new headache pattern that is rapidly worsening.

You should also schedule an evaluation if your headaches are becoming more frequent, lasting longer, requiring more medication, or interfering with your normal routine.

How headaches are diagnosed in the office

Your visit begins with a detailed discussion of your symptoms. Dr. Merson may ask where the pain starts, how long it lasts, what it feels like, what triggers it, and what helps. She may also ask about sleep, stress, hydration, medications, prior injuries, jaw pain, neck pain, and family history of migraines.

Your exam may include posture assessment, neck range of motion, muscle tenderness evaluation, neurological screening, and a review of previous imaging or test results. In some cases, additional imaging or referral may be recommended, especially if symptoms suggest a new neurological concern.

The goal is to identify what type of headache you have and what may be driving it.

Treatment options for headaches and migraines

Treatment may include a combination of lifestyle guidance, medication management, hands-on therapy, and minimally invasive procedures.

Osteopathic manual therapy

Osteopathic manual therapy, or OMT, uses gentle hands-on techniques to address muscle tension, joint restriction, posture-related strain, and neck-related headache triggers. This can be especially helpful when headaches are connected to neck pain, jaw tension, or musculoskeletal imbalance.

Medication management

Medication may be used to reduce inflammation, relax muscle tension, prevent migraines, or treat symptoms when headaches occur. Dr. Merson can also review your current medication use, since frequent use of over-the-counter pain relievers may sometimes contribute to rebound headaches.

Botox® for chronic migraines

Botox® may be an option for patients with chronic migraines. It is used as a preventive treatment and may help reduce the number of migraine days over time.

Nerve blocks and injections

For certain headache patterns, targeted injections or nerve blocks may help calm irritated nerves and provide relief. These treatments can also help clarify which nerves or structures are contributing to your pain.

Follow-up and how long treatment may take

Headache treatment is usually a process, not a one-visit fix. Some patients improve quickly once a trigger is identified and treated. Others need several weeks or months of follow-up to fine-tune medications, therapy, injections, or preventive strategies.

Keeping a headache diary can be very helpful. Track when headaches happen, how long they last, where the pain occurs, possible triggers, medications used, and whether treatment helped. This information helps Dr. Merson adjust your plan and measure progress.

Get help for recurring headaches

You do not have to plan your life around headaches or migraines. If your symptoms are becoming more frequent, more painful, or harder to manage, professional treatment can help.

To schedule a headache or migraine evaluation at Palm Beach Pain Institute in Delray Beach, Florida, call 561-499-7020 or book an appointment online today.