---
title: "Chronic Headaches"
---
## When Headaches Become a Way of Life
Chronic headaches are exhausting in a way that is hard to convey unless you live with them: the constant calculation of whether today is going to be a headache day, medications that work sometimes and not others, cancelled plans, disrupted sleep, and the cumulative effect on work, relationships, and basic quality of life.
Most chronic headache patients we see have already tried a lot: multiple over-the-counter and prescription medications, sometimes injections from other providers, lifestyle modifications, supplements, maybe physical therapy. Some have found partial relief; many have not found enough. What we offer is comprehensive evaluation to identify what is actually contributing to your headaches and the targeted treatments that match those specific contributors. The goal is to move from managing chronic headaches to addressing the specific underlying factors driving them.
## Why Chronic Headaches Is Often a Misnomer
The term chronic headaches describes the pattern, frequent or persistent headaches over months or years, but not the cause. Treating them well requires identifying which specific headache type or types you actually have.
Common patterns we see: chronic migraine, a specific diagnosis (15 or more headache days per month with at least 8 migraine days) with FDA-approved treatments including therapeutic neurotoxin (see our Migraines page); cervicogenic headache, which originates from cervical structures and often gets misdiagnosed as migraine (see our Cervicogenic Headaches page); tension-type headache, a band-like pressure often related to muscle tension; medication overuse headache, which develops from frequent acute medication use and can transform episodic headaches into chronic ones; and mixed headache patterns, which are common and require addressing each contributor. Identifying which pattern or combination applies to you is the most important step.
## What PHI Offers for Chronic Headaches
Once your specific headache pattern is identified, PHI offers several treatments that may help. Therapeutic neurotoxin is FDA-approved for chronic migraine prevention and may also benefit selected patients with cervicogenic headache or significant muscle-driven factors; for chronic migraine specifically, this is one of the most evidence-supported treatments available. Nerve blocks, including occipital nerve blocks for headaches with a significant occipital component, can both treat and help identify which structures are contributing. IV therapy, delivered in a clinic setting, provides supportive care for some patients dealing with frequent severe headaches, and we are honest that this is supportive rather than primary treatment.
We coordinate with neurologists for patients whose chronic headaches require neurology input alongside our interventional treatments, particularly chronic migraine patients who benefit from neurology-managed preventive medications, and with physical therapy for patients with significant muscle-driven or postural contributors. We do not promise quick fixes; we promise honest evaluation, clear identification of what is likely contributing, and a plan matched to those factors.
## When to See Someone
Consider professional evaluation when you have headaches more than several days per month, when they interfere with sleep, work, or daily activities, when standard medications have not provided adequate relief, when you are using acute headache medications frequently (which can contribute to medication overuse headache), or when you have not had a comprehensive evaluation addressing multiple potential contributors.
Seek prompt evaluation for a sudden severe headache (the worst of your life), headache with fever, stiff neck, confusion, or loss of consciousness, headache with new neurological symptoms, a headache pattern that has dramatically changed, or headache after head injury.
## Why PHI for Chronic Headaches
## Frequently Asked Questions
**Q: What's the difference between chronic headaches and migraines?**
Chronic migraine is a specific diagnosis (15 or more headache days per month with at least 8 migraine days). Other chronic headache patterns include cervicogenic headache, tension-type headache, and medication overuse headache. Many patients have multiple types simultaneously, and sorting out which you have is part of evaluation.
**Q: Can therapeutic neurotoxin help my chronic headaches?**
For appropriate candidates with chronic migraine specifically, therapeutic neurotoxin has strong FDA-approved evidence for headache prevention. For other patterns, evidence varies. Patients with significant cervicogenic or muscle-driven contributors may benefit even outside the chronic migraine indication, though the evidence base for those uses is less robust.
**Q: I'm taking pain medication every day. Is that a problem?**
Frequent use of acute headache medications can contribute to medication overuse headache, which can transform episodic headaches into chronic ones. If you are using acute medications more than several days per week, addressing this may be an important part of your plan, and it typically requires careful management to avoid worsening symptoms during the transition.
**Q: How long does it take to see if treatment is working?**
This varies by treatment. Therapeutic neurotoxin for chronic migraine takes 1 to 2 weeks per cycle to develop effect, with most physicians recommending two to three full cycles (6 to 9 months) before fully evaluating response. Nerve blocks often produce effects within hours. IV therapy may produce effects within hours to days.
**Q: Will I need to be on prescription medications forever?**
This depends on your situation. Many patients on chronic preventive medications can reduce or eliminate them when interventional treatments adequately address the underlying contributors. Others continue medications as one component of their plan. The goal is the right level of medication for your specific situation.
**Q: What about lifestyle factors like sleep, stress, and hydration?**
These can be significant contributors. Comprehensive treatment usually involves addressing them alongside medical interventions, and we often recommend coordination with nutrition, sleep medicine, or behavioral specialists for patients whose lifestyle contributors are significant.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation.
**Q: How quickly can I be seen?**
Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Chronic Headaches
PHI offers evidence-based treatments for chronic headache conditions. Your physician will recommend the right option, or combination, based on the specific headache types involved in your case.
- Neurotoxins for Pain, FDA-approved therapeutic neurotoxin for chronic migraine prevention
- Nerve Blocks, including occipital nerve blocks
- IV Therapy, supportive care
> International Classification of Headache Disorders, 3rd edition. International Headache Society.
â [International Headache Society](https://ichd-3.org/)
> Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Peer-reviewed via PMC.
â [Escher CM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5367647/)
> Practice guidelines: treatment of migraine. American Academy of Neurology.
â [American Academy of Neurology](https://www.aan.com/practice/clinical-practice-guidelines/)
## Schedule Your Chronic Headache Consultation
A 60-minute consultation will identify the specific headache types contributing to your pattern, walk through the treatment options that match them, and give you a clear plan. Call (310) 856-9488 or book online now.
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