Professional athletes independent medical examination - National Football League sport concussion and brain injury damage expert witness - Headaches and Traumatic Brain Injury Treatment Specialist

Our Headache Management Program

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The Florida Center for Headache and Sports Neurology is a tertiary headache clinic with   roots in the management of headache. Over the past 15 years we have evaluated and treated over ten thousand patients with headache. Our patients range from episodic to refractory migraine. A majority of the patients we see have chronic and refractory migraine headaches. Dr. Conidi also specializes in the treatment of cluster headache and has a personal interest in this headache disorder. A typical patient has daily headache, have seen numerous physicians (primary care, neurology, pain management) and even headache specialists, are likely overusing medications (including narcotics) and have tried a number of medications.

For the chronic headache patient we incorporate a multi-disciplinary on site management program using medications, interventional procedures, behavioral modification techniques, psychological counseling, diagnostic testing and physical therapy/neuromuscular rehabilitation.

Your Initial Visit includes a comprehensive, detailed neurological/headache history and examination. Dr. Conidi will assess risks factors, triggers, family history, comorbid disorders and screen for possible secondary causes.

botox treatmentHe will then develop an initial treatment program and if necessary order appropriate diagnostic testing which may include MRI (s) and/or a Sleep Study. Initial treatment is usually geared towards breaking the headache cycle and getting the patient off of offending medications. This usually involves a short trial i.e. two to three weeks of medications. Some form of preventative medication is recommended which in many cases will involve the only FDA approved indication for CM, Botox injections (see below).  

massage therapyAs most patients with chronic headache usually have significant cervical musculoskeletal pain, neuromuscular rehabilitation (i.e. massage, ultrasound, electrical stimulation and therapeutic exercise) is recommended.

biofeedbackMany patients also have significant psychological triggers i.e. stress and comorbidity, those patients are also evaluated by an affiliated behavioral psychologist who uses treatment modalities such as biofeedback, behavioral modification techniques, relaxation therapy, meditation and psychological counseling.

Follow up visits usually occur three to four weeks after your initial consultation and involve modifications to the current treatment plan. Most of our chronic headache patients will revert back to an episodic pattern (i.e. one or two headaches per week) after completing our initial program. At this point Dr. Conidi will work on ensuring the patient has an effective and appropriate abortive medication and preventative therapies are effective and at the appropriate dose. He will also begin to transition you off of adjunct treatments i.e. PT and behavioral therapy. Note: If you undergo diagnostic testing your follow up visit will occur a week or two after the initial visit so that the tests can be thoroughly reviewed and your plan of care modified if needed.

occipital nerve blockThe reality is that some patients will not respond to our initial program. Those patients may benefit from interventional techniques such as nerve blocks, trigger point injections and in patient hospitalization or out-patient infusion. Dr. Conidi will also re-evaluate for possible secondary headaches, treatment compliance and the possibility of Refractory Migraine. He has found that in some patients persistence and a never give up attitude often leads to results where others have failed.

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Refractory Migraine Patients As stated in our headache information section Refractory Migraine is a diagnosis of exclusion and should only be given when all standard and abortive and preventative medications have been tried. They key point is the word “standard”. Headache specialists have extensive knowledge of the physiology of headache, with that they often have discovered and/or developed off label medication regiments for these patients. However in many cases these therapies are ineffective. The Florida Center for Headache and Sports Neurology is one of the few centers in the world to offer neuro-stimulation. We use the Reed procedure i.e. dual occipital and supraorbital stimulation which has been demonstrated in well designed placebo controlled studies to reduce the number of headache days in refractory migraine patients by 84%, with many achieving complete remission, and almost all having a significant improvement in quality of life. These studies have been published in prestigious peer reviewed medical journals. Please visit the Reed Migraine website www.reedmigraine.com for more information.

Cluster 3Our Cluster Headache Program Dr. Conidi is about to present and publish the results of an open label trial on the use of injectable testosterone for the treatment of episodic cluster headache. The study is the largest to date and demonstrated an 84% remission rate (i.e. testosterone broke the cluster cycle in 84% of patients) with one or two injections of testosterone. There is also some data showing testosterone replacement therapy as a possible treatment for chronic cluster. In addition, both episodic and especially chronic cluster patients may be candidates for our dual neurostimulation program.

Sports Concussions • Migrains • Fibromyalgia • Neurological Disorders

3 CONVENIENT FLORIDA LOCATIONS:
Treasure Coast :: Palm Beach :: Broward
1.877.648.4762 - 1.772.337.7272

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