Services

• At Vertrees Headache Center, we believe getting to really know you is crucial to establishing an optimal and individualized diagnosis and treatment plan.
• At the first visit, You will fill out an intake form that we’ll review together during your visit. We’ll need this filled out prior to scheduling your visit.
• At the initial visit to our center, expect a 45-60 minute session consisting of lots of questions. We’ll really listen as you tell us what’s going on. It’s your story, and we want to hear it. We’ll review any records you bring in, and then perform a general and neurological examination.
• The next part of the visit is key: we sit together and discuss your condition in detail. This is a dialogue, not a monologue, and your input is essential. We promise to answer all of your questions (and your mom’s, spouse’s, best friend’s, and co-worker’s questions too!) as we design a customized approach to figuring you out and getting you better.
• Please bring or fax your records, labs, scans – we’ll go through it all.
• Expect homework which may or may not include reading, videos, tests, referrals, treatment plans, etc.

• At the follow-up visit, we go over how you’re doing, what the tests showed, and what you’ve learned (yes, we check your homework!). Since we’re holistic we’ll again ask a lot of questions about things like diet, sleep, exercise, stress, medication, side-effects, etc. We may examine you and ask you fill-out those standardized forms again, to track your progress.
• At these 20-30 minute follow-up visits we continue to work together to further customize your health treatment plan. Our promise is to listen, to educate, and to answer all of your questions. Once you’re doing great, the follow-up visit serves as a “check-in” periodically (at least once a year if not more, depending on your needs) to make sure all is well, renew prescriptions, chat and update us on your life.

Okay, so there’s a lot to cover here. Since there seems to be a fair amount of preconceived (if not always accurate) notions, half-truths and strong opinions, we thought we’d get you up to speed on Botox with a Question & Answer session. Here goes:

• Q. What exactly is Botox?
• A. Botox belongs to a class of Botulinum neurotoxins, the same little proteins that can cause botulism if you ingest them (think, poorly canned or refrigerated foods). Botulism is a medical condition that causes paralysis of the body. Obviously, we aren’t giving people botulism! You don’t ingest the toxin. Instead, we use a purified, diluted form of the toxin (Botox) and inject it into specific muscles to get a specific effect. They’re very helpful little molecules.
• Q. But Botox is used for wrinkles, right? Why do you use it?
• A. While everyone‘s heard that Botox reduces brow lines and crow’s feet, Botox has been used to treat a variety of conditions for decades, including chronic migraine, spasticity, hyperhidrosis, cervical dystonia, blepharospasm, hemifacial spasm, spasmodic dysphonia, tremor, overactive bladder, and cosmetic purposes. Our focus is to inject Botox for the treatment of chronic migraine, but occasionally we can satisfy other issues at the same time.
• Q. But the ‘neurotoxin’ part sounds dangerous. Is Botox safe?
• A. Absolutely! Injected locally, Botox generally stays where it’s injected, so there are no systemic side-effects. That means no liver, kidney or heart toxicity, no weight gain, nausea, diarrhea, insomnia, rash, joint pain…well, you get the idea. And, no drug-drug interactions with any of the medications you take.
• Q. Really?
• A. Honest. When done properly, Botox is safer than Tylenol (which can hurt the liver), by a long shot. The only side effects one could ever have are local, at the injection site, and could include a bruise, local pain, or weakness, all of which are temporary. And if weakness occurs, we can modify the injections so that it doesn’t happen to you again. One of my mentors used to say that “all medications are poisons with positive side effects”. This concept applies to pharmaceuticals, vitamins, minerals, herbs, water, and anything else you put in your body. Botox is no different.
• Q. Okay, you convinced me about the safety thing, but does it hurt?
• A. In studies, most people rated the injection pain as mild or non-existent, and only 5% of folks report the pain as anything more than moderate. We chat during the injections, and do them fast, roughly 5 minutes of injection time. The most common reaction we hear after injecting a first-timer is, “That’s it? I stayed up all night worrying about THAT?” We smile. And most of the time, it hurts a bit the first time and gets easier with each time you get it done.
• Q. Is Botox permanent?
• A. No. The body naturally breaks it down over time, and that usually takes about three months, give or take. Most Botox patients drop in four times a year for their shots. It’s a long term treatment, so you can expect to get to know us very well!
• Q. Okay, I’m in. Will my insurance cover Botox?
• A. Botox for chronic migraine is generally covered by your insurance. We’ll do a prior authorization and have all that sorted out for you before the injections.

• Nerve blocks and trigger point injections involve using a small needle to inject numbing medicine, sort of like getting a Novocaine shot at the dentist’s office. They burn a bit during the injection but afterward you feel numb and relaxed, and hopefully headache free.
• Nerve block injections involve using a small needle to inject a numbing medication onto sore, irritated nerves of the head and face.
• Trigger point injections involve using a small needle to inject a numbing medication into sore, tight muscles in the neck and shoulder region.

• SPG blocks involve using a device that threads a tiny, flexible catheter up the nose to numb up a ganglion at the back of the palate (called the sphenopalatine ganglion, or SPG). It’s a lot better than it sounds. The SPG is responsible for causing a variety of headache conditions. The SPG block is therefore a very useful tool. It takes about 5 minutes to perform and is virtually pain free. Here’s a demo video: https://tianmedical.com/#about-us

• Obtaining prior authorizations for special medications can take hours of time. Our fee helps us support our administrative staff.

• Please note that we may not be able to fill out some of these forms under certain circumstances. We believe in keeping our headache patients working and in their jobs if at all possible, and we believe that we should know you well before we are entrusted to fill out this kind of paperwork for you. Therefore, filling out this paperwork is at the discretion of your doctor. Also, functional assessments cannot be performed in our office due to a lack of necessary equipment, but we are happy to provide you with any medical records to support your disability claims.