Heal Your Headaches

Two-part treatment relieves neck pain, chronic migraines.

In early April, not long after the coronavirus began to spread wildly across the United States, the National Institutes of Health launched a study to determine how many people became infected by the virus before anyone really knew what it was.

Photo by Nerissa Johnson.

Robert Palmer

For more than 12 years, guiding the NIH through its decision to launch such studies was a task that belonged to Robert Palmer, who once owned a consulting firm that specialized in organizational development in the Washington, DC, area.

“My specialty was working with not-for-profit and large multinational organizations,” Robert says. “If they had a pain point, they’d contact me, and I’d go in, diagnose the problem, figure out how to fix it and then help them do it.

“During my career, I was fortunate to work with many of the agencies inside the United Nations, including the World Health Organization and the National Institutes of Health, which was my biggest client for about 12 years.”

While advising a smaller client, Robert visited Florida for the first time some 20 years ago. He loved the climate so much that he moved here shortly thereafter, but life in the Sunshine State has not always been sunny for this active 76-year-old retiree.

Twice in the past 12 years, he has been badly injured in accidents that occurred while riding his bicycle. The first incident resulted in Robert undergoing neck fusion surgery. The second resulted in work being done on his lower back.

Throw in that arthritis has developed throughout his spine since the accidents and he has suffered from migraine headaches since childhood, and Robert has spent most of the past decade in debilitating pain.

“I had to give up riding a bike because it actually made my back worse,’’ Robert explains. “Because of the vibration and the jarring movement that came with riding a bike, I’d finish up a ride and just be miserable afterward.

“There were times when the pain was so bad that I almost couldn’t walk and a couple of times when I wound up in the emergency room because the pain was so bad that I couldn’t sit or stand or even lie down.

“As for the headaches, they’re genetic. My maternal grandmother had one on her 100th birthday. I started getting them when I was an adolescent. They diminished a bit when I was in my 20s and 30s, but they came back with a vengeance when I was in my late 40s.

“I could tell when one was coming on because the first thing I noticed was that I would get sick to my stomach. Then my speech would become slurred, and sometimes I’d see what I call fireworks. That’s what they look like. I see them inside my head. It’s these flashes that are just like fireworks going off. But between the slurred speech and nausea, I know a headache is coming on.

“I tried everything I could think of to get rid of them, even acupuncture and Chinese therapies, and when triptans first came out in the 1990s, I was one of the first to start using them, and they’ve helped a lot.

“They’ve sort of allowed me to manage things over the years. Thankfully, I have a high tolerance for pain because I’ve really had to just kind of learn to function with these headaches as well as with the back pain.”

But a functional life is not the same as a rewarding life. As a result, Robert has continually sought relief for his pain. He finally found it at McGreevy NeuroHealth in St. Augustine, the practice of Kai McGreevy, MD, DABPN, RPVI.

A board-certified neurologist and interventional pain management specialist, Dr. McGreevy also has an office in Palm Coast. Robert discovered Dr. McGreevy through his primary care physician shortly after McGreevy opened his practice several years ago.

Flashes of Fireworks

“When Robert came to us, he was suffering with chronic headaches,” Dr. McGreevy remembers. “They initially started as episodes with discrete beginnings and endings, but over the course of years, they turned into daily headaches. The condition was in the context of a history of migraines.

“Robert described his migraines as one-sided, throbbing head pain accompanied by nausea and sensitivity to light and loud sound. The pain worsened with head movement to a point that even his hair hurt and his scalp was very sensitive. The headaches were disabling, and Robert tried various preventive medications, but none sufficiently reduced the frequency or intensity of his headaches.”

Dr. McGreevy began his evaluation of Robert’s condition with a full history and complete neurological examination. He also ordered imaging tests of Robert’s neck and head, and through those tests he was able to rule out a brain tumor, or some other mass or aneurysm.

“But during my exam, I noted a tenderness behind Robert’s head in the region of the occipital nerves,” Dr. McGreevy reports. “He also exhibited something called a Tinel sign. When I tapped over the base of his skull, he felt a brief electrical sensation on top of the nerves in question.

“It became quite obvious that Robert had a condition more complicated than simple migraines. He was suffering from occipital neuralgia that transformed into chronic migraines. I recommended BOTOX® as a treatment for this condition.”

“Dr. McGreevy is a very good diagnostician,” Robert relates. “He’s very thorough and meticulous in the testing that he does and in the comprehensiveness of his evaluations. So when he said, What about BOTOX? I said, Sure, fine. And it’s been a godsend.”

Little Injections

BOTOX is a treatment for patients who have chronic headaches, meaning they have at least 15 headache days per month, or for those who suffer from at least eight migraines per month, McGreevy explains.

“BOTOX treatment is a series of injections designed to reduce the electrical sensation around the occipital nerves and relax the muscles of the scalp and head,” the neurologist notes. “It also relaxes the neck muscles where they insert on the back of the scalp.”

The exact way BOTOX works remains unclear, but it’s believed that it enters the nerve endings and blocks the release of chemicals that are involved in pain transmission. This prevents the brain from triggering pain pathways.

“In Robert’s case, we are able to treat his cervical spinal arthritis as well as his occipital headache pain simply by targeting the appropriate cervical nerves.” – Dr. McGreevy

“The BOTOX treatments involve a series of little injections above my eyebrows and up my forehead,” Robert relates. “They’re placed all around my head, then Dr. McGreevy ends up at the top of my spinal column. And the injections are well worth it.”

“As a result of the BOTOX treatments, Robert experienced a dramatic reduction in frequency and intensity of his headaches, a reduction in migraines specifically, and a reduction in nausea, light sensitivity, phonophobia and scalp sensitivity,” Dr. McGreevy elaborates. “As a result of that, he was able to function better.”

But occipital neuralgia wasn’t the only problem Dr. McGreevy discovered during his examination of Robert.

“Robert also had cervical spondylosis, which is the wear and tear on the neck joints due to osteoarthritis,” Dr. McGreevy expounds. “This complicates the occipital neuralgia and migraines, so we complemented Robert’s BOTOX therapy using another treatment called radiofrequency ablation, or RFA, which concentrates on the nerves of his upper cervical facet joints.

“Radiofrequency ablation helps to stabilize the cervical spondylosis that produces occipital head pain. The goal is to target the source of the head pain, which ultimately leads to relief of migraines and chronic daily headaches.”

The Best Fit

RFA has long been used for the treatment of arthritis neck pain, and today’s pain management specialists have tailored it to treat pain patterns radiating from the neck up into the head or down into the shoulders and arms. RFA can now be customized to address various pain syndromes, their signs and symptoms.

Photo by Nerissa Johnson.

treatments are helping alleviate Robert’s chronic migraines.

“What is unique about radiofrequency ablation is that it does not involve steroids, it is long-lasting and it can treat multiple problems at once,” Dr. McGreevy notes. “So in Robert’s case, we are able to treat his cervical spinal arthritis as well as his occipital headache pain simply by targeting the appropriate cervical nerves.”

Before proceeding with RFA, Dr. McGreevy conducts a diagnostic nerve block, also called a medial branch block, which is an injection of pain-relieving lidocaine under local anesthetic. The purpose of the medial branch block is to further confirm that the pain is being generated by the suspected joints and nerves. It proves the suitability of RFA as a treatment.

“Robert received dramatic pain relief, greater than 80 percent, following each diagnostic injection,” Dr. McGreevy recalls. “That allowed us to proceed with radiofrequency ablation as a definitive treatment for his cervical arthritis.”

RFA is often used for patients who have not received sustained pain relief from other treatments, including epidural steroid injections, facet joint injections and nerve blocks. In many cases, RFA is the best fit to improve patients’ pain control, range of motion and quality of life.

RFA is a minimally invasive, nonsurgical, outpatient procedure during which patients remain awake but are lightly sedated to minimize discomfort and reduce anxiety. Doctors consider it highly effective in temporarily reducing the kind of severe back and neck pain that plagues nearly two-thirds of the world’s population.

During RFA, radio waves are used to produce heat that is delivered through a probe to a group of specified spinal nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, thereby reducing discomfort in the troubled area.

By targeting and damaging the specific nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years.

“There are many chronic pain conditions that respond well to radiofrequency ablation,” Dr. McGreevy asserts. “These include spinal arthritis and spine degeneration, as well as pain after spine surgery.”

Dr. McGreevy details the steps of the RFA procedure: “When we are doing the radiofrequency ablation procedure, the patient lies on a table on their belly, and an x-ray camera is used to take pictures of the region we are working on,” he describes. “That is how we can see all the landmarks we need to safely perform the procedure.”

A local anesthetic is then administered to the skin and deeper tissues to provide comfort so that a needle can be inserted and directed toward the targeted nerves. When the needle is precisely positioned, a stylet is pulled out of the needle and replaced by a thin probe.

“Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.” – Robert

“The probe is directed to the targeted nerve, and a radiofrequency generator is turned on,” Dr. McGreevy continues. “That generator provides 120 seconds of radiofrequency waves, or energy, that are delivered to the targeted nerve and create the lesion that cauterizes the nerve.”

When the nerve is cauterized, it can’t send pain signals, so nothing is received and interpreted by the brain. Subsequently, no return message to feel pain is sent back to the affected area of the body.

“Using radiofrequency ablation, Robert received a 50 to 75 percent reduction in pain consistently over the course of nine to 12 months,” Dr. McGreevy states. “He had dramatic improvement in his occipital headaches as well.”

Garden Sanctuary

For nearly 12 years, Robert has lived with neck pain from spinal arthritis that began following the accidents on his bicycle. But he now understands how, over time, the arthritis has affected the chronic headaches and migraines he’s suffered since his youth.

“Dr. McGreevy explained to me that if I get a migraine I’m also going to get an occipital headache, and those are caused by the arthritis and its pinching of the nerves in my neck,” Robert states. “So, I can have occipital headaches, cluster headaches and migraines all at the same time. But if we stay on top of the headache situation, I can live with it.”

Actually, Robert says that he feels better now than he has in a long time.

“That’s absolutely true,” he agrees. “And my treatment is on a schedule now. About the time that the RFA wears off, it’s time to go back. The BOTOX takes about a week to kick in, then there’s an immediate diminishing of the pain level. The relief lasts for about 80 days, which is great because I can get the treatment every 91 days.”

Without the neck pain and headaches, Robert can participate in his favorite hobby, which is gardening, without restriction.Photo by Nerissa Johnson.

“I have a gorgeous garden,” he boasts. “Everyone in town knows about it. Because this is a tourist town, many people walk by my garden and ask questions such as, What’s that thing? What’s that blooming? And I let them take pictures.

“My garden is a sanctuary of sorts for butterflies, bees and hummingbirds. I provide whatever they need to thrive. Take a butterfly, for example. The adults need nectar flowers to feed on but a different kind of plant to lay their eggs on. When the eggs hatch, they feed on those plants before they turn into a chrysalis and become a butterfly.”

Were it not for Dr. McGreevy, Robert might not be as active in his garden. That’s why he’s grateful for Dr. McGreevy and his staff and why he’s quick to recommend the doctor to others needing a neurologist or pain management specialist.

“Dr. McGreevy is young and knows about all the new research,” Robert describes. “Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.

“And he’s a nice guy, too. He has a nice bedside manner. He also has a great staff at McGreevy NeuroHealth. They’re all very well-trained, so it’s not just him.
Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.”

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