At Modal Pain Management, Dr. Alex Movshis offers headache and migraine injections in NYC for chronic migraine, cluster headache, occipital neuralgia, cervicogenic headache, and tension-type headache with a muscular driver. Each injection type is chosen by headache phenotype rather than applied to everyone: PREEMPT-protocol Botox for chronic migraine, occipital and sphenopalatine ganglion blocks for the headaches that start in the neck or behind the eye, and trigger point injections where taut muscle bands are feeding the pain. Migraines and chronic headaches wear down work, sleep, and family life. The injections below are the treatments with the strongest published evidence for patients who have not done well on oral medication, or who cannot tolerate it.
Conditions We Treat
Our clinic specializes in treating a wide range of headache conditions through targeted injection therapy. We successfully manage chronic migraines with and without aura, helping patients who experience visual disturbances or other warning signs before headache onset. We also treat light and sound sensitivity headaches, which can significantly impact daily functioning and social activities. Cluster headache, with its intense, recurring attacks, is managed with occipital and sphenopalatine ganglion blocks as a bridge while preventive medication takes hold. Additionally, we address vestibular migraines that cause dizziness and balance problems, ocular migraines affecting vision, and migraine-related neck and spine tension that often accompanies head pain. For patients with tension-type headaches resulting from muscle tightness and stress, our injection treatments provide effective relief by addressing both muscular and neurological components of pain.
How Headache Injections Work
Understanding how headache injections provide relief requires knowledge of migraine pain pathways. Migraines and chronic headaches often result from irritated or inflamed nerves, overactive muscle groups, or sensitized nerve endings that transmit excessive pain signals to the brain. Injection-based therapies work by interrupting these pain pathways at strategic points, reducing nerve inflammation, and blocking pain signal transmission to the central nervous system. When we administer targeted injections to specific nerves or muscle groups, we effectively “turn down the volume” on pain signals, preventing migraines before they fully develop or significantly reducing their severity and duration. This mechanism makes injection therapy particularly effective for patients who have not responded adequately to oral medications or who experience limiting side effects from systemic drugs. The beauty of this approach lies in its precision—we target the exact anatomical structures responsible for your pain, minimizing systemic effects and maximizing therapeutic benefit.
Our Treatment Approach
Dr. Movshis and our team perform detailed evaluations using a full neurological exam and imaging when it is needed to identify the specific nerve pathways, muscle patterns, and environmental triggers contributing to your migraines. We spend time understanding your complete medical history, migraine patterns, and previous treatment responses. This thorough assessment allows us to develop a truly individualized treatment plan tailored to your unique pain mechanisms and medical needs. No two patients are identical, and our customized approach reflects this understanding.
Botox™ Injections for Migraine Prevention
Botox™ (onabotulinumtoxinA) is FDA-approved to prevent headaches in adults with chronic migraine — headache on 15 or more days a month for more than three months, with migraine features on at least eight of those days [1][2]. It is given as a fixed map of 31 small injections across seven muscle areas of the head and neck, 155 units per session, repeated every 12 weeks [2][3]. Whether you meet the label and the usual insurance criteria takes two minutes to check: chronic migraine Botox eligibility check.
It is not a muscle relaxant for migraine. The toxin does weaken the muscles it is injected into — that is why neck pain and muscle weakness are its most common side effects — but relaxing muscle is not how it prevents attacks. Migraine is a sensory disease, and the injections work at the sensory nerve endings under the skin: the toxin blocks the release of CGRP and other pain-signalling neuropeptides from those endings, so fewer pain signals reach the trigeminal system and the brain, and the nervous system becomes less sensitized over repeated cycles [4][5][6]. In the pooled PREEMPT trials, patients had 8.4 fewer headache days per month at 24 weeks versus 6.6 on placebo; a Cochrane review puts the placebo-adjusted benefit at about two fewer headache days a month in chronic migraine, with no benefit in episodic migraine [3][7]. Most patients notice a change within the first month, and the response is judged over two to three cycles rather than after one. Our complete guide to Botox for chronic migraine and the 72-second mechanism animation cover the evidence in more depth.
Occipital Nerve Blocks
Occipital nerve blocks represent a highly effective treatment for migraines originating from the back of the head and upper neck. The occipital nerves, which originate from cervical spine nerve roots, supply sensation to the back of the scalp and upper neck. When these nerves become inflamed or sensitized, they generate intense, often unilateral headache pain. By performing precise injections of local anesthetic and anti-inflammatory medications around the occipital nerves, we effectively block pain signal transmission and reduce nerve inflammation. These injections provide both immediate and lasting relief, with many patients experiencing improvement within hours to days. Occipital nerve blocks are particularly valuable for patients with occipital neuralgia, migraines with prominent occipital components, and cervicogenic headaches where neck dysfunction contributes to head pain.
Sphenopalatine Ganglion (SPG) Blocks
The sphenopalatine ganglion is a critical nerve cluster located in the pterygopalatine fossa, deep within the facial region. This ganglion plays a central role in migraine pain generation, particularly in cluster headaches and certain types of facial pain. SPG blocks involve precise injection of anesthetic and anti-inflammatory agents near this ganglion, effectively interrupting the pain and autonomic symptoms associated with cluster headaches and certain migraines. These blocks can provide rapid, dramatic pain relief, often within minutes to hours. For some patients an SPG block shortens or interrupts a cluster cycle. It is a bridge and an adjunct, not a stand-alone preventive, and it is most useful in chronic cluster headache and select facial pain.
Facial Nerve and Trigeminal Nerve Injections
The trigeminal nerve system is the primary pain pathway involved in most migraine pathophysiology. Targeted injections along migraine nerve pathways reduce nerve irritation, decrease nerve sensitization, and interrupt pain signal transmission. This approach is particularly effective for patients with significant trigeminal nerve involvement or facial pain associated with their migraines. We can target various branches of the trigeminal nerve system, including the supratrochlear, supraorbital, and other facial divisions, depending on your specific pain distribution and pattern.
Medial Branch Blocks
Medial branch blocks address the cervical and thoracic spine nerves connected to headaches originating from neck dysfunction and muscular tension. These injections numb the small medial branch nerves that innervate the facet joints in the cervical spine, providing both diagnostic information about pain sources and therapeutic relief. Medial branch blocks are especially valuable for migraines involving neck and occipital pain, particularly in patients with cervicogenic headaches where cervical spine pathology contributes to head pain mechanisms.
What to Expect During Your Headache Injection Treatment
Before coming to our NYC clinic for your procedure, we’ll conduct a full consultation to review your complete migraine history, including frequency, triggers, associated symptoms, and all previous treatment attempts. We’ll discuss your medical history, current medications, and any contraindications. We recommend avoiding blood-thinning medications or supplements for several days before your appointment, as directed by Dr. Movshis, to minimize bruising and bleeding at injection sites. Arrive with a clean face and wearing comfortable clothing that allows easy access to treatment areas.
During your procedure, our clinical team will position you comfortably and apply topical anesthetic to minimize discomfort. The actual injections are quick, minimally invasive procedures typically completed within thirty minutes. Most patients tolerate the treatment exceptionally well, with only mild discomfort during needle placement. We use advanced ultrasound or fluoroscopic guidance for certain blocks, ensuring maximum accuracy and safety. You’ll be able to sit up immediately after treatment and return to normal activities, as there’s no recovery period required.
After your injections, most patients resume normal activities within twenty-four hours. You may experience mild soreness, slight swelling, or bruising at injection sites, which typically resolves within a few days. Some patients report improvement after their first treatment session, while others experience gradual reduction in migraine intensity, frequency, and duration over two to three weeks as medications take full effect. We’ll monitor your response carefully and make treatment adjustments based on your ongoing results. Many patients benefit from maintenance treatments scheduled at regular intervals to sustain their improvements.
Botox™ Savings Program and Insurance
Allergan’s Botox™ Savings Program can reduce out-of-pocket costs for commercially insured patients receiving Botox for chronic migraine; our team checks eligibility with you. Modal Pain Management accepts most major commercial PPO plans and does not participate with Medicare or Medicaid. Benefits are verified before your first injection session, so you know your responsibility in advance.
References
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417738202 · PubMed
- BOTOX (onabotulinumtoxinA) for injection — US Prescribing Information. Allergan, Inc. (an AbbVie company). DailyMed, U.S. National Library of Medicine; label updated November 18, 2023. DailyMed
- Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921-936. doi:10.1111/j.1526-4610.2010.01678.x · PubMed
- Burstein R, Blumenfeld AM, Silberstein SD, Manack Adams A, Brin MF. Mechanism of Action of OnabotulinumtoxinA in Chronic Migraine: A Narrative Review. Headache. 2020;60(7):1259-1272. doi:10.1111/head.13849 · PubMed
- Burstein R, Zhang X, Levy D, Aoki KR, Brin MF. Selective inhibition of meningeal nociceptors by botulinum neurotoxin type A: therapeutic implications for migraine and other pains. Cephalalgia. 2014;34(11):853-869. doi:10.1177/0333102414527648 · PubMed
- Diener HC, Dodick DW, Turkel CC, Demos G, Degryse RE, Earl NL, Brin MF. Pooled analysis of the safety and tolerability of onabotulinumtoxinA in the treatment of chronic migraine. European Journal of Neurology. 2014;21(6):851-859. doi:10.1111/ene.12393 · PubMed
- Herd CP, Tomlinson CL, Rick C, et al. Botulinum toxins for the prevention of migraine in adults. Cochrane Database of Systematic Reviews. 2018;6(6):CD011616. doi:10.1002/14651858.CD011616.pub2 · PubMed
