Headaches and migraines can come from many different sources, including migraine biology, neck pain, jaw dysfunction, nerve irritation, autonomic symptoms, inflammatory conditions, hypermobility, post-COVID changes, or complex chronic pain patterns.
This video explains how Manhattan Pain Medicine evaluates headaches, migraines, facial pain, neck-related headaches, and complex overlapping symptoms through a diagnosis-first approach.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman. I’m medical director at Manhattan Pain Medicine. When we evaluate a patient with headache, we are looking to establish what is the headache and is there more than one kind of headache. We look for primary headaches as well as secondary headaches and we want to understand what triggers for those headaches are in play.
For example, migraine by itself is generally straightforward. If it’s chronic migraine, if it’s constantly being triggered, there’s an underlying reason for that trigger. We look more broadly to understand what those triggers are and how can we treat those triggers; that may include TMJ dysfunction, head-neck instability, autoimmune conditions, any variety of systemic processes may also trigger headache.
We want to understand which primary headaches are in play, which secondary headaches are in play, and what’s driving those headaches. What’s keeping them from getting better? By understanding what the reasons for these headaches are, we are best equipped to develop a comprehensive treatment plan across all of our specialists if needed to provide robust headache treatment for you.
Headache and migraine are not one single condition. Some patients experience occasional headaches, while others live with chronic migraine, daily headache, severe one-sided head pain, facial pain, neck-related headache, dizziness, light sensitivity, nausea, sound sensitivity, or headache symptoms that do not respond to standard treatment.
At Manhattan Pain Medicine (MPM), evaluation begins with understanding the headache pattern before recommending care. The goal is to identify whether symptoms are most consistent with migraine, tension headache, cluster headache, trigeminal autonomic cephalalgia, trigeminal neuralgia, cervicogenic headache, TMJ-related pain, cervical dystonia, post-COVID headache, inflammatory disease, hypermobility-related headache, craniocervical instability, Chiari malformation, intracranial pressure concerns, medication overuse, or central pain sensitization.
Because different headache types require different care pathways, MPM uses a diagnosis-first model to evaluate headache drivers, red flags, overlapping symptoms, and the role of coordinated specialty care.
For patients looking for headache and migraine treatment in Manhattan, MPM evaluates more than the headache itself. The assessment may include headache location, frequency, duration, triggers, medication use, neurologic symptoms, nausea, light or sound sensitivity, dizziness, neck pain, TMJ symptoms, autonomic symptoms, inflammatory history, hypermobility, post-COVID changes, and prior imaging or specialist workup.
Care may involve medication management, Botox for chronic migraine in selected patients, trigeminal nerve blocks, trigger point injections, pain psychology, biofeedback, acupuncture, ketamine-related therapies when appropriate, and coordination with neurology, rheumatology, ENT, dentistry, ophthalmology, neurosurgery, primary care, or other specialists when needed.
MPM does not treat every headache with procedures. The treatment plan depends on the headache type, suspected pain generator, medical history, prior response to care, risk profile, and functional goals.
Headaches can be difficult to diagnose because similar symptoms may come from different systems. A patient with head pain may have migraine, neck-related headache, TMJ dysfunction, trigeminal neuralgia, cluster headache, hemicrania, tension headache, cervical dystonia, sinus or ENT symptoms, autoimmune inflammation, autonomic dysfunction, or medication overuse headache.
Some patients also have complex overlap with EDS, hypermobility spectrum disorder, POTS, MCAS, lupus, post-COVID pain, suspected CCI, Chiari malformation, CSF outflow obstruction, or intracranial hypertension. These conditions do not automatically explain every headache, but they may influence how symptoms are evaluated.
MPM’s diagnosis-first approach helps determine whether the headache is primarily neurologic, musculoskeletal, autonomic, inflammatory, jaw-related, nerve-related, centrally sensitized, or mixed.
Headache and migraine sit at the center of MPM’s Headache Zone of Expertise, with important overlap across Complex Chronic Pain, Hypermobility, Autoimmune and Inflammatory, Autonomic dysfunction, Psychology of Pain, and Musculoskeletal issues.
For some patients, headache symptoms are primarily migraine-driven. For others, symptoms may involve cervical pain, jaw mechanics, dystonia, trigeminal nerve irritation, autonomic symptoms, inflammatory disease, post-viral changes, hypermobility-related instability, or centralized pain processing.
MPM’s role is to identify the most likely drivers, clarify the treatment pathway, and coordinate care when the headache pattern is complex or multi-source.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
A headache is a broad symptom that can have many causes. Migraine is a neurological condition that can cause head pain along with symptoms such as nausea, light sensitivity, sound sensitivity, aura, dizziness, brain fog, or functional impairment. Migraine pain may be throbbing, pulsing, one-sided, or disabling, but symptoms vary by patient. Care begins by identifying the headache type rather than assuming every headache is migraine.
A specialist evaluation may be helpful when headaches are frequent, severe, worsening, disabling, treatment-resistant, or associated with complex symptoms such as facial pain, dizziness, neck pain, jaw pain, autonomic symptoms, neurologic symptoms, inflammatory disease, hypermobility, post-COVID symptoms, or medication overuse. New or concerning headache symptoms should be evaluated promptly.
Chronic migraine can involve migraine biology, genetics, triggers, sleep disruption, hormones, stress physiology, medication overuse, neck and jaw contributors, autonomic dysfunction, inflammatory conditions, and overlapping chronic pain patterns. Many patients have more than one contributor, which is why diagnosis-first evaluation is important before changing medications or adding procedures.
Neck problems may contribute to selected headache patterns. Cervical joints, muscles, nerves, posture, dystonia, CCI, or musculoskeletal dysfunction can overlap with headache and migraine symptoms. However, not every migraine is caused by the neck. MPM evaluates the neck, jaw, nerve pathways, and headache pattern together to determine whether cervical factors are clinically relevant.
TMJ disorders can overlap with headaches, facial pain, jaw pain, ear pressure, neck tension, and migraine-like symptoms. Jaw clenching, bruxism, muscle overactivity, joint irritation, and orofacial pain may contribute to tension-type headache, migraine flares, or facial pain in selected patients. MPM evaluates TMJ-related symptoms in the broader headache and facial pain context.
Treatment depends on the headache diagnosis and patient history. Options may include medication management, acute medications, preventive medications, CGRP-targeting therapies, Botox for chronic migraine in appropriately selected patients, trigger management, sleep and lifestyle strategies, pain psychology, biofeedback, acupuncture, and selected nerve blocks when the pain pattern supports them.
Botox is used as a preventive treatment for chronic migraine in appropriately selected patients. It is not a treatment for every headache type. The decision depends on headache frequency, diagnosis, prior treatments, medical history, risk profile, and clinician evaluation. Botox for migraine is different from cosmetic Botox and follows a medical treatment protocol.
Nerve blocks may be considered for selected headache or facial pain patterns. Depending on the diagnosis, options may include trigeminal nerve block, occipital nerve block, or other targeted approaches. Nerve blocks are not appropriate for every patient and should be guided by the headache type, pain location, neurologic findings, and overall treatment plan.
Autonomic dysfunction, hypermobility, mast cell-related symptoms, inflammatory conditions, and autoimmune disease may coexist with headache disorders in some patients. These conditions can influence symptoms such as dizziness, flushing, fatigue, neck pain, light sensitivity, inflammatory flares, or pain sensitivity. MPM evaluates these relationships carefully without assuming that one condition explains every headache.
A headache should be evaluated urgently if it is sudden and severe, the worst headache of the patient’s life, follows head injury, or occurs with fever, stiff neck, confusion, fainting, seizure, weakness, numbness, trouble speaking, vision loss, new neurologic symptoms, pregnancy, cancer history, immune suppression, new headache after age 50 or 55, or a major change in headache pattern.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If recurring headaches, chronic migraine, facial pain, neck-related headaches, dizziness, light sensitivity, nausea, or treatment-resistant symptoms are affecting your life, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers migraine, cluster headache, tension headache, trigeminal neuralgia, TMJ-related pain, cervical dystonia, autonomic dysfunction, hypermobility, inflammatory disease, post-COVID pain, and complex chronic pain patterns. Request an appointment to discuss your symptoms and care options.
Headache and migraine are common, but persistent or complex head pain should not be treated as one simple diagnosis. A patient may have migraine, tension headache, cluster headache, hemicrania, trigeminal autonomic cephalalgia, trigeminal neuralgia, cervicogenic headache, TMJ-related headache, post-COVID headache, medication overuse headache, or another condition that requires a different treatment pathway.
At Manhattan Pain Medicine, the first step is to understand the pattern. Where is the pain? How often does it happen? How long does it last? What triggers it? What symptoms come with it? Does the patient experience nausea, light sensitivity, sound sensitivity, aura, dizziness, facial pain, jaw pain, tearing, nasal symptoms, neck pain, weakness, numbness, or vision changes?
These details help determine whether the headache is primarily migraine-related, nerve-related, neck-related, jaw-related, autonomic, inflammatory, structural, or part of a broader chronic pain pattern.
Migraine is a neurological condition. It can involve head pain, nausea, light sensitivity, sound sensitivity, aura, dizziness, visual changes, brain fog, neck discomfort, fatigue, and functional impairment. Some patients have clear triggers. Others have attacks that seem unpredictable.
Chronic migraine can be especially disruptive because symptoms may occur frequently and interfere with work, sleep, family life, concentration, movement, and daily function. Patients may also develop medication overuse headache when acute medications are used too often, which can make headache patterns more difficult to manage.
MPM evaluates medication history, prior response to care, headache frequency, and overlapping pain contributors before recommending a treatment plan.
Several headache disorders can resemble migraine but require different evaluation. Cluster headache and other trigeminal autonomic cephalalgias may cause severe one-sided pain around the eye or temple with tearing, eyelid changes, nasal congestion, runny nose, or restlessness. Hemicrania can also involve one-sided headache patterns that may respond to specific medication strategies.
Tension headache may feel like pressure, tightness, or band-like pain and may overlap with neck tension, jaw clenching, stress physiology, or muscle pain. Trigeminal neuralgia may cause brief electric-shock facial pain triggered by touch, chewing, brushing teeth, or speaking. TMJ disorders may cause jaw pain, clicking, chewing pain, facial pain, ear pressure, and headache.
A diagnosis-first approach helps avoid treating all head pain as the same condition.
Many patients with headache also have neck pain, jaw pain, shoulder tension, or facial pain. These symptoms may be secondary to migraine, or they may point to a separate pain generator.
Cervical muscle dysfunction, trigger points, cervical dystonia, craniocervical instability, posture and movement patterns, TMJ dysfunction, bruxism, or trigeminal nerve irritation may all contribute to certain headache presentations.
MPM evaluates these relationships carefully. The goal is not to assume that every headache comes from the neck or jaw. The goal is to determine whether those areas are meaningfully contributing to the patient’s symptoms.
Some patients with EDS or hypermobility spectrum disorder experience headaches alongside neck pain, dizziness, fatigue, jaw symptoms, autonomic symptoms, or suspected instability. In selected patients, headache evaluation may need to consider craniocervical instability, Chiari malformation, CSF outflow obstruction, intracranial hypertension, POTS, or other autonomic concerns.
These conditions require careful evaluation and appropriate specialty coordination. MPM considers hypermobility and autonomic symptoms as part of the overall clinical picture without assuming they explain every headache.
Headache can also overlap with inflammatory, autoimmune, mast cell-related, or post-viral symptoms. Patients with lupus, MCAS-like symptoms, post-COVID pain, or inflammatory disease may describe headache flares alongside fatigue, body pain, dizziness, sensitivity, or systemic symptoms.
MPM evaluates whether the headache appears to be a primary headache disorder, part of an inflammatory pattern, post-viral symptom pattern, autonomic overlap, medication effect, or centralized pain process. Coordination with rheumatology, neurology, primary care, or other specialists may be needed.
Treatment depends on the diagnosis. Some patients need medication management, acute migraine strategies, preventive therapy, CGRP-targeting therapies, or Botox for chronic migraine. Others may benefit from trigger point injections, trigeminal nerve block, acupuncture, biofeedback, pain psychology, or coordinated treatment for TMJ, dystonia, neck pain, or autonomic symptoms.
Botox may be used for chronic migraine in appropriately selected patients. Botulinum toxin may also be used for selected dystonia or TMJ-related muscle patterns when those diagnoses are present. Nerve blocks may be considered when the headache or facial pain pattern supports a targeted approach.
Ketamine therapy, lidocaine and ketamine infusions, and other infusions should be considered only for selected pain patterns after careful evaluation. They are not standard treatments for every migraine or headache presentation.
Pain psychology and biofeedback can be helpful tools for some patients with chronic headache, migraine, central sensitization, medical trauma, stress-related flares, sleep disruption, fear of symptoms, or nervous system sensitivity.
These treatments do not mean the headache is imagined. They support nervous system regulation, coping, pacing, sleep, stress physiology, and functional recovery while medical care continues.
Some patients with headache need imaging or specialty evaluation, especially when headaches are new, changing, severe, neurologically complex, or associated with red flags. Neurology, ophthalmology, ENT, dentistry, neurosurgery, rheumatology, or primary care may be involved depending on the suspected cause.
MPM coordinates care when headache symptoms suggest trigeminal neuralgia, cluster headache, CCI, Chiari malformation, intracranial hypertension, CSF outflow concerns, inflammatory disease, TMJ dysfunction, cervical dystonia, or other complex conditions.
Patients should seek urgent medical evaluation for sudden severe headache, the worst headache of their life, headache after head injury, headache with fever or stiff neck, confusion, fainting, seizure, weakness, numbness, trouble speaking, vision loss, new neurologic symptoms, pregnancy with headache, cancer history, immune suppression, new headache after age 50 or 55, or a major change in headache pattern.
These symptoms may reflect serious neurologic, vascular, infectious, inflammatory, or pressure-related conditions and should not be managed as routine migraine.
MPM approaches headache and migraine through a diagnosis-first, coordinated model. The goal is to identify the headache type, map overlapping pain generators, screen for red flags, and build a plan that fits the patient’s symptoms and history.
For patients looking for headache and migraine treatment in Manhattan, MPM offers a careful pain medicine perspective that integrates headache care, neck and jaw contributors, nerve pain, autonomic dysfunction, hypermobility, inflammatory overlap, psychology of pain, and complex chronic pain.
The goal is to clarify what is driving the headache pattern and guide appropriate next steps without overpromising outcomes.
