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Headaches & Migraines

Are you experiencing too many headaches?

Millions of Americans suffer from migraine headaches. If you or someone you know has been suffering from migraines, the Headache & Pain Center of Palm Beach and Dr. Robert J. Friedman can help provide the latest insights on new headache and migraine treatments.

We Specialize in Migraine and Headache Management

Below are some of the treatments that the Headache & Pain Center of Palm Beach, located in Palm Beach Gardens, Florida, can offer to people suffering from headaches and migraines. Dr. Friedman will work with you to devise a plan that is right for you and your pain needs.

Medical Acupuncture

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning. In the right hands, acupuncture is a low-risk treatment.

Dr. Friedman combines treatment of traditional Chinese acupuncture points with his medical experience and knowledge of nerves and muscles to help with headaches.

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Transcranial Magnetic Stimulation (TMS) for Headaches

Recent studies show that transcranial magnetic stimulation (TMS) can be useful for some types of migraine, and a trigeminal nerve stimulation device was approved by the FDA for migraine treatment.

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Cefaly

Cefaly is the first device of its kind created to prevent migraine headaches. The FDA-cleared, non-drug migraine treatment prevents migraines by applying a gentle, electric current to the head that stimulates specific nerves. Dr. Robert J. Friedman is one of the first headache specialists to offer Cefaly treatments for individuals suffering from migraines.

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tDCS for Headaches

Transcranial Direct Current Stimulation (tDCS) is a type of neuromodulation therapy designed to alter the way the nervous system (nerves, spinal cord, and/or brain) transmits messages that occur when pain nerve cells are stimulated or damaged. tDCS is a unique, safe option for trying to alleviate chronic pain. tDCS trials that have shown success include migraine headaches.

Medical Foods

We offer several types of medical foods focused on pain conditions and related disorders. These formulations are designed to boost certain neurotransmitters, reduce inflammation, or relieve associated problems

A few types of nutritional and herbal supplements have enough evidence to support their use for conditions such as headaches (eg: Feverfew and MigreLief).

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Nerve Blocks & Botox

Nerve blocks can be used for headaches such as occipital neuralgia and cluster headaches. They are injections of numbing medicine (local anesthetic) and anti-inflammatory steroids that can be useful for certain types of headaches and other pain conditions.

Botox was recently approved by the FDA for the treatment of chronic migraines (15 or greater headache days per month).

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Medication Management

Some newer, very effective medications are available to treat migraines. They specifically act on the migraine mechanism and usually don't have the drawbacks associated with painkillers. However, in some patients with very frequent headaches, medication may actually be part of the problem.

Depending on your type of pain, the cause of your pain, your individual needs and other factors, your physician can determine if managing your pain with medications is the right choice for you.

Learn More »

Medical-Legal Services and IMEs

medical-legal-servicesRobert J. Friedman, MD is available for medical-legal consultations (attorneys call this being an expert witness) in Pain Management and Neurology cases. Often, in the legal system, a doctor is needed to explain medical issues to, or to educate the “trier of fact” (jury and/or judge). Dr. Friedman has been retained by both plaintiff and defense attorneys for this type of work.

Dr. Friedman has acted as an expert witness in neurology and an expert witness in pain management. Dr. Friedman has been retained numerous times to address pain medication issues. Dr. Friedman has testified live in Federal court as well as several Florida courts. He has also been asked to address issues relating to the practice of medicine in relation to state medical board actions.

Dr. Friedman also performs neurology Independent Medical Examinations (IMEs) and pain management Independent Medical Examinations at the request of both plaintiff and defense attorneys, insurance companies, government agencies, and other entities.

"Dr. Friedman is an experienced neurologist who treats his patients with compassion and insight. He has a painless EMG technique and is an excellent diagnostician. Highly recommended."

Charles Eaton
President, Dupuytren Foundation

Dr. Friedman is Certified by the American Board of Independent Medical Examiners and recently completed a 15-hour course in the implementation of the AMA Guides to the Evaluation of Permanent Impairment (6th Edition). These guides are used to determine the degree of impairment (which means loss of bodily function) due to a permanent medical condition or injury.

Dr. Friedman has been appointed an Expert Medical Advisor for the Florida Division of Worker’s Compensation. Expert Medical Advisors help Florida administrative judges settle disputes in worker’s compensation cases.

Dr. Friedman has provided opinions and testimony as an expert witness regarding the following issues, among others:

  • Standard of care in neurology
  • Standard of care for pain management
  • Pain medication issues (involving such drugs as narcotic (opioid) pain medications)
  • State medical board cases
  • Peripheral nerve injuries
  • Complex Regional Pain Syndrome
  • Botulinum (Botox) injection
  • Spinal trauma
  • Traumatic brain injury
  • Headache disorders
  • Complex Regional Pain Syndrome (CRPS)/RSD

Attorneys and other professionals such as insurance company representatives may request a medical-legal consultation or schedule a neurology or pain management Independent Medical Examination by sending a request or calling 561-842-7246.

» Download Robert J. Friedman, MD's Full CV

Medication Management

There are a number of different types of treatments involving medications. Depending on your type of pain, the cause of your pain, your individual needs and other factors, your physician can determine if managing your pain with medications is the right choice for you. 

  • OTC (Over-the Counter)
  • NSAIDs
  • Opioid Analgesics
  • Tramadol
  • Neuropathic Medications
  • Topical Medications
  • Migraine Medications
  • Vitamins & Supplements

  • OTC (Over-the Counter) Medications

    These are sometimes overlooked, but can be helpful for pain such as from headaches or arthritis.

    Example: Tylenol

    medicationmanagment2

  • Non-Steroidal Anti-Inflammatory Drugs

    + Advantages: Little chance of sedation, dizziness etc. 

    - Disadvantages: Risk of ulcers; May be some increased stroke and heart attack risk in people with high blood pressure, heart disease, etc.

    Example: Naproxen

    medicationmanagement

  • Opioid Analgesics

    Although these medications are often called “narcotics”, the term opioids more properly encompasses all powerful pain killer medications acting on a certain pain-modulating neurotransmitter receptor in the body.

    These medications can be very effective for some types of chronic pain; however, they are not appropriate for everybody. Your body may become dependent on the medication and withdrawal symptoms may be experienced if the medication is stopped too suddenly. People with a personal or family history of addiction are at higher risk to experience compulsive use of the medication for purposes other than pain control. Taking the medication in doses other than prescribed, or by another route, can be fatal.

    So, this type of drug is not appropriate for everybody with chronic pain, and certain precautions need to be taken when they are being considered. Other options should usually be tried before committing to this type of treatment.

    ADDITIONAL INFORMATION | Our Pain Medication Office Policy

    ADDITIONAL INFORMATION | Clinical Guidelines for the Use of Chronic Opioid Therapy

    ADDITIONAL INFORMATION | Florida's Department of Health "Standards for the Use of Controlled Substances for the Treatment of Pain" Opioid Guidelines

  • Tramadol

    This medication is in a class by itself. It has many of the painkilling properties of opioids but also seems to act on other pain-modulating systems such as norepinephrine.

    It has some possible side effects that are similar to those of opioids but also should be avoided if there is a history of seizures.

  • Medications for neuropathic pain

    A number of pain medications are not painkillers per se, but act to reduce pain by acting on various areas of the nervous system. They can be very helpful for neuropathic pain (which is due to injury or damage to the nerves or spinal cord).

    Examples: Neurontin (gabapentin - also used to prevent seizures), Lyrica, and Cymbalta (used for nerve pain, fibromyalgia, as well as depression)

  • Topical medications (patches, creams)

    Some of these can be helpful when the pain is localized to a small area. One advantage is a lower risk of side effects than when pills are administered to the whole body.

    topicalmedications

  • Migraine medications

    Some newer, very effective medications are available to treat migraines. They specifically act on the migraine mechanism and usually don't have the drawbacks associated with painkillers. However, in some patients with very frequent headaches, medication may actually be part of the problem.

    The regular use of medication to relieve the pain of headache can result in “rebound headache” with increasing frequency of headache episodes. In such cases, the answer may lie in modification of lifestyle and dietary habits as well as other preventative measures. These measures may be daily medication to modify the migraine propensity, acupuncture, or Botox®.

  • Vitamins, supplements, and herbal medications

    Some of these have a beneficial effect on migraines and a few other pain conditions. In most cases, the effect is not very strong.

    Some nutritional deficiencies can result in neurological or neuropathy conditions. Large doses of some supplements can have side effects.

    Some vitamins and herbal medications can interact with prescription medications, so always inform your doctor if you are taking any of these.

    vitamins and supplements

Neurological/Neuromuscular Conditions

Neurology is the diagnosis and treatment of conditions of or relating to the nervous system (brain, spinal cord, peripheral nerves, muscles) by a medical specialist. Neurologists complete 4 years of college, 4 years of medical school, and 4 years of internship / residency. Some neurologists also do fellowship work. At Headache and Pain Center of Palm Beach, we treat a variety of neurological and neuromuscular conditions such as:

  • carpal tunnel syndrome
  • diseases of peripheral nerves and muscles
  • pinched nerves
  • neuropathy
  • nerve damage
  • nerve root problems due to herniated discs
  • Complex Regional Pain Syndrome (CRPS)/RSD

Muscle spasm, weakness, numbness, tingling, twitching, and pain can be symptoms of a neuromuscular condition.

Chronic Pain

As opposed to acute pain which occurs as a result of a recent injury, chronic pain is not useful and can be considered a disease in and of itself. This is different from acute pain, which is has a purpose of conveying a message about injury, and is usually self-limited.

Chronic pain affects people in many ways that interfere with their lives; those suffering from chronic pain require treatment for the pain itself and for its adverse effects, such as sleep problems and mood disorders. Treating painful conditions early on sometimes prevents pain from becoming chronic.

Pain Medicine specialists are doctors who have education and experience to help you with difficult pain problems.  Read this article on WebMD to better understand what pain doctors can do for you.

Chronic Pain Relief: New Treatments

Read Headache & Pain Center of Palm Beach's Pain Medication Policy