Initial treatments for headaches and chronic pain typically begin with non-invasive and minimally invasive approaches. In cases where these options are not effective, neurosurgical treatments may be explored.

Non-Invasive and Minimally Invasive Treatment

Some non- and less-invasive treatments include:

  • A combination of medications, including anticonvulsants and antidepressants.
  • Topical therapies, patches
  • Noninvasive therapies such as acupuncture, chiropractic and feedback can be utilized
  • Topical electrical stimulation can also be used

If the above noninvasive strategies are insufficient, then a patient may be a candidate for a number of different injection therapies, including:

  • Epidural steroid injections
  • Trigger point injections
  • Selective nerve root blocks
  • Botox injections
  • Sympathetic blocks
  • Nerve blocks

Neurosurgical Pain Management

Patients who do not get sufficient pain relief with nonoperative strategies may then be considered for more aggressive neurosurgical pain management strategies.


Neurostimulation is the placement of an electrical device along the nervous system. It administers a weak electrical current, which patients feel as a tingling sensation, and blocks the subjective experience of pain. Neurostimulation includes spinal cord stimulation, peripheral nerve stimulation, ultrasound-guided peripheral nerve stimulation, and motor cortex stimulation to treat a variety of chronic neuropathic pain disorders.

Intrathecal Pain Medication

Intrathecal pain medication is injected into the spine. If the patient benefits from the spinal medication, a spinal infusion pump is implanted. This pump can then provide a constant infusion of spinal medication, resulting in durable pain relief.

Laser Cingulotomy

Laser Cingulotomy is a new technique being researched and developed at Columbia. It is a last resort treatment option for patients that have had no success with other treatment options. This therapy targets the area of the brain that processes pain as a bothersome sensation. It does not take away the pain, rather it takes away a person’s ability to be bothered by the pain. Some patients find that the procedure can dramatically improve their quality of life. It is as if the pain is consigned to background noise, rather than being at the forefront of their minds and disruptive to their day-to-day lives. By pushing the pain into the background of the conscious awareness, this frees up patients to resume their lives as normally as possible without being bothered by the pain.