Headache & Migraine Center

Headaches have many faces. In addition to classic migraines and tension headaches, we often see complaints that originate in the cervical spine (cervical spine), jaw joint or muscular imbalances. Our team combines a thorough anamnesis with a functional examination of the neck, shoulders and jaw as well as a neurologically oriented basic diagnosis. In this way, we differentiate between primary types of headaches and secondary causes and initiate targeted, as gentle as possible therapies.

• Conservative first: education, trigger management, physio, training, relaxation procedures
• Interlinked with neurology: e.g. B. in migraine prophylaxis and acute therapy
• Focus on the cervical spine/jaw: cervicogenic headaches, myofascial triggers
• Options such as acupuncture (TCM) as a complementary, evidence-based method
• Interventions only with clear indications and information

Many headaches are mediated via the trigemino-vascular system: stimuli from the meninges and vessels are picked up by the trigeminal nerve and perceived as pain. At the same time, pain fibers from the upper cervical spine (C1–C3) flow into similar brainstem nuclei. This is why tension, blockages in the head joints or irritation of the small vertebral joints can trigger or intensify pain in the forehead, temples or back of the head.

• Trigeminovascular system: central to migraines
• Cervico-cervical coupling: Cervical spine can trigger headaches
• Muscle fascia and trigger points: myofascial pain projection
• Temporomandibular joint (TMD): Incorrect strain can cause headaches

• Migraine: pulsating, usually one-sided, nausea, sensitivity to light/noise; with or without aura
• Tension headache: pressing/pulling, bilateral, mild to moderate intensity
• Cervicogenic headache: Originating in the neck/head joint, triggered by cervical spine movement or pressure
• Myofascial headache: trigger points in the neck/jaw muscles with radiating pain
• Cluster headache and trigemino-autonomic headache: rare, very severe, with accompanying autonomic symptoms
• Drug-induced headache: overuse of acute medication
• Post-traumatic headache: after whiplash or head injury
• Temporomandibular joint-associated headache (TMD): teeth grinding, jaw dysfunction

The combination of anamnesis, pain diary, examination and - if necessary - additional diagnostics determines which form is present.

• Sudden, severe headache (“destruction headache”)
• Neurological deficits: paralysis, speech/vision problems, double vision
• Fever, stiff neck, changes in consciousness
• Headache after severe trauma or when taking blood thinners
• Increasingly new headaches from the age of 50
• History of cancer or HIV with new headache
• Personality changes, seizures

If you see warning signs like this, please see a doctor immediately or call emergency services. In our practice, we clarify unclear processes in a structured and interdisciplinary manner.

• Medical history and pain diary: frequency, duration, intensity, triggers, acute medication
• Neurological and neuroorthopedic examination: cranial nerves, coordination, sensorimotor functions
• Cervical spine and jaw function diagnostics: mobility, joint function, muscular triggers
• Screening comorbidities: sleep, stress, diet, menstrual cycle, physical activity
• Apparatus diagnostics if indicated: ultrasound, X-ray/CT/MRI (only targeted), laboratory if suspected
• Differentiation between primary and secondary: decision on further specialist clarification (neurology, ENT, dentistry)

Imaging is usually not necessary for typical migraines or tension headaches. We only use them if the anamnesis/examination provides evidence of other causes.

Conservative measures are effective and safe for most types of headaches. We combine education, non-drug strategies and - coordinated with your family doctor or neurologist - guideline-oriented drug treatment if necessary.

• Education and trigger management: Identification of triggers (sleep deficit, stress, dehydration, menstruation, screen work, alcohol), structuring everyday life
• Physiotherapy and manual techniques: mobilization of the cervical spine, strengthening of deep neck muscles, posture training; Evidence-based especially for cervicogenic/myofascial headaches
• Targeted training: endurance (moderate 3x/week), neck/shoulder stabilization, ergonomic exercises in the office
• Relaxation methods: progressive muscle relaxation, biofeedback, breathing techniques, mindfulness-based methods
• Sleep and screen break hygiene: constant sleep rhythm, blue light and break management
• Nutrition & Hydration: regular meals, drink enough; Caffeine moderately and consistently
• Acupuncture (TCM): can be helpful prophylactically for migraines and tension headaches; Clarification about benefits and limitations
• Acute drug therapy: depending on the diagnosis, e.g. B. NSAIDs, triptans; Use sparingly to avoid overuse of medication
• Prophylaxis after consultation: e.g. B. Beta blockers, amitriptyline or topiramate for frequent attacks; individual consideration and control

We accompany you during implementation, document effects in the pain diary and adapt the plan. In complex cases, we specifically involve neurology, ENT, dentistry or psychotherapy.

If conservative measures have been exhausted or the findings clearly indicate this, interventional procedures may make sense. We discuss the benefits, risks and the evidence transparently and decide together.

• Peripheral nerve blocks (e.g. greater occipital nerve) for certain types of headache
• Infiltration of irritated cervical facet joints or myofascial triggers in cervicogenic headaches
• Botulinum toxin A for chronic migraines according to guidelines (in cooperation, information about indications and course)
• Radio wave or interventional cervical spine procedures: only selectively and after differentiated diagnostics
• Regenerative procedures: for headaches only in special cases (e.g. accompanying cervical spine tendon attachment irritation) and after strict indications

Not every procedure is suitable for every type of headache. Safety and accuracy of fit are more important than invasiveness.

• Keep a pain diary: date, trigger, intensity, medication taken
• Plan exercise: 150 minutes of moderate endurance training per week
• Micro-breaks at the screen: mobilize easily for 2-3 minutes every 30-45 minutes
• Neck routine: 5-10 minutes daily mobilization and light strengthening
• Aim for regular meals and a drinking quantity of 1.5-2 liters
• Relaxation exercise: 10 minutes daily (e.g. progressive muscle relaxation)
• Keep caffeine consistent and avoid alcohol, especially on migraine days

These components do not replace diagnostics, but they are an effective basis. We show you exercises suitable for everyday use and adapt them to your situation.

Many headaches benefit from cooperation. We coordinate closely with neurology (e.g. prophylaxis, cluster headaches), ENT (dizziness, sinus or ear involvement), dentistry/orthodontics (CMD) and psychological services (stress, sleep, pain management).

• Neuroorthopedic examination for sensorimotor dysfunction
• Dizziness and balance diagnostics with accompanying dizziness
• Physiotherapy on site: manual therapy, training, biofeedback-based practice
• TCM/acupuncture as a supplementary option for selected courses

• Appointment: online via Doctolib or by email
• Preparation: bring existing findings/medication list, if necessary a pain diary
• Initial appointment: structured anamnesis, neuro-orthopedic and cervical spine/jaw functional diagnostics
• Planning: individual therapy plan with priorities, exercise program and follow-up
• Control: Evaluation after 4-12 weeks, adjustment of training/medication/interventions

Location: Dorotheenstraße 48, 22301 Hamburg. Good accessibility by public transport and parking options in the area.

Depending on the cause and accompanying complaints, the following departments and focal points can be sensibly linked:

• Atlas back center: head joints, cervical spine function and cervicogenic headache
• Dizziness & Tinnitus Center: if headache occurs with dizziness or auditory symptoms
• Neuroorthopaedics: sensorimotor control, gait and posture analysis
• Physiotherapy: manual therapy and training-based treatment
• TCM: Acupuncture as a complementary option for prophylaxis
• Orthobiology / Institute for Regenerative Movement Medicine: for accompanying cervical spine tendon or fascia problems according to individual indication
• Sports orthopedics Hamburg: Return-to-activity, headache in the context of training/stress

Effective headache prevention is practical in everyday life. Small, consistent adjustments have significant effects over weeks and months.

• Ergonomics: visual axis at eye level, external keyboard/mouse, alternating sitting/standing
• Break strategy: 20-20-20 rule (look 20 feet/6 m away for 20 seconds every 20 minutes)
• Movement: active commutes, stairs instead of elevators, short mobilization routines
• Stress management: realistic to-dos, buffer times, short breaks
• Regularity: Meals, sleep and caffeine consumption as constant as possible
• Team coordination: clear work/break windows and good lighting in the home office

There is no method that will quickly and permanently eliminate all headaches. We make no promises of healing. Our goal is to use comprehensible, safe measures to reduce the frequency and severity of seizures, improve function and avoid relapses. Where limits have been reached, we openly identify them and - if appropriate - move on.