Severe headache? Get relief today.

The emergency department is the right place for a headache that might be a bleed, an infection or a stroke. It is the wrong place for a headache you already know the name of. You wait behind higher-acuity patients. You see a clinician who does not manage headache disorders day to day. You leave with a shot and a referral, not a plan. Neurology waiting lists run to months.

That gap is where most people with a severe recurring headache live. Headache Express was built to close it.

Not sure this is your service? Tap the directory assistant (the light in the corner of the page) and it will point you to the right place. This page sits in our pain and metabolic medicine directory.

Who treats you at Headache Express?

Dr. Gurpreet Singh Padda, MD, MBA, MHP, an interventional pain physician board certified in five specialties, including addiction medicine.

Two of those trainings decide how the clinic works. Interventional training makes a same-visit nerve block possible. Addiction medicine is why the rebound cycle gets named instead of missed: the mechanism that turns episodic headache into daily headache is the same one that makes frequent acute dosing self-sustaining.

The third qualification is not on a certificate. Dr. Padda has lived with chronic cluster headache since he was 17. Not migraine. Cluster: the attack that arrives at the same hour, drills in behind one eye and lasts long enough that you learn to watch the clock. He spent years inside that cycle and had to find his own way out. Pacing the room at three in the morning, pressing a fist into the eye socket, being told it is stress or sinus: none of it has to be explained here.

How does same-day headache treatment work?

Call or text first. Tell the team what the headache is doing. They get you in today.

Do not arrive unannounced. The right drug and the right room have to be ready when you walk in.

• Hours: Monday to Friday, 8:00 a.m. to 8:00 p.m. Saturday, 8:00 a.m. to noon. Closed Sunday.
• Why twelve hours: a headache that starts at six in the evening is still treatable the same day.
• Online booking shows scheduled openings. Calling or texting opens additional hours.
• Plan on one to two hours. Aborting an attack properly takes that long. This is treatment, not a five-minute injection.
• No referral needed.

Bring every medication you have taken for this headache in the past month, over the counter included, and any imaging report of the head or neck. How often you have been treating changes what the clinic does that day.

Which headache do you have?

The drug that aborts one headache does very little for another. Identifying the pattern is most of the work.

• Migraine. Throbbing, often one-sided, with nausea and sensitivity to light or sound. Worse with movement. Four hours to three days untreated. About a quarter of people get a visual aura first.
• Cluster headache. Strictly one-sided pain in or behind the eye, with a watering eye, drooping lid or blocked nostril on that side. Peaks in minutes, lasts under three hours, comes in bouts and keeps the same hour. People pace; they do not lie still.
• Tension-type headache. A pressing band on both sides. Mild to moderate. No nausea. Not worse on stairs. If it ever forces you into a dark room, it was never tension-type.
• Occipital neuralgia. Electric jolts from the base of the skull up the back of the head. The scalp is so tender that brushing your hair hurts.
• Cervicogenic headache. Pain generated in the neck and referred to the head. One-sided, triggered by neck position or desk posture, often months after whiplash.

The clinic also treats head and neck cancer pain and persistent pain after dental work. Neither is a headache. Both run through the same nerves.

How do you stop a migraine when pills have failed?

The problem is absorption. Migraine slows the stomach as part of the disease. A tablet taken three hours in sits there, unabsorbed. Vomiting ends the question entirely.

IV migraine therapy removes the variable. The combination is built for your attack, drawn from four components:

• An anti-nausea agent, metoclopramide or prochlorperazine. These dopamine blockers act on the migraine pain itself.
• Fluids, when vomiting has left you dry.
• Magnesium, strongest in migraine with aura and in true deficiency.
• An anti-inflammatory, ketorolac, sometimes with one dose of dexamethasone to stop the headache returning over the next day or two.

You sit in a chair, unsedated, and usually drive yourself home.

No opioids. For migraine they are close to the worst option available. They miss the mechanism. They worsen the nausea. They interfere with the antiemetics that work. And they drive the rebound cycle faster than anything but butalbital.

Why do headache pills make headaches worse?

Count days, not doses. The number of days a month you treat matters more than how much you take on any one day.

Treat too often and episodic migraine converts into medication-overuse headache: attacks become more frequent and less responsive because of the treatment. Each drug class crosses the line at a different point. Butalbital crosses fastest, at about five days a month. NSAIDs are the most forgiving, at 10 to 15 days. Any barbiturate or opioid raises the odds of chronic transformation. The working rule: acute treatment two days a week or fewer.

The mechanism is a loop. A drug that is not specific for the headache produces a partial response. The headache returns. The dose is repeated. The pattern sets. The American Headache Society's Choosing Wisely list says it directly: do not prescribe opioid- or butalbital-containing medication first-line for recurrent headache.

Unwinding the loop means withdrawing the offending drug while covering the withdrawal with something that does not feed it. That is the job of the infusion and the nerve block.

Stewardship here is not confiscation. The measure is fewer headache days. A drug doing real work stays. A drug quietly driving the frequency up is named plainly. It is harm reduction, not abstinence.

Opioids remain legitimate, sometimes necessary, in three conditions the clinic treats: head and neck cancer pain, destructive facet disease in the cervical spine, and failed neck surgery. Different problems, judged on their own terms. For the practice-wide approach, see opioid stewardship.

How is cluster headache treated?

Cluster headache is among the most severe pain in medicine. It is routinely called migraine or sinusitis for years. Same side every time, same hour every day, repeated antibiotics for "sinus headaches" that never clear: bring that history in.

High-flow normobaric oxygen is first-line. 100% oxygen through a non-rebreather mask, fifteen to twenty minutes, from the first minutes of the attack. A randomized trial in JAMA in 2009 showed it aborts attacks within fifteen minutes far more often than air. No systemic side effects. No interactions. No ceiling on use.

It fails for two reasons. Wrong delivery: a nasal cannula at two or three liters a minute does not reproduce the effect. Wrong location: an abortive you have to drive to is close to useless. The clinic starts oxygen in the office and arranges the prescription for a home setup.

The bout gets its own treatment:

• Greater occipital nerve block with a corticosteroid, to interrupt the bout and bridge the weeks while a preventive takes hold. A meta-analysis found 50% of patients pain-free at one month.
• Sphenopalatine ganglion block, aimed at the relay behind the tearing and congestion.
• Preventive medication, started the moment a bout is recognized.
• Stellate ganglion block, where the sympathetic system is part of the syndrome.

Cluster headache is called the suicide headache. The name is earned, not dramatic. If you are having thoughts of harming yourself, call or text 988, 24 hours a day. Cluster headache is treatable.

Hyperbaric oxygen is a different treatment. The evidence for it in acute migraine is small, old and low quality. There is no good evidence it prevents attacks or treats cluster. The clinic offers it and will talk you out of it if a better-supported option has not been tried.

Why is every injection image guided?

A nerve block is only as good as where the needle lands. Landmarks estimate. Imaging sees. Around the head and neck, the structure you are avoiding sits millimeters from the one you are aiming at.

Every injection at Headache Express is placed under ultrasound or fluoroscopy. Not an upgrade. Not on request. The default.

Guidance buys three things. The medication reaches the target. The vessels are visible. And a failed block becomes information: the pain lives somewhere else. A failed landmark block tells you nothing, because it may have missed.

Occipital nerve block

Local anesthetic around the nerves at the base of the skull, under ultrasound with Doppler because the occipital artery runs beside the nerve. Seconds. No sedation. You drive home.

Best fits: occipital neuralgia and cervicogenic headache, cluster bouts, and migraine with a neck or scalp component. In the largest placebo-controlled trial in chronic migraine, weekly blocks cut headache days from 18.1 to 8.8 a month, against 16.9 to 13.2 on saline. The block reduces how often and how hard headaches come. It does not shorten the attack you have today.

It is also a test. Numb the nerve, lose the pain: that nerve carried it. Relief commonly outlasts the anesthetic by weeks. There is no series of three. The next block is timed by how long the last one held.

Sphenopalatine ganglion block

The ganglion sits just behind the nasal cavity and fires the tearing, congestion and flushing of a cluster attack. A soft catheter delivers anesthetic through the nostril. No needle. No sedation. About fifteen minutes.

Atlanto-axial (C1-C2) injection

The joint that lets you shake your head "no" is a recognized, frequently missed generator of cervicogenic headache. It sits above the levels most imaging and injections reach. The vertebral artery and C2 nerve root lie beside the target. Fluoroscopy with contrast, always. Never blind.

Trigeminal and stellate ganglion blocks

The trigeminal nerve is the pathway through which migraine and cluster make pain. The branch blocked is the branch that hurts. It treats trigeminal neuralgia, post-dental nerve pain and cluster. The stellate ganglion block, under ultrasound in the lower neck, treats cluster, sympathetically driven facial pain and upper-limb complex regional pain syndrome.

Is Botox right for your migraines?

Only if the migraine is chronic: headache on 15 or more days a month, at least eight with migraine features, for over three months. Below that line the trials showed no benefit. Four migraines a month is a different problem with better answers.

The protocol is fixed: 155 units across 31 sites on the head, neck and shoulders, every 12 weeks. About fifteen minutes. The effect builds over two to three cycles, roughly six months, and cuts headache days rather than abolishing them. Cosmetic Botox is not the same treatment.

Rule out rebound first. Many people over the 15-day line are in a medication-overuse cycle. Break that and the frequency often drops below the threshold on its own. Otherwise you pay for an expensive preventive to fight a problem the medicine cabinet is creating.

What prevents the next attack?

Stopping attacks is half the job. Having fewer is the other half, and that work is metabolic, autonomic and circadian before it is pharmacological.

• Hold your wake time. Insomnia pushes episodic migraine toward chronic. The best-evidenced fix is not more sleep but regular sleep. Weekend lie-ins shift the body clock and trigger attacks.
• Screen for sleep apnea. It produces morning headache and is commonly missed.
• Eat on schedule. Migraine travels with insulin resistance far more often than chance explains. Skipped meals and the glucose swings behind them are among the most reliable triggers, and fully modifiable. Elimination diets hunting single trigger foods usually backfire: people eat less, less regularly.
• Move. Regular moderate aerobic exercise has trial evidence comparable in some studies to a preventive drug. An abrupt hard session can provoke an attack.
• Raise vagal tone. The vagus nerve feeds the same brainstem relay that generates headache pain. Non-invasive vagus nerve stimulation, a handheld device on the neck, has randomized evidence in cluster headache and more modest evidence in migraine. Slow-paced breathing works the same pathway at no cost.
• Measure vitamin D. Correct a real deficiency. Magnesium, riboflavin and coenzyme Q10 have a longer record; judge them against a headache diary.
• Treat the mood. Treating the anxiety, depression and post-traumatic stress that travel with headache improves headache outcomes, not just mood.

When headache sits alongside weight gain, blood sugar trouble or pain elsewhere, the terrain is the target. See interventional pain management and type 2 diabetes reversal.

When should you go to the ER instead?

Headache Express is an outpatient clinic. Call 911 or go to an emergency department for:

• A headache that hits maximum intensity within seconds
• Headache with fever, a stiff neck or a new rash
• Weakness, numbness, trouble speaking, vision loss or confusion
• Headache after a head injury or with a seizure
• A new headache in pregnancy, over 50, when immunosuppressed or with a cancer history

If your presentation looks dangerous, the clinic says so plainly and sends you.

What about insurance and timing?

Same-day treatment and prior authorization run on different clocks. Insurers often take days to weeks. Some acute headache treatments are not covered at all. Your headache will not wait.

The clinic verifies benefits and attempts prior authorization where a treatment needs it. An authorization confirms a service meets criteria for review. It is not a guarantee of payment, and no clinic can promise one for your insurer. If something is unlikely to be covered, or cannot be certified in time, you hear it before treatment, not after. Payment is due at the time of service.

How do referring physicians send a patient?

No form. Send the working diagnosis, headache days and acute treatment days per month, what has been tried and at what dose, and any imaging, with the patient or by calling ahead. Primary care, neurology, emergency and urgent care, dentistry and oral surgery all refer here. Coding references for occipital, SPG, trigeminal, stellate and chemodenervation procedures are published for referring offices.

Where is Headache Express?

4477 Woodson Rd, Suite 205, St. Louis, MO 63134. On Woodson Road, immediately south of St. Louis Lambert International Airport, minutes from I-70. Short drive from St. Louis City, Bridgeton, Florissant, Clayton and Chesterfield, and straightforward from Illinois.

People arrive mid-attack nauseated, light-sensitive and unsteady, usually driven by someone else. So: free on-site parking, flat ground-level entry at every door, a full-size elevator that fits a wheelchair or stretcher, and seven accessible restrooms.

Call (314) 464-7162 or text (314) 886-5902. The text line is shared across affiliated practices, so say it is Headache Express. Keep clinical detail out of text and email.

Frequently asked questions

What does a first visit cost me in time?

One to two hours. Aborting an attack properly takes that long, whether it is an infusion, a block or oxygen.

Can a nerve block help my migraine?

When the neck or scalp is involved, yes: scalp tenderness, neck-triggered attacks, pain from the base of the skull. If numbing the occipital nerve abolishes the pain, that nerve was the source.

Why won't my "tension headache" go away?

A daily headache usually means one of three things: rebound from painkillers, mild migraine under the wrong label, or a neck generator. Each has a different fix.

What if I don't know what kind of headache I have?

That is a normal reason to come. Bring whatever pattern you can describe: times, durations, which side. The diagnosis is part of the visit.

Can I have a block while on other headache treatment?

Usually yes. The occipital block is commonly used alongside preventive treatment, not instead of it.

What if the block does not work?

Because it was image guided, the failure is information. The pain is coming from somewhere other than the nerve blocked, and the search moves, most often toward the cervical joints or migraine.