Deciding who to trust for your healthcare is challenging, here are some insights into the frequently asked questions that we receive at Novera:

What kind of treatment do you provide?

In our clinic, we are manual therapists. We provide full examinations of the body’s movement, but for headache and migraine patients we look more specifically at the neck. We then evaluate where your pain is coming from, or to put it another way, we discover “which tissue is the issue.” We want to educate you on each structure, i.e the joint, muscle, connective tissue, or nerve, what their role is, and which ones are contributing most to your pain.

We provide hands on treatment, meaning joint mobilizations, to improve movement and treat trigger points in the muscles. We can also provide dry needling to those trigger points, if needed. These treatments take stress off of the nerves that are ultimately sending pain signals to your brain, causing your headache and migraine symptoms. We can then guide you through specific exercises that you do on your own to maintain the movement improvements made during each session. We do not provide medications or Botox, and many of our patients wean off of their medication entirely.

Are headaches and migraines the same thing?

Yes and no. There are several different diagnoses for headaches and migraines, which tend to put them in different categories. We do know that migraines present differently than headaches, but that does not necessarily mean the original source of pain is completely different. We see all types of headaches and migraines in our office including, but not limited to, migraine with and without aura, tension type headaches, cervicogenic headaches, trigeminal neuralgia, occipital neuralgia, abdominal headaches, cyclic vomiting cycle headaches, and chronic migraine.

Why don’t medications work well for me?
It is very common for the medications prescribed for headaches and migraines to not work well, or work initially but then decrease in effectiveness over time. This is due to several factors. First, most headache and migraine medication was actually created to treat another ailment, such as high or low blood pressure, mental health issues, etc. and are not specific for headache or migraine pain, therefore not treating the source – just some of the symptoms. Secondly, we know that the vagus nerve (which is in charge of digestion) becomes less active in headache and migraine sufferers, making medications less likely to absorb and be effective. That is why on some of the prescriptions it will say “Take at first sign of a headache.” If you decide to “power through” and wait too long to take it, you will have missed your window and your stomach will not absorb the medication.
Do I need an X-ray or MRI?

When attempting to understand headaches it is important to know that the initial diagnosis will be based on your symptoms alone and not an image. This means that in general there is no X-ray, MRI or CT-scan that is going to come back with any specific findings that explain your pain or show something that can diagnose your pain.

These tests can be performed to rule out other conditions that may cause headaches, but these conditions are far less common. Many times a patient will receive these tests and the results will show degenerative disc disease, disc herniations, spinal stenosis or other arthritic changes, but the headache pain may very well be unrelated to those findings.

This can be a very frustrating process as many patients never find a straight answer as to where their pain is coming from when they rely on imaging alone.

Why has no one explained the source of my headaches?
Because the current standard of care relies heavily on medications, it’s common for people to feel they are just masking their symptoms rather than treating the underlying problem. Their hope is really only to reduce the frequency or intensity of their pain, primarily because they don’t have a good answer for the source of the problem. Many of these medications are costly and/or come with side-effects that make them unreasonable to use for extended periods of time.

In addition, findings with imaging like X-rays or MRIs, such as a diagnosis of arthritis, may be blamed for the cause of pain when in reality it may be unrelated. Unfortunately, this can be a conclusion that is reached too quickly within a patient’s course of care, leading to invasive injections or even surgery that may not prove to be effective.

How can evaluating and treating the neck help?
There is a vital role that the neck plays when making a proper diagnosis for headaches and migraines. Believe it or not we have seen headaches, dizziness, jaw pain, nausea, light/sound sensitivities and visual disturbances all come about because of restrictions in the neck.

When we say restrictions in the neck, we are referring to loss of movement for three joints in particular- the most important being C1-2. This is referring to the 1st and 2nd vertebrae (bones) in the top of the neck. This C1-2 joint is responsible for half of our rotation when we turn our head to the right or left. C1-2 rotation for someone with headaches is typically nearly completely gone. The joints above and below C1-2 are also important to assess, but most patients present with C1-2 as the main issue.

Novera will provide you with an evaluation that is specific enough to catch these restrictions. The majority of patients with headaches & migraines will go their entire lifetime without their neck properly assessed, which is why many are never able to find a solution to their pain.

If this specific evaluation is missed, the patient could be missing out on an opportunity to restore proper mobility and treat their headaches and migraines with a non-invasive, non-medication approach that is very effective.

Is it like going to the chiropractor?

Here at Novera we focus on manual therapy. As hands-on therapists we are trained in how to evaluate and restore movement problems. As we discussed above, all of the symptoms of a headache can be explained by loss of movement in specific joints in the neck.

There is actually a significant difference between chiropractic and physical therapy when it comes to treating headaches and migraines.

It is essential for anyone with headaches to be evaluated by a physical therapist that specializes in headaches because they are best equipped to evaluate and restore movement problems. In this case, evaluating the movement of each specific joint in the neck that may cause your pain is essential. Chiropractic care can be helpful, but the focus is primarily on alignment rather than movement.

I've already tried Physical Therapy...

Most of our patients that come to see us have already seen a physical therapist. So it’s normal to ask, “What makes you different?”

The idea is this… having a lack of success with a physician or MD means that you move on to the next MD, or maybe you are referred to a specialist that is better equipped to handle your specific case. That specialist has dedicated his or her career to that one subset of medicine and will have a better idea of what treatment will be effective.

The same is true for Physical Therapy. As a profession, we are growing and increasing in our reach within the community. With increased growth comes the ability to specialize and have a more focused patient population.

Novera means “New Era,” meaning a new era of what a Physical Therapist can do for you. Novera is your headache specialist. Our providers have dedicated their careers to helping this specific patient population with treatments that can be effective for even the toughest cases.

Do you take my insurance?

We are a fee-for-service clinic. We do not bill your insurance directly, but can provide you with paperwork to submit to your insurance or health sharing plan independently to receive reimbursement. Many of our patients get reimbursed for our services under their out of network. Additionally, we have many patients who are able to use their FSA or HSA account to pay for our services.