Coastal Orthopedic physician and certified headache specialist offers a variety of treatment options for patients suffering from chronic migraines

Migraine headaches are one of the most common conditions that send patients to the emergency room — often resulting in billions of dollars in lost revenue and time.

But not every headache is considered a migraine. So what distinguishes the two?

Migraines are a specific diagnosis in which a headache lasts for more than four hours and is associated with severe discomfort often resulting in a person’s inability to work or function. Symptoms may also frequently include nausea, vomiting, visual impairment and numbing and tingling in rare cases.

“Women of child-bearing age tend to get them more frequently,” says Dr. Gennady Gekht, a pain management specialist with Coastal Orthopedics.

Dr. Gekht is part of a select group of 520 American physicians who have earned their certification as a headache specialist from the United Council for Neurologic Subspecialties. With his certification, Dr. Gekht is the only recognized headache specialist between St. Petersburg and Fort Myers, and is the only headache specialist in Florida with training in cervical spine injections.

Dr. Gekht treats at least two to three patients a week for chronic migraines. For those patients suffering from migraine headaches, it’s important to not only live a healthy lifestyle but also to avoid taking unnecessary medication.

“Medication overuse is one of the consistent reasons for poorly controlled migraines,” says Dr. Gekht. “Most headache sufferers can treat their pain with diet and lifestyle modifications and basic medicine, but if a case is severe, that’s when you need a headache specialist.”

Headaches are one of the world’s most common nervous system disorders — affecting more than half of adults around the globe every year. According to the World Health Organization, of those individuals suffering from headaches, at least 30 percent have had at least one migraine and almost 2 percent of the world’s adult population suffers headaches on 15 or more days each month.

Physicians have been trying to treat migraines for decades with the majority of migraine treatments revolving around medication, including antidepressants and seizure medication. In the coming months, Teva Pharmaceutical Industries and Amgen will be releasing new migraine-specific medications.

Teva Pharmaceutical Industries and Amgen have been developing and testing their investigational therapies, erenumab and fremanezumab, respectively, for the past few years.

Amgen recently received approval from the FDA in June 2018. Aimovig (or erenumab) is a first medication of its kind to be designed specifically for prevention of migraine headaches. With excellent side effect profile and outstanding early reports of efficacy, the doctors at Coastal Orthopedics look forward to using the medication for its migraine patients.

“We’ve never had migraine-specific medication before, so that’s something to be on the lookout for and keep checking in on,” says Dr. Gekht.

In addition to medication, Dr. Gekht also can try cervical injections, occipital nerve stimulation or injections in the neck to ablate and cauterize small nerves. Coastal Orthopedics and Dr. Gekht pride themselves on offering a wide range of headache treatments all under one roof.

“Whatever procedure we decide on, our overall goal is always to reduce the amount of medication our patients are taking and increase their ability to function,” says Dr. Gekht. “Our primary objective is to help patients return to their daily lives, pain free.”

One of the most effective treatments, and the only one approved by the Food and Drug Administration, for prevention of chronic migraines is the use of Botox, known primarily for its wrinkle-preventing cosmetic properties. Botox blocks neurotransmitters around the forehead and neck and as a result has been found to curb migraines and prevent future ones from occurring.

Since its FDA approval in 2010, two million Botox treatments have been given to 500,000 people with chronic migraines. Many patients pay out of pocket to cosmetic and plastic doctors, but what they don’t realize is that the use of Botox for the treatment of migraine headaches is actually covered by most insurance companies.

During each 15-minute treatment, patients receive 31 shallow injections in seven key areas of the head and neck. While you may start to feel results as early as four weeks after the first treatment, it will take two treatments, 12 weeks apart, to determine how well Botox is working for you. Statistically, according to, patients have noted having eight to nine fewer migraine days per month after 24 weeks of treatment.

“Botox has been shown to significantly benefit patients with severe migraine disorders, and people with more than 15 days of headaches a month,” says Dr. Gekht.