Quick Answer
A migraine specialist establishes whether headaches are migraine, whether they meet the definition of chronic migraine, and which preventive approach fits the pattern. CNS evaluates and manages adult headache disorders across Las Vegas and Henderson, including in-office Botox and CGRP preventive therapy where a patient is a candidate.
Key Takeaways
- Chronic migraine has a numerical definition: fifteen or more headache days a month, with migraine features on at least eight. That definition, not how severe the pain feels, is what determines candidacy for preventive treatment.
- The first job of a consultation is separating migraine from tension-type headache, cluster headache and secondary causes. Those need different treatment, and a generic headache diagnosis is the commonest reason a patient spends years on the wrong plan.
- Medication overuse is frequently part of the pattern and frequently missed. Acute medication taken often enough can sustain the headaches it was taken to relieve, which changes the treatment plan before any new prescription is considered.
- Prevention and acute treatment are different strategies. Acute treatment addresses an attack in progress; prevention reduces how often attacks occur, and it is assessed over months rather than weeks.
- Imaging is not routine. It is ordered when the history or examination raises a specific concern, not to confirm migraine, because migraine is diagnosed clinically rather than by a scan.
01 — OverviewWhy headache is so often diagnosed generically
Headache is the highest-volume entry point in adult neurology and the one where the gap between an accurate diagnosis and a generic one is widest. Patients frequently arrive having been told they have headaches, which is a description rather than a diagnosis, and having been treated for the pain rather than for the disorder producing it. This page sits within the wider neurological conditions library at Clinical Neurology Specialists.
Primary versus secondary, first
The initial division is whether the headache is the condition or a symptom of something else. Primary headache disorders include migraine, tension-type headache and cluster headache. Secondary headaches are produced by another process, and the history and examination are what raise or lower that concern. The American Headache Society maintains the classification framework clinicians work from, and a consultation that engages with it explicitly is more useful than one that reaches for a prescription.
What "just headaches" costs a patient
The practical consequence of a generic diagnosis is years of acute treatment for a condition that needed prevention. Acute medication is designed to end an attack; it does nothing about how often attacks occur, and taken often enough it can make them more frequent. A patient managing fifteen headache days a month with acute medication alone is therefore working against themselves, and the reason it persists is that nobody counted the days. Counting is what converts an impression of frequent headaches into a diagnosis with a treatment pathway attached.
Then migraine against what it resembles
Within the primary group the distinctions matter for treatment. Migraine typically produces recurrent attacks with throbbing pain, often one-sided, with sensitivity to light or sound, nausea, and worsening on activity. Tension-type headache is usually bilateral, pressing rather than throbbing, and without those associated features. Cluster headache is shorter, far more severe, strictly one-sided and often accompanied by tearing or nasal congestion on the same side. These are three different conditions with three different treatment pathways, and calling all three headache is how a patient ends up on a plan that was never designed for them.
Migraine is a primary headache disorder, meaning the headache is the condition rather than a symptom of something else, characterised by recurrent attacks with features such as one-sided throbbing pain, sensitivity to light or sound, nausea, and worsening with activity.
02Chronic migraine, and why the definition is numerical
Chronic migraine is defined rather than described. Fifteen or more headache days a month, with migraine features present on at least eight of them. That threshold is what determines candidacy for several preventive treatments, and it is the single most useful thing a patient can bring to a first appointment, because it can only be established from a record kept over time.
Why a headache diary changes the appointment
Counting is unglamorous and it is the difference between an accurate diagnosis and an approximate one. Most people underestimate their headache days, partly because milder days do not register as episodes and partly because memory compresses. A month of dates, with a note of severity and what was taken, converts a conversation about how bad the headaches feel into a conversation about how often they occur, which is the axis treatment decisions actually run on.
Medication overuse, the pattern most often missed
Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. This is common, it is not a failure of willpower, and it changes the plan: addressing the overuse usually has to come before or alongside a new preventive, because a preventive started on top of an unrecognised overuse pattern is being asked to work against a headwind. A consultation that does not ask carefully about what you take and how often has skipped a step.
| Feature | Migraine | Tension-type | Cluster |
|---|---|---|---|
| Location | Often one-sided | Usually both sides | Strictly one-sided |
| Character | Throbbing | Pressing, tightening | Severe, boring |
| Duration | Hours to days | Variable | Minutes to a few hours |
| Associated features | Light and sound sensitivity, nausea | Few or none | Tearing, nasal congestion, restlessness |
| Effect of activity | Worsens | Little change | Restlessness rather than stillness |
03What a migraine specialist evaluation involves
The evaluation is a history and an examination, in that order, and only then a test if the findings call for one.
The pattern
Onset, frequency, duration, character, what precedes an attack, what relieves it, what you take and how often, and what has changed recently.
The neurological check
Cranial nerves, eye movement, visual fields, strength, coordination and reflexes, looking for anything that points away from a primary headache disorder.
Only where indicated
Imaging is not routine for migraine. It is ordered when something in the history or examination raises a specific concern, and it is coordinated with an outside facility.
What would make imaging appropriate
A headache that is new and different from previous headaches, one that reaches maximum intensity abruptly, one accompanied by neurological signs on examination, one that changes with position or with straining, or a pattern that has altered materially in a short period. Those are reasons to look further. A long-standing recurrent headache with a normal examination and typical migraine features generally is not, and ordering a scan to confirm migraine misunderstands how migraine is diagnosed. Where imaging is warranted, magnetic resonance and computed tomography are coordinated with outside facilities, since CNS does not operate a scanner.
What the examination is looking for
A neurological examination in a headache consultation is largely a search for reasons not to accept the obvious answer. Visual fields, eye movement, pupil responses, facial sensation and strength, coordination and reflexes are each checked because an abnormality in any of them shifts the question away from a primary headache disorder. A normal examination alongside a typical history is positive evidence rather than an absence of findings, and it is what allows a diagnosis to be made confidently without imaging.
Triggers, and why the list matters less than people expect
Patients often arrive with a trigger list, and triggers are real, but they are less useful than the frequency count. Sleep, hydration, caffeine, meal timing, hormonal cycles and stress all appear in migraine patterns, and identifying them is worthwhile. What they rarely do is change which treatment is appropriate, because a preventive is chosen on how often attacks occur rather than on what precedes them. The most valuable trigger to identify is medication overuse, precisely because it is the one that treatment can address directly.
Where testing does contribute
Occasionally headache overlaps with another neurological question the examination raises, and then a study earns its place. Suspected seizure activity may warrant electroencephalography, and blood-flow questions may warrant transcranial Doppler. Both are performed in-office and described on the diagnostic testing hub. Neither is used to diagnose migraine itself.
Been told you just get headaches?
Bring a month of dates and what you took. That single record changes what a first appointment can do.
04Treatment: acute, preventive, and the in-office options
Acute treatment addresses an attack in progress. Preventive treatment reduces how often attacks occur. They are different strategies with different success measures, and confusing them is a common source of frustration, because a preventive judged on whether it stopped one attack will always look like a failure.
Acute treatment, briefly
Acute treatment is what you take when an attack has started, and the useful principles are few. Take it early, because most acute options work better before an attack is established. Take enough of it, because an underdose that fails prompts a second dose later and contributes to overuse. And keep a record of how many days a month you need it, because that number is both a measure of how well prevention is working and the earliest warning of an overuse pattern developing. What acute treatment cannot do is reduce attack frequency, which is the entire purpose of the other strategy.
How prevention is assessed
Preventive therapy is evaluated over months rather than weeks, because the measure is a change in headache frequency across a period long enough to be meaningful. Abandoning a preventive after two weeks is the commonest way a workable plan gets discarded before it has been tested. Where a preventive has genuinely not helped after a fair trial, it is stopped rather than continued indefinitely, and the alternatives are considered against what the trial revealed.
In-office preventive treatment at CNS
Two preventive options are delivered by the practice. Botox for chronic migraine is a series of small injections following a fixed pattern across the head and neck, given on a repeating schedule, and candidacy rests on the chronic migraine definition. CGRP therapies target a specific pathway involved in migraine attacks and are prescribed and monitored here. Dr. Jessica Knirk holds chronic migraine and Botox administration among her areas of focus. Both options are set out on the treatments hub, with detail on the Botox guide and the CGRP guide.
Why the plan usually changes at least once
Preventive treatment is iterative by nature. The first preventive tried is a reasoned choice rather than a certainty, and adjusting after a fair trial is the normal course rather than evidence something went wrong. That expectation is worth setting early, because patients who are told a plan will work and then find it does not tend to disengage, while patients who are told the plan is a starting point tend to stay for the second attempt. Long-term headache management is mostly this: a sequence of informed adjustments against a frequency record.
What is not on offer, and why the distinction matters
CNS does not run an interventional pain programme and does not perform surgery. Nerve blocks are performed where the examination localises tenderness to a specific nerve, which is a targeted procedure rather than a general headache treatment. And nothing on this page promises an outcome: two patients with the same diagnosis can respond differently, and a practice that guarantees relief is describing its marketing rather than its medicine.
05Migraine care across the valley
Both CNS offices provide headache evaluation and both deliver in-office preventive treatment, so the choice between them is about travel rather than capability. Clark County has a thin supply of neurologists relative to its population, consistent with the shortage the American Academy of Neurology has documented, which is worth factoring in when a repeating treatment schedule is part of the plan.
Migraine Las Vegas and the west valley
Patients seeking migraine Las Vegas care generally attend the West Flamingo Road office, which the 215 and Summerlin Parkway feed toward. Consultations, follow-up and both in-office preventive treatments are available there.
Migraine Henderson NV and Green Valley
For migraine Henderson NV patients the West Horizon Ridge Parkway office sits just off the 215 Beltway. Migraine Green Valley Henderson residents almost always find that address the shorter trip, and it offers the same treatments as the Las Vegas site.
Migraine Summerlin and the northwest
Migraine Summerlin patients are usually closest to West Flamingo Road. CNS consolidated from a wider footprint into two offices, so those further north attend whichever is the shorter drive; we will not imply a third location exists.
Migraine Southern Nevada: why the repeating schedule matters
Migraine Southern Nevada patients on a repeating in-office preventive make more trips than most neurology patients, which makes the commute a clinical variable rather than a convenience. A treatment given on schedule works as intended; one that slips because the drive is difficult does not. Choosing the closer office is therefore part of the plan rather than an afterthought, and telling the scheduling team which matters more to you, the office or a specific provider, is the fastest way to resolve it. Coverage and any prior authorisation are verified before your appointment, with detail on the insurance page.
Headache and Migraine Guides
7 in-depth guidesThis hub covers adult headache and migraine care at CNS. The guides below go deeper on the in-office preventive treatments, on how chronic migraine is established, and on the related conditions headache is most often confused with. Start with the guide matching what you have already been told, rather than with the symptom.
Start Here — Cornerstone Guides
Botox for chronic migraine
Candidacy rests on the chronic migraine definition rather than on severity.
Read the guide → PreventionCGRP therapy for migraine prevention
A newer preventive class, assessed over months rather than weeks.
Read more → Facial painTrigeminal neuralgia
Brief electric-shock facial pain, frequently mistaken for migraine.
Read more →Browse by Category
In-office prevention
Targeted procedures
Frequently confused with migraine
When testing helps
The Complete Index — every guide in this hub
Five board-certified physicians
Leo Germin, M.D., FAANEM, founder and medical director, triple board-certified in Neurology and Vascular Neurology through the ABPN and Neuromuscular Medicine through the ABEM, with subspecialty certification in Neurosonology and Neuroimaging. Anup Panduranga, M.D., fellowship-trained in epilepsy. Eric Gutglueck, M.D., neuromuscular medicine and neuromuscular ultrasound. Jessica A. Knirk, M.D., general adult neurology with Botox for chronic migraine. William Lujan, M.D., broad general adult neurology.
Four advanced practice providers
Fara Tan, APRN, MSCN, a Multiple Sclerosis Certified Nurse through the Multiple Sclerosis Nurses International Certification Board. Lindsey Evans, PA-C, general neurology and electromyography. Terra Fonseca, PA-C, a surgical and vascular background applied to general adult neurology. Alissa Nakamura, PA-C, board-certified through the NCCPA, with three years in pain management that transfer directly to nerve-injury and neuropathy questions.
Spread, not headcount
A referral that lands somewhere without neuromuscular or epilepsy depth often becomes a second referral, and each handoff adds weeks. Here an ambiguous nerve study can be reviewed by a neuromuscular specialist and an ambiguous EEG by a fellowship-trained epileptologist without the patient leaving the practice. Full biographies are on the providers page.
The Bottom Line
Ask for a diagnosis rather than relief. Establishing whether headaches are migraine, and whether they meet the chronic migraine definition, is what makes a preventive plan possible instead of a series of attempts at the pain.
Frequently Asked Questions
What does a migraine specialist do differently?
Establishes a diagnosis rather than treating a symptom. That means separating migraine from tension-type and cluster headache and from secondary causes, determining whether the pattern meets the chronic migraine definition, checking for medication overuse, and then matching prevention to frequency rather than to severity.
What counts as chronic migraine?
Fifteen or more headache days a month, with migraine features present on at least eight of them. It is a numerical definition rather than a description of severity, and it determines candidacy for several preventive treatments.
Do I need an MRI to diagnose migraine?
No. Migraine is diagnosed clinically from the pattern and the examination. Imaging is ordered when something specific raises concern, such as a headache that is new and different, one reaching maximum intensity abruptly, or neurological signs on examination. Where warranted it is coordinated with an outside facility.
Can taking painkillers make headaches worse?
Yes. Acute headache medication taken frequently enough can sustain the headaches it was taken to relieve. It is common and it is not a failure of willpower, but it changes the plan, because addressing the overuse usually has to happen before or alongside a new preventive.
How long before a preventive treatment shows an effect?
It is assessed over months rather than weeks, because the measure is a change in headache frequency across a meaningful period. Judging a preventive on whether it stopped a single attack will always make it look like a failure.
Does CNS give Botox for migraine?
Yes, in-office at both the Las Vegas and Henderson offices, for patients who meet the chronic migraine definition. It is given as a series of small injections following a fixed pattern on a repeating schedule, and Dr. Jessica Knirk holds chronic migraine and Botox administration among her areas of focus.
What should I bring to a first headache appointment?
A month of dates recording which days you had a headache, roughly how severe it was, and what you took, along with your full medication list. Most people underestimate their headache days, and that record is what turns an approximate conversation into a diagnosis.
Is CNS a pain clinic?
No. CNS is a diagnostic and medical neurology practice for adults 18 and older. Nerve blocks are performed where an examination localises tenderness to a specific nerve, but the practice does not run an interventional pain programme and does not perform surgery.
How this page was sourced
Practice facts here come from Clinical Neurology Specialists directly: the provider roster, the in-office preventive treatments delivered at both offices, and the absence of an on-site imaging suite. Headache classification and clinical context are sourced to the three organisations listed below, cited inline where each supports a specific claim.
The chronic migraine definition quoted is a diagnostic criterion rather than a CNS figure. Feature comparisons in the table describe typical presentations and are not a self-diagnosis tool, because individual patients vary and overlap is common. No outcome is promised. Scope is adults 18 and older, medical rather than surgical.
References
- American Headache Society — classification and clinical guidance for headache disorders.
- American Academy of Neurology — practice guidance and specialist supply.
- National Institute of Neurological Disorders and Stroke — the reference catalogue of nervous-system disorders.
This page is for general education about adult neurological care and is not medical advice, a diagnosis, or a treatment recommendation. It does not create a physician-patient relationship. Adults 18 and older. For an active stroke, a first-time or prolonged seizure, sudden severe headache, sudden weakness, sudden vision loss, or a head injury with loss of consciousness, call 911 or go to the nearest emergency department. Speak with a qualified clinician about your own circumstances.