For more than 10 years, Connie Chung, 24, suffered from frequent headaches.

“I would have to curl up under the covers with a pillow over my head and wait for it to go away,” said Ms. Chung, now a paralegal with a New York law office.

As a college student at the Wharton School, she constantly took Excedrin Migraine. Worried about taking too much over-the-counter medication, however, she turned to a neurologist who prescribed nortriptyline, an antidepressant, to treat the pain instead. She felt better.

But after moving to New York three years ago, she stopped taking the medication for a month when she didn’t refill her prescription. “I pretty much woke up every day with a pounding headache,” she said. “I went everywhere with Excedrin in my bag.”

She sought help again, this time visiting the Headache Center at Columbia University Medical Center Eastside. The four-year-old center sees about 150 people each week. It has a staff of 13.

Ms. Chung had a 90-minute consultation with the Headache Center’s co-director, Dr. Mark Green, who is also a clinical professor of neurology at Columbia University of Physicians and Surgeons and the author of “Managing Your Headaches,” (Springer, 2005). Dr. Green diagnosed her with chronic headaches and occasional migraine. He suggested that she go to sleep earlier, and prescribed divalproex, a prophylactic medication frequently used in treating epilepsy, as a preventative against migraines for her to take at bedtime. He also prescribed a medication called sumatriptan, which Ms. Chung takes at the first sign of pain or light sensitivity to stop a headache from worsening.

“It doesn’t mean I’m never going to get a headache again,” Ms. Chung said. But life is better. She rarely has to call in sick to her office or explain to friends that migraine is sidelining her.

Columbia’s headache center is one of five medical facilities in New York devoted to treating headache sufferers. It’s no coincidence that New York has several headache specialty centers: Stress can be a trigger for headaches. “I hear all the time, ‘I moved to New York and I started having headaches,'” said Dr. Alexander Mauskop, director of the New York Headache Center on East 76th Street.

The New York Headache Center is both a treatment and research center for migraine and other types of headaches. It was founded in 1988 and has offices in Manhattan, Brooklyn, and Westchester. With a staff of 12, the center treats 200 patients a week. Through clinical trials, the center tries new medications not yet approved by the Food and Drug Administration (FDA) as well as FDA-approved drugs.

How do you know if you have migraine? “Most people with several headaches a week suffer from migraines,” said Dr. Mauskop, who is also an associate professor of neurology at SUNY Downstate Medical Center and co-author, with Barry Fox, of “What Your Doctor May Not Tell You About Migraines” (Warner Books, 2001). “If you suffer from severe headaches, chances are it’s a migraine.” Signs of a migraine headache include sensitivity to light, nausea, and disabling pain.

To distinguish between a secondary headache – one that is a symptom of an underlying condition – and a primary headache, when the headache itself is the condition, physicians rely on the patient’s medical history and a thorough physical examination, according to Dr. Green. Other diagnostic tools often used by physicians include computerized tomography (CT), magnetic resonance imaging (MRI), electrocephalogram (EEG), blood tests, and lumbar puncture to extract cerebrospinal fluid. Most headaches, whether episodic or chronic, are not symptoms of other diseases but are primary headache disorders, Dr. Green said. Severe and disabling headaches are usually migraine.

Its exact causes are not clear but research has linked migraine to lack of magnesium, serotonin imbalances, and electrical changes in the brain. “What’s going on is up for grabs,” Dr. Green said. He cited changes in brain chemistry as one theory. “You inherit migraine, a brain that is more excitable than other brains,” Dr. Green said. Eighteen percent of women and 6% of men suffer from migraine. The “excitable brain” functions best with constancy: the same sleep/wake cycle, the same stress cycle, and the same meal cycle. “A high-performance, high-maintenance brain is inherited. It needs constancy,” Dr. Green said.

Migraine can be triggered by a variety of factors, which vary from person to person. Among them are chemical fumes, weather, the menstrual cycle, missing a meal, particular foods, lack of sleep, caffeine, alcohol (especially red wine), and chocolate. Stress can also be a factor. It depletes the body of magnesium, which causes blood vessel constriction.

Treating chronic headache and migraine can be a trial-and-error process. No one approach works for everyone. Treatment options range from lifestyle changes to natural remedies, biofeedback, meditation, acupuncture, and even Botox injections, as well as prescription drugs that stop migraine headaches already in progress (called abortive drugs) and those designed to prevent future migraines (prophylactic drugs). Some medications that were developed to treat other diseases, such as depression, high blood pressure, and epilepsy, have been found to help migraine sufferers.

“Get an exact diagnosis,” said Dr. Anthony Geraci, director of the Lutheran Medical Center Headache Center in Brooklyn. At Lutheran, each patient has a one-hour consultation with Dr. Geraci to examine the cause of the headache and develop a treatment plan.

New York’s oldest facility for treating headaches is the Headache Unit at Montefiore Medical Center in the Bronx. The unit was started 60 years ago, has a staff of eight, and treats 150 patients a week. Dr. Richard Lipton, the unit’s director (who is also a professor of neurology, epidemiology, and population health at Albert Einstein College of Medicine), noted that it’s important to treat migraines because there is some evidence that cumulative migraine attacks can cause changes in MRI (magnetic resonance imaging) of the brain. He added, however, that “there is no evidence to demonstrate permanent cognitive impairment in people with frequent migraine, although a person may be impaired while he or she has a headache.”

WHERE TO GET HELP

The Headache Center at Columbia University Medical Center Eastside
Dr. Mark Green, Co-director
16 E. 60th St., Suite 310
212-326-8456
www.columbiaheadache.org

Headache Unit at Montefiore Medical Center
Dr. Richard Lipton, Director
111 E. 210 St., Bronx
718-430-3886
www.montefiore.org/services/headacheprogram

New York Headache Center
Dr. Alexander Mauskop, Director
30 E. 76th St.
212-794-3550
www.nyheadache.com

Lutheran Medical Center Headache Center
Dr. Anthony Geraci, Director
150 55th St., Brooklyn
718-630-7316
www.lutheranmedicalcenter.com

The Headache Institute at St. Luke’s-Roosevelt Hospital Center
Dr. Lawrence Newman, Director
1000 Tenth Ave.
212-523-5869
www.bethisraelny.org/headache