- Primary CareFor patients who are unaware of the closing or who are looking to schedule an appointment in the future, please contact your primary care provider to discuss a referral to a new physician.
- Emergency CareOccasionally, patients may suffer from severe headaches that last for several days. These more severe headaches may not respond to medications at home. For this reason, we offer injectable medications at our clinic. Examples of these mediations include intravenous dihydroergotamine (DHE) and ketorolac. This often allows patients to avoid unpleasant and costly visits to the emergency room. Whenever possible, these treatments can be done on the same day if the patient calls our office in the morning.
- Macular DegenerationVision is very important for balance. Conditions causing poor vision such as cataracts and macular degeneration can lead to imbalance, particularly in patients who also have any of the conditions listed above.
- Cataracts
- NeurologyMel was a Board-Certified Neurologist who trained at Albert Einstein College of Medicine in New York City. After finishing Medical School, he returned to his Central Valley roots where he opened the California Headache & Balance Center in Fresno. Mel's medical practice is the only clinic in central California that specializes in difficult headache problems as well as conditions related to dizziness and imbalance. He was a well-respected doctor of neurology and will be greatly missed by his many patients as well as the Central Valley medical community.
- Multiple SclerosisImbalance is very common is patients with multiple sclerosis (MS). In MS, the insulation around brain and spinal cord cells is defective. The lesion in the brain or spinal cord caused by the defective insulation is called a "plaque." If a plaque occurs in the regions of the brain responsible for balance such as the brain stem or the cerebellum, the patient may experience severe imbalance and ataxia.
- MRIAcoustic neuromas, also known as vestibular schwannomas, are non-malignant tumors of the eighth cranial nerve. Most commonly they arise from the covering cells (Schwann cells) of the inferior vestibular nerve. These cells provide the insulation of the nerves, much like the insulation around an electrical wire. Acoustic neuromas usually cause hearing loss, but may not cause dizziness or imbalance. Acoustic neuromas are relatively rare as only about 10 tumors are newly diagnosed each year per million persons in the United States. Diagnosis is made with MRI after changes are detected on audiometry and brain stem auditory evoked responses. Treatment options for acoustic neuromas include surgery and radiation.
- X-Rays
- Computed TomographyLike the MRI, the CT scan provides pictures of the brain. Rather than magnetic fields, X rays are used to construct the images. Although the resolution of the images is higher with MRI, CT is more sensitive for detecting bleeding. For this reason, CT imaging is the test of choice if a brain hemorrhage is expected.
- BotoxBotox is one of the newest treatments for headache prevention. Although Botox is the same toxin that causes botulism, the medication form of this substance is in low concentration and is safe for injection. The medication is injected diffusely into the muscles of the head and neck. Although Botox induces muscle relaxtion, it also blocks pain in ways that are not completely understood. The procedure takes about ten minutes and only minor pain typically occurs. The advantage of Botox is that it has fewer side effects compared to other medications. The disadvantage of Botox is that it is expensive and not all insurances will pay for it. In our experience, Botox is not neccesarily more effective than other medications, but it is better tolerated. Also, it is a good alternative for patients who have tried multiple preventitive medications without relief.
- LesionsABRs are a method of determining the integrity of the auditory portion of the eighth cranial nerve. This test is done by stimulating the ears with sound and then recording electrical potentials produced by the brain with electrodes placed on the scalp. The entire pathway for hearing from the ear to the brain can be studies with this technique. ABRs are used most commonly to screen for acoustic neuromas. They also can be used to localize lesions in the brainstem (for example in stroke and multiple sclerosis).
- Physical TherapyOtotoxicity is the term used to describe damage to the ear caused by toxic substances. This occurs when individuals come into contact with drugs or chemicals that are poisonous to the inner ear or to the nerve that supplies the inner ear (vestibulocochlear nerve). Because the inner ear is involved in both hearing and balance, ototoxicity can result in problems with either or both of these senses. Symptoms vary considerably from drug to drug and person to person. They range from mild imbalance to severe vertigo, tinnitus (ringing in the ears) to total hearing loss. If symptoms involve both the right and left inner ears, the patient may not have vertigo or hearing loss, but severe imbalance and blurred vision caused by poor stabilization of the eyes. This also causes the inability to tolerate head movement. The diagnosis is based upon the patient's history, symptoms, and test results. Tests that may be used to determine how much hearing or balance function has been lost include the vestibular autorotation test (VAT), electronystagmography (ENG), computerized dynamic posturography (CDP), auditory brainstem response (ABR), and pure tone audiometry. The goal of treatment is to help the brain become accustomed to the changed information from the inner ear and to assist the individual in developing other ways to maintain balance. Greater use of vision and muscle sensory information (proprioception) can be developed through formal physical therapy and a program of general physical conditioning and exercise.