NeuroNews

Why A Headache Center?

One of the things that we have learned over time is that headaches are best treated in the context of a headache clinic or a headache program. This brings together multiple disciplines including radiology, physical therapy, and other areas of expertise that can be utilized to treat whatever kind of headache that someone has.

The first thing to do if you have a headache and simple measures like over-the-counter medicines are not really working, and chiropractic intervention really has not helped you; the first thing to do is get into a headache center and get the type of headache properly diagnosed. Certainly it is true that brain tumors, aneurysms, and various other scary things can cause headaches, but typically that is not what is going on. It is important to investigate to rule these things out with appropriate types of MRI, appropriate studies otherwise, and not just any MRI or any blood work, but blood work and MRI specific to the diagnosis of headache type. Once the headache type is pinned down - and sometimes an individual may have more than one kind of headache - then we know about a number of interventions which may help that individual. It may be physical therapy that they need or perhaps they have headaches induced by sleep apnea or some sleep-related disorder that simply needs a CPAP mask or something simple.

There are a lot of medications that can be given on a daily basis or an intermittent basis to help with headaches. Depending on the headache type, the treatment could be very, very different for individuals. If you go into a headache center, the expectation should be that there is a 70% chance you will get rid of your headaches or get them under your control. There is a 30% chance that you may not get complete control of your headaches, but you can certainly get some control and improve your lifestyle. It is only the rare patient that cannot gain control of their headaches through the simple startup measures that would be applied when they first come to a headache center. With those individuals we have to go deeper and look at more options, but I will tell you a lot of patients come in and they tell me "Doc, I had an MRI done 10 years ago and they didn't see anything. I've had all this blood work done and I've been on every medicine there is", but when we start interviewing them, we find out that in fact the MRI they had was a more or less generic MRI. Sometimes if we repeat the MRI and do it a slightly different way, we find something that was missed on the previous MRI. Nobody asked them about their sleep and sometimes that is critical. Perhaps certain blood work was not checked for. Certain inherited disorders can cause headaches and we can rule those out.

When patients are given a list of all the available treatments for headache, even the individual who says "I've been on and tried everything, there's nothing left", is usually amazed. They have usually been tried on less than one-tenth of what is available and that is why in a headache center such as ours we have such a high success rate because we know of treatments that have not been applied.

The average physician, the family practitioner, has one or two really good treatments for headache up their sleeve. They will try these. If they are successful, that is great. If that does not work, then the primary care physician has a lot more to worry about than headaches.

At our center on the other hand, we make it our business to worry about headaches, and since I am a headache sufferer, I take it very personal. We try to keep up with all of the literature. We investigate new therapeutic approaches for headache and we involve ourselves in research in the headache arena, which is not something that you can get from just any neurology office or your primary care doctor. If that is the type of headache treatment and the depth of headache treatment you need, find a headache center with a neurologist that specializes in headaches and see if there isn't something that you have been missing in the management of your headaches. - by Dr. Dana Winegarner, DO