Goals and Methods of Pacific Rim Headache Center—What to Expect
Goals:
If wishes could be transformed into goals, then our ultimate goal would be that our patients
never have pain again and live forever in prosperity. However, speaking realistically, our goals
include the following:
1) We arrive at a precise diagnosis according to the International Headache Society’s
criteria for headache classification. Our diagnoses are honest and we never attempt to
make up simple, but false, explanations for complex disorders.
2) The patient experiences 80% reduction in number of hours with pain.
3) When a headache does occur, the patient can eliminate the pain within two hours of
onset.
4) If medications are used, they are used safely and any resulting side effects would be far
less than the benefit experienced.
Methods:
We are an evidence-based medical practice. This simply means that we do not promote any
treatment that hasn’t been proven to be safe and effective. With our combined 70 years in
medical practice, and most of that in headache research and management, we follow the
cutting edge thinking from research in headache treatment. Besides our years of training, we
annually attend the most important American and international headache meetings. We also
read the major journals on a monthly basis. There is rarely a legitimate treatment or idea that
we don’t know about before the public does.
Prevention
When headaches occur once a week or more, the goal is prevent as many as we can. This is
achieved through the following approaches:
1) Look for real underlying causes or triggers and try to mitigate them. We do not “make
up” causes simply to win the patient’s confidence and trust. Many patients have no
controllable triggers.
2) Hands-on treatments. The only ones with supporting data are aerobic exercise,
biofeedback and possibly acupuncture. However, if the patient wants to try
chiropractic, massage or other physical treatments we support their decision .
3) Natural supplements. Scientists have searched for natural vitamins and supplements
that can prevent headaches for decades. Unfortunately, most of the honest trials have
been disappointing. The only supplements with marginal supporting data are;
a. Butterbur (but we are no longer using it because of possible liver toxicity)
b. Riboflavin at 400 MG per day
c. Co Enzyme Q 10.
d. Boswellia
e. Magnesium
f. Feverfew
While there are claims of cures and treatments for other supplements, these are the
ONLY ones at this time with supporting evidence of helping. These supplements are
weakly helpful and can take up to three months to be beneficial.
4) Prescription Medications. At this time, there are no medications on the market
developed to prevent headaches. They are working on several. However, of over 6,000
medications approved by the FDA for the US market, about 30 have accidently been
found to prevent headaches. We know how the seizure drugs and calcium channel
blockers work to prevent headaches, but we don’t have a clue how the others work . . .
but they do. These treatments are by far the most effective treatment in preventing
headaches. All of these, except for Methergine® (methylergonovine maleate), will take
2-3 weeks to start working and can take up to three months to realize their peak
effectiveness. At PRHC, we carefully select preventative medication based on an
individual’s type of headaches and our desire to avoid unwanted side effects and risk.
We don’t just throw a medication at a patient haphazardly. We often start with subtherapeutic doses to prevent side effects so the medication doesn’t have the chance to
start working until it is titrated upward.
While we wish that all patients reach these therapeutic goals after the first visit, we realize that,
due to the complexity of headache disorders and each patient being unique, it can take several
visits to get this right. The patient needs to keep their follow up appointments and be patient as
we adjust treatment to the maximum benefit. Once we accomplish these goals, we will see the
patient annually if we are prescribing medications or turn them back over to their PCP. If we are
prescribing controlled substances, the law requires us to see patients more often.