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Headache Medicine

Headaches are the most common neurological disorder. Approximately 40 million Americans have migraine headaches and other headache disorders causing incapacitation and requiring medical care. Among these individuals are 8 million persons with migraine headache episodes occurring at least 15 days per month in each of the last 6 months.  The World Health Organization ranks a migraine as the 7th leading cause of disability worldwide. In the United States, migraine and related disorders are the most common cause of pain related disability. The economic costs resulting from migraine-related loss of productive time in the US workforce is more than $13 billion per year, most of which is in the form of reduced work productivity. More than 85% of women and 82% of men with migraine had some headache-related disability. And it is more than just economic consequences the nature of migraine headaches and that impact on the person with them results in significant lost time from home and family affairs and a significant diminished quality of life for the patient and also their family members. Just as in other areas of medicine, the majority of care can be rendered by primary care providers however for the most seriously afflicted there is a new for advanced care in the form of a headache medicine specialist. This specialty is in its relative infancy having been recognized as such in only the past 15 years.

Headache Medicine is a subspecialty concerned with the diagnosis and treatment of head and face pain. Its scope includes the primary headache disorder such as migraine, tension-type, and cluster headache. Complications related to these primary headaches such as Medication Overuse, Chronic Migraine, and Status Migraine require the specialized expertise that the specialty of Headache Medicine delivers. Headache medicine specialists also provide care for other painful disorders of the head and neck treating disorders such as Trigeminal and Occipital Neuralgia, Cervicogenic Headache and secondary causes of a headache such as a sinus disease, infection, brain tumors, vascular disease and exposure to certain medications and environmental sources.

Headaches are experienced by essentially everyone at some time in their life. For the vast majority, rest and simple over the counter medications may be more than sufficient. Patients with significant headaches require more than rest, reassurance, and simple medicines. They require concerned and knowledgeable clinicians who can work with them to find successful means of controlling their headaches and restoring their quality of life. Specialists in headache medicine may come from various backgrounds including neurology, psychiatry, or primary care.

In 2013, Dr. Frederick Freitag, a headache medicine specialist with 30 years of experience at the largest headache medicine practice in the Midwest, along with the Chair of Neurology, a team of highly experienced neurologists and specialists in other areas of medicine, and the support of administration at the Medical College of Wisconsin and Froedtert hospital developed the first comprehensive headache medicine specialty program in Wisconsin. Since then it has expanded its staff and services into a program recognized internationally for its expertise in providing quality care to the citizens of Wisconsin.

The headache medicine program is now under the leadership of Fallon Schloemer, DO, who was the first trainee in the headache medicine fellowship at MCW. She is joined by Jonathon Florczak, MD, who oversees the headache medicine fellowship. And her colleagues include Dr. Freitag, Derrick Shumate, DO; Amir Tolebeyan, MD; and Cheryl Blaschuk C-ANP, Sonia Neuberger, PA-C, and our dedicated pain psychologist, Kirti Thummala, PhD. These clinicians work hand-in-hand with an array of other medical and surgical specialists from many departments at the Froedtert and the Medical College of Wisconsin to provide a comprehensive approach to the diagnosis and management of headache disorders. These other specialists include otorhinolaryngology, physical medicine and rehabilitation, chiropractic, sleep medicine, neuro-ophthalmology, pain medicine, psychiatry, neurosurgery, plastic surgery, physical therapy, nutrition, and nursing.

This type of a comprehensive team approach is needed to address the complex issues that occur in patients with migraine headaches and other painful disorders of the head and neck. This program brings to together the ability to address the evaluation and diagnosis of headache required by our patients. It also provides the wherewithal to provide an array of treatment options to deliver the best evidence-based approach and quality care to for these various disorders.

Assessment of headache disorders encompasses obtaining a thorough history, a thoughtful review of a patient’s past care, and careful physical and neurologic examinations as a starting point. Prior evaluations and diagnostic examinations with other specialists and therapists, diagnostic laboratory studies, and the most advanced neuro-radiologic imaging is obtained.

The plan of care is established in conjunction with other specialists and based on the diagnostic finding, but most importantly, the plan is established through a discussion with the patient to assure understanding of the needs, concerns and expectations they have.

Newer is not always better so we all make use of medical and other therapies that have been well investigated for safety and efficacy and are the cornerstones upon which all subsequent advances in headache medicine treatment have rested and still serve us and our patients well. These include beta blockers and antidepressants, both classes medications which were proven to be effective for headache patients by Dr Freitag’s former partner and long-time mentor, Seymour Diamond, MD. But beyond these we use treatments that are at the forefront of improving headache medicine care such as the Calcitonin Gene Related Peptide inhibitors and antibodies which have been shown repeatedly to improve outcomes for patients with an almost complete lack of side effects.

Other innovative and effective approaches are used. These include the use of neurotoxin injections for patients with chronic migraine which Dr Freitag helped to pioneer for headache through expert discussions and numerous clinical trials. We have been at the forefront of other advanced treatment through the use of medical devices and procedures including sphenopalatine ganglion blocks performed with a thin plastic catheter, to transcranial electrical stimulation and transcranial magnetic stimulation (TMS). and now with a peripheral stimulator applied to the arm, called Nerivio which can stop a migraine without a medication in 45 minutes.

The headache medicine team is actively involved in the development of newer and safer approaches to treatment through clinical research. We have been involved in the clinical trials for the CGRP antibodies and oral inhibitors, the  use of SPG blocks done weekly to prevent chronic migraine headaches and will be working with cardiology to assess the benefits of closure of a defect in the heart wall called a PFO as a means of preventing migraines and strokes related to migraine.

Headache medicine is a growing field and The Medical College of Wisconsin along with the section on headache medicine have one of only 50 programs in the country to train physicians through a fellowship after they have completed their residency training. For the physicians in the section this is also very important, because, as many of you know, one of the best ways to learn something is to teach it to others.

This teaching is not just for medical trainees, but the section, along with significant support from Froedtert Hospital, has developed a variety of teaching methods for patients. These learning materials help the patient, their family, and coworkers to better understand the nature of migraine and other headache disorders, instruct them in approaches that they can use to help themselves better control and avert their headaches, as well as develop an understanding for the most effective and safe use of their medical therapies.