Headache disorders: Subspecialized, compassionate care

June 25, 2019

Jonathan H. Smith, M.D., a headache neurologist at Mayo Clinic in Phoenix/Scottsdale, Arizona, answers questions about subspecialized management of headache disorders. Mayo Clinic is committed to providing optimal care for people with headaches, an often-underserved group.

When should a physician think about referring a patient for subspecialized headache care?

Headache disorders need to be taken seriously. They can strike in the prime of life, affecting quality of life, career stability and relationships — truly every aspect of a patient's life. Referral to a headache neurologist is appropriate anytime there is uncertainty regarding the diagnosis or management of a patient with headaches. Since the symptoms of many different headache disorders are very similar, a headache specialist will focus on a detailed clinical history and examination to ensure that the diagnosis and treatment approaches are correct.

Unfortunately, headache disorders are often misdiagnosed, mistreated and not given their due respect in the overall scope of medical practice. Patients often feel stigmatized. The members of our group are passionate about the care of patients with headache disorders. We are actively engaged in patient education and advocacy.

What types of headaches can a headache neurologist manage?

Any type of headache falls within the purview of a headache neurologist. At Mayo Clinic, we are able to manage the spectrum of pain treatments, including acute headache, sports-related concussion and chronic pain rehabilitative efforts.

Our group also has extensive experience in the care of individuals with common headache disorders, such as migraines and cluster headaches, as well as more unusual headache disorders, such as cerebrospinal fluid pressure disorders, trigeminal neuralgia and giant cell arteritis.

What other medical specialists might be involved in managing headache disorders?

Headache disorders intersect with a wide scope of medical specialties, including internal medicine, sleep medicine, otorhinolaryngology, psychiatry, ophthalmology, allergy, physical medicine, integrative medicine, pain medicine and neuroradiology. As members of a fully integrated practice, Mayo Clinic doctors work as a team to care for all the needs that our patients present, in a coordinated and timely fashion.

What is Mayo Clinic's approach to the management of headache disorders?

Patients referred to Mayo Clinic can expect a comprehensive and patient-centered approach to their headache concerns. We are able to provide a breadth of treatment options, depending on the patient's diagnosis and personal preferences, including:

  • Nonmedical options, such as acupuncture
  • Injection-based treatments, such as nerve blocks and onabotulinumtoxinA
  • Device-based approaches, such as noninvasive vagal nerve stimulation
  • Traditional medical approaches, such as topiramate or calcitonin gene-related peptide antibodies
  • Interventional approaches, such as radiofrequency ablation

We also have opportunities for patients to be involved in clinical trials of emerging treatments. Mayo Clinic is working to advance headache care through research. As clinicians, we regularly interact with our research colleagues and are able to inform one another to advance our shared mission of always improving our level of care for our patients.

With a detailed, patient-oriented and often multidisciplinary approach, we are generally able to help even people with the most challenging conditions.

What new insights and therapies are emerging for the management of headache disorders?

Our understanding of the biology of headache disorders is rapidly advancing. That, in turn, is leading to new therapies. In the last year alone, the Food and Drug Administration has approved new treatments that are effective and have low side effect profiles, including therapies targeting calcitonin gene-related peptide. Mayo Clinic was actively involved in designing clinical trials for these medications and analyzing the resulting data. In addition, our Neuroimaging of Headache Disorders Laboratory is using functional and structural MRI to identify subtypes of migraine.

It's an exciting time to be able to care for patients with these conditions. In our practice, we like to empower our patients, validate their concerns and take a compassionate approach to care.