Stanford Medicine Newsletter Updates For the Local Community

 

Making headway on headaches

New clinic combines expertise with innovation

As director of the new Stanford Headache Clinic, Robert Cowan, MD, is taking a multifaceted approach to treating patients’ pain symptoms.

   

Miriam Edelman spent the last 32 years of her life fighting one serious migraine after another. And she tried over and over again to stop the pain.

“I’ve had many things done to my body, including IV medication drips,” she said. “I did biofeedback. I avoid the sun. I have ice packs. I’ve been on a horrible path of doctors.”

But her life took a different turn in July when she met Robert P. Cowan, MD, director of the new Stanford Headache Clinic. He really listened to her, she said. “He’s the first one who put it all together.”

This summer, following Cowan’s treatment suggestions, Edelman went to the kind of outdoor event that once would have immediately brought on a headache. Amid migraine triggers like music and dancing and bright sun, she did not suffer any pain. “It was the happiest day of my life,” she said. “At 70, I’m free at last."

A serious issue

Cowan, a nationally renowned headache specialist, is at the center of a program that’s the first of its kind at a West Coast academic medical center. It starts with a panoramic view of headache, drawn with the combined expertise of physicians and nurses who specialize in headache care, as well as a nutritionist, a physical therapist, a psychologist and a sleep specialist who all understand the complexity and difficulty of managing headache pain.

“Only recently has headache been considered a serious issue,” Cowan said. “Stanford is bringing its tremendous resources to a problem that affects 60 million Americans and costs the economy $30 billion a year.”

Specialty focus

Headaches are a very common complaint, yet most medical training does not include substantive teaching about them, said Frank Longo, MD, PhD, chair of Stanford’s Department of Neurology and Neurological Sciences. “Unless one has specialized training, it’s a very intimidating area.”

To address the shortage of specialists in the field, the clinic includes another unusual element—a fellowship for physicians in treating headache pain.

Cowan, who was chosen to direct the new clinic after a national search, is board certified in psychiatry and neurology, with a subspecialty certification in headache management. He chairs the American Headache Society’s section on complementary and alternative medicine and is vice president of the Headache Cooperative of the Pacific. He has written more than 50 journal articles, as well as a best-selling book, on headache pain.

Combined expertise

Cowan will be joined at the new clinic by Meredith Barad, MD, a new faculty member in neurology who has specialized training in pain management. Her focus is on overuse of medication for headaches and multidisciplinary care.

Multidisciplinary treatment will be at the forefront of the clinic’s approach, with “physical therapists who understand that people with migraines are sensitive to touch, psychologists who understand that a migraine can be a physical manifestation of stress, nutritionists who understand that it’s not just what you eat but when you eat it, and sleep experts who recognize it is more than sleep apnea,” Cowan said.

He said migraine is a very complex condition requiring complex care. “We don’t have a cure, so the goal is to manage it as a chronic condition. It can become a footnote or it can ruin your life.”

For more information about the Stanford Headache Clinic, visit stanfordhospital.org/headache.

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