Headache Center: When Pain Becomes A Burden, With No Relief

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By Noreen Kirk, Special to Health News Hub

Many of us experience minor headaches from time to time and think little of it. But roughly 45 million Americans suffer from severe, chronic, recurring headaches. For these people, the pain is a burden that affects every aspect of their lives, and relief can be hard to find.

Fortunately, headache relief is available now at the new Hartford HealthCare Headache Center. The Headache Center, part of Hartford HealthCare’s Neuroscience Institute, opened in fall 2015 under the leadership of Medical Director Dr. Brian Grosberg.

“Our mission is to create and grow a state and nationally recognized, comprehensive, multidisciplinary headache program that provides highly individualized care,” Grosberg says. “Our passion is taking care of people.”

Grosberg came to Hartford HealthCare from the world-renowned Montefiore Headache Center in New York City, where he served as co-director. He also served as program director of its Headache and Facial Pain Fellowship, educating physicians planning to specialize in headache medicine. He is board-certified in neurology by the American Board of Psychiatry and Neurology and board-certified in headache medicine by the United Council for Neurologic Subspecialties

Grosberg has been the recipient of several prestigious awards for his work, including the Clinical Headache Fellowship Award from the American Headache Society.

Grosberg has applied his expertise and experience to assemble and train a team of headache specialists who also see patients at the Hartford HealthCare Headache Center. They include Dr. Abigail Chua, physician assistant Sheena Doyle and nurse practitioners Renee Kane and Andrea Murphy. Other clinical team members include infusion and triage nurses Sarah Fiedler and Christina Fraley. Grosberg describes all of them as “nothing short of superb — the most compassionate, knowledgeable and patient-oriented specialists I’ve ever worked with.”

Plans call for the Hartford HealthCare Headache Center to become recognized as a one-of-a-kind center and a regional and national destination site for headache treatment and prevention. A significant number of patients already are traveling from a number of states to obtain care at the center.

Headache Care: It’s Personal

Before their first visit, patients complete a detailed questionnaire about their health and headache history, lifestyle and more. Grosberg and his team of specially trained headache specialists review the completed questionnaires in advance and again on the patient’s first visit.

The questionnaire, Grosberg says, helps ensure that “patients will experience a comprehensive approach, with an explanation of the type of headache they have and
a treatment plan tailored just for them, because no two people have the same type of headache.”

A priority is involving patients in their own care. When it comes to developing an individualized treatment plan, Grosberg says, “The other headache specialists and I always look to partner with patients. I tell patients, ‘If you’re not comfortable with the plan, neither am I.’”

The team also looks at the whole person, not just the headache. The individualized treatment plan takes into consideration all aspects of the person’s life to maximize treatment effectiveness.

People who suffer from chronic headaches may experience stress, anxiety and depression as a result.

The center also has a licensed psychologist, Dr. Brooke Walters, who is specially trained in both headache medicine and sleep medicine. One of only a handful of psychologists with such expertise, Dr. Walters helps patients deal with emotional issues and works with them on nonpharmaceutical ways to reduce pain.

Treatments

The center offers an array of therapies, some offered at only a few places in the country. One is intravenous (IV) therapy. Patients with headaches that are particularly difficult to treat — or pregnant patients who can’t take oral medications — can come into the office and receive IV medication to help break the headache cycle and offer rapid relief.

“We are the only facility in New England with the capacity to offer it in this fashion,” Grosberg says.

The center is one of only 60 sites in the country able to prescribe transcranial magnetic stimulation, or TMS, for headache. TMS is a painless, noninvasive treatment that uses a hand-held device to deliver magnetic pulses believed to create electronic currents in the brain that help treat migraine. Studies have shown that TMS may also be effective in preventing headache and reducing headache frequency and severity.

Biobehavioral treatments such as biofeedback, cognitive behavioral therapy, relaxation training and stress management are also available. These treatments have proven effective both on their own and as adjuncts to medication.

Depending on the patient’s individual needs, Grosberg and his team may recommend injection therapies. These are administered in the center. They include Botox, which is effective in treating chronic migraines; nerve blocks, which use local anesthetics and sometimes steroids to provide immediate relief from headaches; and trigger point injections, which treat headaches, neck and shoulder pain by relaxing muscles that contribute to pain.

These treatments and a variety of oral medications give the center’s providers and patients a range of choices for relieving pain. Treatment is adjusted over time based on the patient’s response. Each patient keeps a detailed headache journal so his or her experience can be reviewed at each visit.

Looking Ahead

Grosberg sees the center continuing to grow as a hub of provider education and headache research. Additional locations will be established late this year to make the center’s exceptional care more readily available to patients throughout Hartford HealthCare’s service area, something no other program in the country has done. Grosberg’s collaboration with a leading researcher at Harvard Medical School will enable patients to receive treatments available at only a few places in the country. Philanthropy will play a significant role in the growth of both the Headache Center and the Neuroscience Institute it is part of.

As Carol Garlick, vice president of philanthropy, says, “Through Dr. Grosberg’s personal, compassionate care, he has developed a network of grateful patients who understand the unique value of the center and are interested in supporting his vision to build, enhance and expand the center to be recognized nationally for exemplary and innovative care.”

Finding Migraine Relief

Sarah Hughes began suffering severe headaches when she was a junior in college.

“The pain was extreme and absolutely debilitating,” Hughes recalls. “When I’d been in bed for three days straight, my roommates decided to drive me home to my parents.”

For the next 20 years, Hughes sought relief from the pain that plagued her and disrupted her life. Diagnosed with migraine, she saw specialists, had numerous tests and was given different combinations of medications, but nothing worked.

She noticed patterns. When the pain came, it was as a constant, burning headache punctuated by intermittent, stabbing pain, all on the right side of her head. Weather was a trigger.

“During the same week in October, for the last 20- plus years, I go down,” Hughes says. “The change from summer to fall is crippling.”

When she learned about the new Hartford HealthCare Headache Center in October 2015, she called for an appointment, completed the headache questionnaire and saw Dr. Brian Grosberg and his colleague, headache specialist Andrea Murphy.

“I was utterly amazed, and so thankful, because I knew I just couldn’t take it anymore,” Hughes says. “They spent a good three hours with me, explaining what they thought was going on. It was like Neurolo- gy 101. And Dr. Grosberg’s bedside manner is the best I’ve ever seen.”
Targeted Treatment

For decades, Hughes had been treated for migraine or cluster headaches. Grosberg determined that what she actually had was a less common type of headache called hemicrania continua. With the correct diagnosis, Hughes and Grosberg were able to develop a targeted treatment plan.

A combination of nerve block injections and oral medications has given Hughes the relief that eluded her for more than 20 years. When she does experience a baseline headache, the intensity on a pain scale is a manageable 1 or less, instead of the 8 or 9 it used to be. She has more days when she’s completely headache-free.

The change has made a dramatic difference in Hughes’s life. She can listen to her car radio without cringing at the sound. She can brush her hair in the morning. She no longer dreads the change of seasons. And she can sleep through the night without being awakened by pain.

Hughes has high praise for the center’s entire team, describing them as “super-responsive” and “caring.” “But what’s really different there,” she adds, “is the level of personalized care.”

Today, Hughes is a business analyst with a major insurance company. The headache journey she be- gan as a college student has been long and difficult. Thanks to the Hartford HealthCare Headache Center, she hopes to be able to use her allotted vacation days, not to deal with headaches, but to enjoy her life.


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