Headaches have been part of your daily life for so long, you can’t even remember when they started.
You’ve tried everything—over-the-counter medications, prescription painkillers, herbal supplements. You’ve changed your diet. You’ve changed your sleep habits. You’ve stopped going out with friends and family. But no matter what you do, the incapacitating headaches keep coming back.
For a select and unfortunate group of headache sufferers, this extreme scenario is the status quo. Despite doing everything they can to treat their headaches, their pain is persistent, severe and debilitating. Unique cases like this warrant unique care. That’s where inpatient headache clinics come in.
Inpatient headache care is a multidisciplinary treatment approach administered by medical professionals who specialize in complex headache cases, says Wade Cooper, DO, director of the Headache and Neuropathic Pain Program at the University of Michigan. This type of care provides a host of benefits, including access to a team of specialists, close medical observation for more difficult cases and intensive therapeutic options, such as IV medications, that are not available at home or in most acute care settings.
For patients who can’t find relief elsewhere, inpatient headache clinics can provide tools to reduce pain and improve quality of life.
Headache Clinic Acceptance
The roots of inpatient headache care date back to the 1980s, when Seymour Diamond, MD, executive chairman of the National Headache Foundation and founder and director emeritus of the Diamond Headache Clinic, established the first dedicated acute inpatient headache unit at Bethany Methodist Hospital in Chicago. The inpatient unit of the clinic has since moved to its current location at Chicago’s Saint Joseph Hospital.
“Nobody really thought of a [headache] unit to help people who were acutely ill or had a medication problem,” Dr. Seymour Diamond says. “The model of our unit was distinct.”
Despite collaborating closely with a hospital, Dr. Seymour Diamond recognized the importance of keeping the unit separate. “We didn’t rotate nurses from a surgical ward to our ward—our staff was trained to take care of [headache] patients,” he says. “That includes the nursing assistants, the unit secretary—everybody was attuned to the headache patient rather than the confusion of a general hospital.”
The Diamond Inpatient Headache Unit—still the only dedicated unit of its kind in the United States—has always focused on multidisciplinary care, which was a unique treatment philosophy when the facility opened nearly 30 years ago. In addition to the physicians and nursing staff, the unit staff includes a full-time pharmacist, biofeedback therapist, dietitian, physical therapist, psychiatrist and two psychologists to treat all aspects of pain. The unit even incorporated special lighting in its design that is easier on headache patients.
“At the onset, we incorporated a lot of elements that people wouldn’t think of doing in terms of headache care,” Dr. Seymour Diamond says. “Today we’re nationally and internationally accepted, but at that time, our efforts were questioned.”
Anatomy of a Headache Clinic
Merle Diamond, MD, managing director of the Diamond Headache Clinic (and Dr. Seymour Diamond’s daughter), says inpatient headache care is a good option for people who don’t respond to traditional outpatient treatments. Although inpatient care likely won’t make headache disorders go away, it can significantly improve quality of life—the clinic’s inpatient population has a 75 percent improvement rate, she says.
“Our goal is to give patients the ability to recover from chronic headache and become part of their family’s life again and part of the world again,” Dr. Merle Diamond says. “A lot of these people have lost that ability because they are bedridden and often don’t work.”
The Diamond Inpatient Headache Unit offers 38 adult beds and eight pediatric and adolescent beds. Approximately 2,000 patients are admitted each year—some even travel from other countries because this type of treatment is so rare.
The Inpatient Headache Treatment Approach
One of the biggest challenges of treating complex headache disorders from an inpatient standpoint is setting realistic expectations.
“Virtually every patient we see says they want to be cured of their headaches,” Dr. Merle Diamond says. “We have to adjust their expectations to the extent that they will be better, but sometimes they will still have headaches.”
Many headache sufferers, especially those who have become accustomed to taking medication for quick bouts of relief, find it hard to accept a multidisciplinary inpatient treatment approach. According to Richard Wenzel, PharmD, the pharmacist at The Diamond Inpatient Headache Unit, changing ingrained patient behaviors takes time.
“Many would rather take a medication to treat their pain instead of trying non-medication options, including biofeedback or stress coping techniques,” Wenzel says.
Wenzel, who also teaches classes to help patients fully understand their medications, says medication-induced, or rebound, headaches are a major problem. He estimates at least half the patients who walk into the inpatient unit are overusing medication.
“Some people didn’t know what else to do, so they just took more medication—that’s one side of the spectrum,” he says. “On the other side, we do have a small number of people with some kind of substance abuse disorder.”
There are many factors that contribute to complex headaches, which is why it takes a variety of approaches and techniques to create an effective treatment strategy. Regardless of whether a patient is overusing medication or simply doesn’t recognize his or her triggers, the comprehensive care found at an inpatient headache clinic is designed to address all aspects of the disease.
“There’s an unrecognized need for inpatient headache care,” Wenzel says. “Patients don’t know what to do—they just keep sucking down more medicine. If we identify these people sooner and get them treated sooner, we can prevent them from coming to our clinic.”
Intensive Care
Although an inpatient clinic offers a wide range of benefits, most patients do not require such intensive treatment and might be able to find relief at an outpatient clinic, Dr. Cooper says.
“Development of outpatient detoxification programs, including those focused on opioid medications, has allowed many patients to be successfully treated as an outpatient,” Dr. Cooper says.
For people with complex headaches, The Cleveland Clinic offers an intensive outpatient headache program, called the Interdisciplinary Method for the Assessment and Treatment of Chronic Headache (IMATCH). This is a three-week, structured day-hospital program that takes a multidisciplinary approach, just like an inpatient clinic. The first week is focused primarily on using intravenous infusions to clear patients’ systems of medications that may be contributing to their headaches or on treating chronic daily headache. The next two weeks provide a combination of medical and psychological treatment, education, physical therapy and group sessions that enable patients to control their pain once they complete the program.
“The goal is to shift the locus of control to the patient—to give them the tools to manage their pain without resorting to the excessive use of medication,” says Stewart Tepper, MD, professor of medicine (neurology) at the Cleveland Clinic Lerner College of Medicine.
While outpatient care can be helpful, there are circumstances for which a patient needs to be referred to an inpatient clinic. For example, if the patient shows symptoms of withdrawal, has a drug addiction or has a fragile psychiatric state (e.g., depression or previous suicide attempts).
“When a patient goes to an inpatient headache program, it’s not a detox program, it’s not a psychology program and they’re not walking around in a drafty hospital robe,” says Edmund Messina, MD, director of the Michigan Headache Clinic. “With inpatient care, patients are actively taught about headaches and given therapy and infusions, as well as other medical strategies that might not be safe or practical in the outpatient sector.”
It’s important, he says, for people to realize that complex headaches warrant complex care and that headache sufferers should not simply accept chronic headaches as part of their daily life.
“Most headache treatment is done in outpatient headache clinics, but there are times when an inpatient stay is essential,” Dr. Messina says. “That is why it is essential for regional inpatient centers to exist. It’s not OK for people to suffer with headaches.”
Recommended Headache Clinics
If you are looking for more intensive treatment for your headache disorders, try one of the following facilities:
Diamond Headache Clinic
1460 North Halsted St., Suite 501
Chicago, IL 60642
(800) 432-3224
Diamond Inpatient Headache Unit*
Saint Joseph Hospital, 9th Floor
2900 North Lake Shore Drive
Chicago, IL 60657
*Patients must be evaluated at the clinic before admission.
Cleveland Clinic IMATCH and Center for Headache and Facial Pain Clinic
9500 Euclid Ave. – T33
Cleveland, OH 44195
(216) 636-5860 or (866) 588-2264
University of Michigan Headache and Neuropathic Pain Program
Burlington Office Center
Headache and Neuropathic Pain Clinic
325 E. Eisenhower Pkwy., Suite 100
Ann Arbor, MI 48108
(734) 615-7246
Houston Headache Clinic
1213 Hermann Drive,Suite 820
Houston, TX 77004
(713) 528-1916
The Pain Center at Cedars-Sinai
Cedars-Sinai Medical Center
Mark Goodson Building
444 S. San Vicente Blvd., Suite 1101
Los Angeles, CA 90048
(800) 233-2771
Michigan Headache Clinic
1675 Watertower Place, Suite 600
East Lansing, MI 48823
(517) 324-3445
