Cleveland Clinic’s Headache and Facial Pain Clinic is a multidisciplinary center working closely with allied medical and surgical services across the organization. It consists of adult neurologists, pediatric neurologists, internists, psychologists, nurse clinicians, physical therapists, dieticians, and research associates who meet on a weekly basis to discuss headache patients’ care-plans and progress with therapy. When necessary, our clinicians refer patients to consultants in allied medical and surgical services, including neurosurgeons, physiatrists, ophthalmologists, psychiatrists, rheumatologists, otolaryngologists, dentists, and oral surgeons for further consultation and care. The setting at Cleveland Clinic fosters an active and ongoing interchange of expert professional opinions, all under the umbrella of one institution.
- To excel in service and compassionate care.
- To provide complete state-of-the-art diagnosis and management of headache and facial pain, utilizing the full complement of available medical and surgical subspecialties.
- To advance knowledge in the mechanisms and management of headache disorders through basic science and clinical research.
- To educate the lay public, medical trainees and practicing clinicians about headache, facial pain, and allied pain disorders.
The Multidisciplinary Approach to Headache Management
The cornerstone to effective patient management is individualized treatment based on open communication avenues among the patient and treating clinicians and referring physicians
The Headache Physician
Cleveland Clinic employs a number of subspecialized physicians, including a pediatric neurologist, specially trained in headache management and clinical research. With the help of our multidisciplinary team, these physicians oversee patient management and individualize treatment plans. They also function as the principle investigators for investigational studies.
The psychologists, from the Department of Psychiatry and Psychology, offer a diagnostic assessment of headache triggers, stress, substance use and abuse, and tension-based headache factors, upon which a stress management and relaxation training approach is employed. An individualized program combines relaxation training, biofeedback, and psychotherapy in comprehensive personal sessions to teach the patient to manage headache symptoms associated with anxiety, pain and tension.
Headache Clinical Nurse Specialist
The nurse clinician is an integral part of our program, serving as a patient’s ambassador to the Headache and Facial Pain Clinic. Initial assessments and follow-ups are coordinated with physician evaluations and function as a starting point for the development of a care-plan. Other important roles for the nurse clinician specialist are as a contact person with patients and referring physicians, ensuring continuity of care between return visits and as an educational resource for the patient.
The nurse clinician is also in charge of our infusion suite, a treatment room devoted to intravenous infusions specific for headaches. Cleveland Clinic’s Headache and Facial Pain Clinic pioneered the development of the headache infusion service several years ago as a means to provide urgent, inpatient-type care to patients who would otherwise have visited an emergency room. This room, which is available Monday through Friday, 8am – 4:30pm, is under the guidance of our staff physician, and provides “same day” care for patients already in the CCHC program or patients new to the program. It also provides an accessible site for initiation of analgesic research studies and analgesic treatment programs.
In the latter regard, the infusion suite successfully functions as a site where patients can be detoxified from medications that perpetuate headaches. It functions as an alternative to hospitalization. Combined with innovative approaches developed at Cleveland Clinic, the headache team has successfully treated many chronic headache patients as outpatients.
Home Care Infusion Nursing
This service can be provided in an outpatient setting, allowing the patient to stay at home or at work, while still receiving aggressive medical therapy for headaches.
Physical therapists work closely with the Headache and Facial Pain Clinic where they employ their knowledge of anatomy, biomechanics, and ergonomics to assess and treat mechanical factors contributing to headaches. Therapists will assess mobility of the neck and upper body, posture, and physical environment of the home and work. Pain response to repeated movements and sustained positions is evaluated, and the patient’s general condition and activity level are considered.
Treatment focuses on educating and empowering the patient to participate in techniques and specific exercises to correct mechanical problems.
A registered dietitian is available to analyze and review a patient’s eating patterns and medical history as they relate not only to the headache disorder but also to the patient’s general lifestyle and individual needs.
Education and Research
Cleveland Clinic’s Headache and Facial Pain Clinic is an active participant in research studies on the management of a variety of headache syndromes. Some of these are institutional studies, available only at Cleveland Clinic, while others are part of larger, multi-institutional projects. We employ a full time research associate with expertise in running clinical research studies in full compliance with national and international practice and ethical standards.
Active educational programs are available both for the lay public, under the auspices of Cleveland Clinic and other sponsoring institutions such as the National Headache Foundation, and for medical professionals. Our staff conducts a post-graduate course for physicians each year. In addition, we offer a fellowship program for physicians interested in post-graduate training in headache management. It also acts as a site for on site training of pharmaceutical industry representatives, in order to promote professional interchange and an influx of new information and ideas.