Pearls From an Inpatient Headache Unit
Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hos...
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| Published in | Headache Vol. 48; no. 6; pp. 820 - 827 |
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| Main Author | |
| Format | Journal Article |
| Language | English |
| Published |
Malden, USA
Blackwell Publishing Inc
01.06.2008
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hospital unit developed a set of criteria for admission and a growing staff of professionals to serve this complex population of patients. Experience has taught us many lessons; several are considered in this review. Among the important topics discussed are: admission criteria to the hospital unit; treatment protocols and other hospital‐based strategies; integration of behavioral therapy and therapists into the treatment system; diagnostic testing of patients with intractable headache; identifying the “problem patient” and “medication misuse” early in the course of therapy; approaching the headache patient with cluster B personality disorder; and the use of interventional and anesthesiological treatment for intractable headache. Outcome data and a review of recent publications are presented. |
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| AbstractList | Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hospital unit developed a set of criteria for admission and a growing staff of professionals to serve this complex population of patients. Experience has taught us many lessons; several are considered in this review. Among the important topics discussed are: admission criteria to the hospital unit; treatment protocols and other hospital-based strategies; integration of behavioral therapy and therapists into the treatment system; diagnostic testing of patients with intractable headache; identifying the "problem patient" and "medication misuse" early in the course of therapy; approaching the headache patient with cluster B personality disorder; and the use of interventional and anesthesiological treatment for intractable headache. Outcome data and a review of recent publications are presented. Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hospital unit developed a set of criteria for admission and a growing staff of professionals to serve this complex population of patients. Experience has taught us many lessons; several are considered in this review. Among the important topics discussed are: admission criteria to the hospital unit; treatment protocols and other hospital-based strategies; integration of behavioral therapy and therapists into the treatment system; diagnostic testing of patients with intractable headache; identifying the "problem patient" and "medication misuse" early in the course of therapy; approaching the headache patient with cluster B personality disorder; and the use of interventional and anesthesiological treatment for intractable headache. Outcome data and a review of recent publications are presented.Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hospital unit developed a set of criteria for admission and a growing staff of professionals to serve this complex population of patients. Experience has taught us many lessons; several are considered in this review. Among the important topics discussed are: admission criteria to the hospital unit; treatment protocols and other hospital-based strategies; integration of behavioral therapy and therapists into the treatment system; diagnostic testing of patients with intractable headache; identifying the "problem patient" and "medication misuse" early in the course of therapy; approaching the headache patient with cluster B personality disorder; and the use of interventional and anesthesiological treatment for intractable headache. Outcome data and a review of recent publications are presented. |
| Author | Saper, Joel R. |
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| References | Saper JR. Are you talking to me? Confronting behavioral disturbances in patients with headache. Headache. 2006;46(Suppl. 3):S151-156. Saper JR, Lake AE III. Sustained opioid therapy should rarely be administered to headache patients: Clinical observations, literature review, and proposed guidelines. Headache Currents. 2006;3:67-70. Saper JR. Approach to the intractable headache case: Identifying treatable barriers to improvement. Continuum: Lifelong learning in neurology. Neurology. 2006;12:259-284. Saper JR, Lake AE III, Hamel RL, et al. Daily scheduled opioids for intractable head pain: Long-term observations of a treatment program. Neurology. 2004;62:1687-1694. Lake AE III, Saper JR, Madden SF, Kreeger C. Comprehensive inpatient treatment for intractable migraine: A prospective long-term outcome study. Headache. 1993;33:55-62. Saper JR, Lake AE III, Madden SF, Kreeger C. Comprehensive/tertiary care for headache: A 6-month outcome study. Headache. 1999;39:249-263. Saper JR, Silberstein SD, Gordon CD, Hamel RL, Swidan SS. Handbook of Headache Management, 2nd edn. Baltimore: Lippincott Williams and Wilkins; 1999. Saper JR, Lake AE III. Borderline personality disorder and the chronic headache patient: Review and management recommendations. Headache. 2002;42:663-674. Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve (GON) enhances responses of dural responsive convergent neurons in the trigeminal cervical complex in the rat. Cephalalgia. 2001;21:401-402. Lake AE III, Saper JR, Hamel RL. Inpatient treatment of intractable headache: Outcome for 267 consecutive program completers (abstract). Headache. 2006;46:893. Saper JR, Hamel RL, Lake AE III. Medication overuse headache (MOH) is a biobehavioral disorder. Cephalalgia. 2005;25:545. Bogduk N, Marsland A. The cervical zygapophyseal joints as a source of neck pain. Spine. 1988;13:610-617. 1988; 13 2006; 3 2004; 62 2006; 12 1990 2006; 46 2002; 42 1993; 33 1999; 39 1999 2005; 25 2001; 21 Bartsch T (e_1_2_4_9_2) 2001; 21 e_1_2_4_4_2 Lake AE (e_1_2_4_13_2) 2006; 46 e_1_2_4_6_2 e_1_2_4_5_2 e_1_2_4_8_2 e_1_2_4_7_2 Saper JR (e_1_2_4_14_2) 1990 e_1_2_4_10_2 e_1_2_4_11_2 e_1_2_4_12_2 Saper JR (e_1_2_4_2_2) 1999 Saper JR (e_1_2_4_3_2) 2006; 12 |
| References_xml | – reference: Bartsch T, Goadsby PJ. Stimulation of the greater occipital nerve (GON) enhances responses of dural responsive convergent neurons in the trigeminal cervical complex in the rat. Cephalalgia. 2001;21:401-402. – reference: Saper JR. Approach to the intractable headache case: Identifying treatable barriers to improvement. Continuum: Lifelong learning in neurology. Neurology. 2006;12:259-284. – reference: Saper JR, Silberstein SD, Gordon CD, Hamel RL, Swidan SS. Handbook of Headache Management, 2nd edn. Baltimore: Lippincott Williams and Wilkins; 1999. – reference: Saper JR, Hamel RL, Lake AE III. Medication overuse headache (MOH) is a biobehavioral disorder. Cephalalgia. 2005;25:545. – reference: Saper JR, Lake AE III. Sustained opioid therapy should rarely be administered to headache patients: Clinical observations, literature review, and proposed guidelines. Headache Currents. 2006;3:67-70. – reference: Bogduk N, Marsland A. The cervical zygapophyseal joints as a source of neck pain. Spine. 1988;13:610-617. – reference: Saper JR, Lake AE III, Hamel RL, et al. Daily scheduled opioids for intractable head pain: Long-term observations of a treatment program. Neurology. 2004;62:1687-1694. – reference: Saper JR, Lake AE III. Borderline personality disorder and the chronic headache patient: Review and management recommendations. Headache. 2002;42:663-674. – reference: Lake AE III, Saper JR, Hamel RL. Inpatient treatment of intractable headache: Outcome for 267 consecutive program completers (abstract). Headache. 2006;46:893. – reference: Saper JR. Are you talking to me? Confronting behavioral disturbances in patients with headache. Headache. 2006;46(Suppl. 3):S151-156. – reference: Lake AE III, Saper JR, Madden SF, Kreeger C. Comprehensive inpatient treatment for intractable migraine: A prospective long-term outcome study. Headache. 1993;33:55-62. – reference: Saper JR, Lake AE III, Madden SF, Kreeger C. Comprehensive/tertiary care for headache: A 6-month outcome study. Headache. 1999;39:249-263. – volume: 21 start-page: 401 year: 2001 end-page: 402 article-title: Stimulation of the greater occipital nerve (GON) enhances responses of dural responsive convergent neurons in the trigeminal cervical complex in the rat publication-title: Cephalalgia – volume: 13 start-page: 610 year: 1988 end-page: 617 article-title: The cervical zygapophyseal joints as a source of neck pain publication-title: Spine – volume: 46 start-page: S151 issue: Suppl. 3 year: 2006 end-page: 156 article-title: Are you talking to me? Confronting behavioral disturbances in patients with headache publication-title: Headache – volume: 12 start-page: 259 year: 2006 end-page: 284 article-title: Approach to the intractable headache case: Identifying treatable barriers to improvement. Continuum: Lifelong learning in neurology publication-title: Neurology – volume: 3 start-page: 67 year: 2006 end-page: 70 article-title: Sustained opioid therapy should rarely be administered to headache patients: Clinical observations, literature review, and proposed guidelines publication-title: Headache Currents – volume: 39 start-page: 249 year: 1999 end-page: 263 article-title: Comprehensive/tertiary care for headache: A 6‐month outcome study publication-title: Headache – volume: 62 start-page: 1687 year: 2004 end-page: 1694 article-title: Daily scheduled opioids for intractable head pain: Long‐term observations of a treatment program publication-title: Neurology – year: 1990 – volume: 25 start-page: 545 year: 2005 article-title: Medication overuse headache (MOH) is a biobehavioral disorder publication-title: Cephalalgia – volume: 33 start-page: 55 year: 1993 end-page: 62 article-title: Comprehensive inpatient treatment for intractable migraine: A prospective long‐term outcome study publication-title: Headache – volume: 42 start-page: 663 year: 2002 end-page: 674 article-title: Borderline personality disorder and the chronic headache patient: Review and management recommendations publication-title: Headache – volume: 46 start-page: 893 year: 2006 article-title: Inpatient treatment of intractable headache: Outcome for 267 consecutive program completers (abstract) publication-title: Headache – year: 1999 – ident: e_1_2_4_4_2 doi: 10.1111/j.1526-4610.2006.00569.x – volume-title: Handbook of Headache Management year: 1999 ident: e_1_2_4_2_2 – ident: e_1_2_4_11_2 doi: 10.1111/j.1526-4610.1993.hed3302055.x – volume-title: Scottsdale year: 1990 ident: e_1_2_4_14_2 – volume: 46 start-page: 893 year: 2006 ident: e_1_2_4_13_2 article-title: Inpatient treatment of intractable headache: Outcome for 267 consecutive program completers (abstract) publication-title: Headache – ident: e_1_2_4_5_2 doi: 10.1111/j.1468-2982.2005.00879.x – ident: e_1_2_4_7_2 doi: 10.1212/01.WNL.0000125189.17830.02 – ident: e_1_2_4_8_2 doi: 10.1046/j.1526-4610.2002.02156.x – volume: 21 start-page: 401 year: 2001 ident: e_1_2_4_9_2 article-title: Stimulation of the greater occipital nerve (GON) enhances responses of dural responsive convergent neurons in the trigeminal cervical complex in the rat publication-title: Cephalalgia – ident: e_1_2_4_6_2 doi: 10.1111/j.1743-5013.2006.00034.x – ident: e_1_2_4_12_2 doi: 10.1046/j.1526-4610.1999.3904249.x – volume: 12 start-page: 259 year: 2006 ident: e_1_2_4_3_2 article-title: Approach to the intractable headache case: Identifying treatable barriers to improvement. Continuum: Lifelong learning in neurology publication-title: Neurology – ident: e_1_2_4_10_2 doi: 10.1097/00007632-198813060-00003 |
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| SubjectTerms | Combined Modality Therapy criteria headache Headache Disorders - therapy Hospital Units hospitalization Humans Michigan Migraine Disorders - therapy MOH outcome Pain, Intractable - therapy pearls Physician-Patient Relations problem patient |
| Title | Pearls From an Inpatient Headache Unit |
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