Part 1:

The Diamond Headache Clinic

“It’s an epidemic. It’s crazy.” So says Dr. Christopher Rhyne, Director of Clinical Research and Staff Physician at the Diamond Headache Clinic (DHC), a world-renowned treatment center and the very first in its class, founded in 1974. Statistics show that Dr. Rhyne is not exaggerating:

· Approximately 40 million Americans struggle with migraines

· Approximately 1 billion people worldwide struggle with migraines

· The World Health Organization lists migraine as the #2 reason worldwide for productive hours lived with disability

· Among women ages 15-49, migraine is the #1 reason for years lived with disability

History and Mission

Prior to opening the DHC, Dr. Seymour Diamond was “able to count on one hand the number of physicians throughout the United States who were just focused on doing ‘headache work.’” That drove the desire to bring awareness across the world that headaches are a legitimate disease. He stated, that the DHC “is a place that’s always been and always will be about providing a continuum of care. Our patients need us to persevere at every stage of the process: to accurately diagnose their condition, to adjust their treatment, to continue our follow-up, and to show them an opportunity for life beyond headache.”

Dr. Diamond, father of DHC current managing director Dr. Merle Diamond, formally began headache medicine as a field of medical study and DHC as the first outpatient clinic in the United States; it is 1 of 3 inpatient headache units in the country. In addition to driving the day-to-day clinical therapies for patients who come to the clinic or the hospital, DHC pushes the science. The Diamond Headache Research and Education Foundation is a nonprofit delivering national CME-style conferences for physicians all over the country 3 times a year to provide more headache education, and it partners with organizations like PAINWeek and BRAINWeek to do the same.

Common Triggers for Migraines

Patients ask “What am I doing wrong. What is the one food I am eating, or thing I’m exposing myself to, that’s creating the problem?” The answer is it’s usually a combination of things:

· Strong genetic component

· Stress or sleep

· Allergies

· Hormonal changes: particularly towards menstruation, puberty, menopause, pregnancy

Any of these stacking up can create a perfect storm. It helps to not think of migraines as a product of a single experience, such as “I had a glass of red wine and had a migraine because of it.” Certainly, that may have been enough to tip someone over migraine, but maybe the reason

for the red wine was a stressful day at work. Or an argument with a loved one. Or a favorite baseball team not doing well. Wine + a long day of work + stress + poor sleep = it’s all working against you! For women during their menstrual cycle, there’s yet another potential trigger. All these components happening at the same time is what is typically tip people over. Patients can learn their triggers and combinations of triggers that may be causing migraine.

Barriers to Care

· Only 10% of people who struggle with migraine achieve the appropriate diagnosis and then also achieve the appropriate treatment

· The length of time to treatment is about 9 years from when they start looking for help

The literature is very clear that only half of people who are struggling with migraine seek care. Patients misunderstand the disease and may not realize they have a problem. It might be a learned behavior, brought on by a lack of communication to the patient about these headaches not being normal on a frequent basis. The learned behavior may come from a sufferer having seen their elders “just deal with” this natural occurrence. No one has told them “This is wrong!” which creates an environment where 20 million people don’t get help. Of those that do, only about half of get the diagnosis. When the patient finally decides to get help, the provider may not make the appropriate diagnosis for migraine and the patient doesn’t receive needed levels of care. DHC is seeking to better educate the medical community, and sufferers.

Screening & Differential Diagnosis

The International Classification of Headache Disorders version 3 (ICHD-3) is a searchable website of headache medicine. It is the diagnostic guidebook of all the primary and secondary headaches that are recognized internationally. Under “Migraine Headache” is clear and concise diagnostic criteria that a patient would need to present with in order to make the diagnosis of a migraine headache, or a cluster or tension headache, both of which are common and often confused with migraine.

It is vitally important to understand diagnostic criteria in order to make a diagnosis. Along with ICHD-3, other tools include ID Migraine, an objective-vetted screening tool for migraine: it is an easily administered 3-question screener that is approximately 85% sensitive. A nurse or medical assistant can administer it at the beginning of a patient visit. If a patient answers YES to 2 of the questions, it is likely they have migraine, which will lead to a deeper dive for treatment. There are easy refence and screening tools to drive a provider to a diagnosis of migraine if it is appropriate.

Part 2 will cover migraine acute pain management and practitioner tips.