Saturday, April 23, 2016

Rotation #7 Diamond Headache Clinic

During the past two weeks I finished the last of M4 year with a short rotation at the Diamond Headache Clinic. The clinic treats many patients whose headaches are refractory. Many of them have already been seen by several doctors including going through their primary doctors then various neurologists before arriving at the clinic here in Chicago. A good number of patients that I saw travel from all over the United States, some even from other countries to be treated here. Many patients make multiple trips to Chicago every year to be seen. Not only is there a clinic but the Attendings here can directly admit their patients to the Headache Unit which takes up the entire 9th floor at St. Joseph's Hospital.

There are several different types of primary headache diagnosis. The four that I saw the most included 1) Migraines 2) Clusters 3) Tension and 4) New daily persistent headaches. Although the age range of patients that come to the clinic is incredibly wide, I was mostly interested in those in the younger age group. Most of those in this group, between the ages of 11-24, were newly diagnosed with new daily persistent headaches which is commonly caused by EBV, the Epstein Barr virus.

What I found so amazing was that patients had suffered from headaches for so long prior to presenting here and with their debilitating headaches, there were often a multitude of psychiatric diagnosis that were associated. The most common were depression and anxiety, but a couple of patients also had bipolar, chronic fatigue syndrome, fibromyalgia, and various other pain syndromes. It's no wonder that most patients, especially those that were over 40, were on over ten different medications including antidepressants, antianxiolytics, antipsychotics, antiseizure meds, antiinflammatories, and about 3-4 different pain meds. This does not even include medications most older patients were taking for relatively common diseases such as hypertension, hyperlipidemia, and diabetes. The amount of medication management required for these patients is a complete art alone and it was crazy to watch my Attendings run through the list for each patient on every visit.

Those with chronic headaches tended to also have depression as a diagnosis as well and it reminded me how interrelated neurology, pain management, and psychiatry truly is. It's so connected that it's difficult to treat one without dipping into the realm of the other two.

On a side note, recently, I also had an interesting conversation with my sister regarding euthanasia and physician assisted suicide. Then I happened to run across a video posted by the Economist on YouTube. It's a short documentary called 24 & Ready To Die and it explores euthanasia in Belgium which has one of the world's most liberal physician assisted suicide programs. Very very touching and an extremely well done video.

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