3 Things Our Headache Experts Want You to Know

Highlights | Improving primary care access to headache treatment

• One of every six people in the U.S. have headaches every year.
• Migraines are ranked as the second cause of disability by the World Health Organization.
• Taking acute pain medication for frequent headaches can cause daily rebound headaches.
• Instead, try adding preventive treatment options, lifestyle changes and neuromodulation devices.
• UW Medicine providers can use eConsults with the Headache Clinic at UW Medical Center – Roosevelt for earlier access to expert advice.

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Headaches, especially migraine-type headaches, are common. There are more than 150 headache diagnoses, from tension-type headaches to migraine-type headaches to rare diagnoses such as cluster and hypnic headaches. In the U.S., 45 million people (roughly one in six) have headaches every year, and 8 million of these individuals end up in their doctor’s office looking for help.   

Despite the extreme need for headache care, there are only about 800 board-certified headache specialists in the U.S. in 2022 — and just eight listed in Washington state. At the Headache Clinic at UW Medical Center – Roosevelt, we’re lucky to have one of these individuals.  

“People don’t realize that the headache specialty is extremely rare in the U.S.,” says Natalia Murinova, MD, a board-certified headache specialist and director of the Headache Clinic. “We want to disseminate the latest knowledge so people know what to do when they have headaches and how to work with their primary care provider to get the best care.”  

Because of the severe shortage of board-certified headache experts compared to the number of patients who have one of these conditions, the Headache Clinic offers eConsults to any medical providers at UW Medicine.  

Medical providers can use the consults to ask questions regarding headache diagnosis, next steps and treatment options — and will receive an answer within about three business days. The Headache Clinic is also planning to launch a “Headache Mini-Fellowship” for primary care providers in July 2022.   

Whether you’re looking for how to cope with your own headaches or ways to help your patients, here’s what experts at the Headache Clinic want you to know about headache care.  

How to cope with and treat headaches (and what to avoid)

Oftentimes, when people have a headache, the first thing they do is reach for over-the-counter pain medication to help them manage pain and other symptoms. This is understandable, but it also can be harmful. 

If you take pain medication more than a few days per month, this can lead to medication overuse headaches, which are near-daily headaches, as well as chronic migraines. In other words, your attempts to cope with headaches may be causing daily headaches. 

The International Classification for Headache Disorders defines medication overuse headaches as using pain medication more than 10 days a month for three months. However, depending on your genes and stress, you can start developing rebound headaches if you use as-needed medications even three to four days a month, Murinova says.   

This means taking any mix of drugs such as acetaminophen (Tylenol), ibuprofen (Motrin/Advil) and other migraine-specific medications like triptans (sumatriptan, which is a common drug prescribed to treat migraines), for more than 10 days per month will get you into trouble, Murinova says. And it takes even fewer days of opioid usage to cause medication overuse headaches.  

Moreover, opioids put you at high risk of rebound headaches as well as other negative effects on your brain, and they are not recommended for headache treatment.    

Instead of relying on as-needed medications to cope with headache symptoms, Murinova recommends these alternative options to help prevent headaches and migraines from occurring in the first place. 

Lifestyle changes

Healthy lifestyle changes go a long way to reducing the onset of headaches. At the Headache Clinic, the treatment team takes time to discuss with patients how they can make healthier choices in their day-to-day lives to help their overall well-being.  

Most patients who have frequent headaches have many other things happening in their lives, such as stress, sleep disruption and not enough time for exercise and self-care, Murniova says. Lifestyle changes are often key to helping decrease headaches and improve brain function.  

The lifestyle changes recommended by the Headache Clinic include practicing good sleep hygiene, getting exercise at least 150 minutes per week, managing stress, and eating a nutritious diet of fruits, vegetables and whole grains. 

Behavioral therapy, physical therapy and relaxation, along with other therapies such as massage and acupuncture, can also help. 

Preventive medication

Unlike as-needed medication, which manages symptoms after you develop a headache, these medications prevent headaches from occurring and importantly do not cause rebound headaches.  

A new class of migraine-specific preventive medication, such as anti-CGRP medication, was designed specifically to treat headaches and migraines, providing better results for patients. In the case of anti-CGPR medication, the drug blocks the effects of CGRP, a neuropeptide in your brain that plays a role in the development of migraines. These medications can be used once per month at home, or once every three months.  

“Preventive medications used to be taken every single day to decrease the likelihood of having headaches,” Murinova says. “Now we have new preventive medication options that can be given as a monthly injection instead of having to take pills every day, or we can give BOTOX injection treatments every three months.” 

Headache and migraine devices

An exciting alternative for people who do not want to take medication is wearable neuromodulation devices that use nerve stimulation to prevent and treat migraines and other types of debilitating headaches. 

“Neuromodulation devices allow you to be self-reliant and access treatment in the luxury of your own home,” Murinova says. “These are great options for people who prefer not to take any medications, have no response to medications or have contraindication for medication use.” 

The Headache Clinic has helped patients reduce their headache frequency and intensity using neuromodulation devices like Transcutaneous Supraorbital Nerve Stimulation (t-SNS) Cefaly, a device that’s applied to your forehead and used for both acute and preventive treatment of migraines.  

There are also multiple other neuromodulation devices available: 

• gammaCore, a non-invasive vagus nerve stimulator (nVNS), that treats migraine and episodic cluster headaches. 
• Nerivio, a wearable remote electrical neuromodulation device on an armband that is controlled by a smartphone application. 
• Relivion, which uses an external combined occipital and trigeminal neurostimulation (eCOT-NS) system to treat migraine and major depressive disorder. 

Meet the Headache Clinic team — and get involved

 “At the Headache Clinic, we’re here to support everyone — both our patients and our referring providers — and to make sure people can start feeling better and heal,” Murinova says. “Treatment does not only address pain, but also the cognitive impairment, sensitivity to light and sound, and fatigue that often accompany migraine. I just want to let everyone know that there is hope for them, and we are here to help.” 

Along with Murinova, the clinic team includes Ami Cuneo, MD, a board-certified neurologist; Tara Sharma, DO, a board-certified neurologist; Mui Chan-Goh, ARNP, DNP, CAQ-NHF; and Marcel Budica, PA-C. Starting this year, two providers, Ian Hanikken, MD, and Maria Chavez-Keatts, MD, will also join the medical team as a part of a United Council for Neurologic Subspecialties accredited Headache Fellowship. 

The team is working hard to share headache information so that patients can work with their medical providers to make the best evidence-based decisions and choose the optimal treatment plan for their situations.  

“We want to make sure providers have the information they need to feel empowered to provide the best care for their patients with headaches,” Murinova says. 

To get involved and learn more about headache care, use EPIC for eConsults or reach out to Kelly Bender at kdb4@uw.edu about the Headache and Facial Pain Mini-Fellowship at the Headache Clinic.