The initial member of a team developing the first headache clinic in the West with an inpatient component for diagnosis and treatment has arrived at UCSF.
Abraham J. Nagy, MD, has begun seeing patients, and in the coming months he will be joined by other neurologists, fellows, residents, nurses and support staff. He comes to UCSF from the Headache Group at the University College of London (UCL) Institute of Neurology, Queen Square.
Leading the team will be Peter J. Goadsby, MD, PhD, who will arrive at UCSF Medical Center later this year. Rounding out the team of attending physicians will be Manjit S. Matharu, MB, ChB, who was a clinical fellow with Goadsby and is now a consultant at UCL.
"Our goal is to provide a unique level of care for the most intractable of headache patients," Nagy says. "By functioning as primarily a consultant service, we aim to work in conjunction with patients' referring physicians to develop individualized medical strategies and to significantly improve the patients' quality of life. Sometimes this will require inpatient hospitalization for a brief time."
According to Nagy, the most common headache is migraine, but one of the most serious is the cluster headache.
"It is the worst pain you can imagine," Nagy says. "They have been called 'suicide' headaches because of the severity of the pain."
Because headaches are not life-threatening, they are often not taken as seriously as they should be, according to Nagy. "Patients get written off as drug seeking or emotionally unstable," he says. "What we strive to do is evaluate each patient and come up with a treatment plan specific to that individual."
Ironically, one cause of headache is excessive use of drugs to treat them, such as acetaminophen, codeine and Vicodin, according to Nagy. Other medications and activities can also trigger headaches, and the team - through careful examination and evaluation - will work with the patients to develop a unique treatment plan.
"We are clear that the majority of people who get headaches have a genetic predisposition to having headaches," he says, "but that does not mean there are not ways to treat them. With an understanding of brain physiology, we have been quite successful in getting most of our patients the relief they are seeking."
Once the entire team is here, there are plans to begin clinical trials, as well as basic science research. "More people suffer from headaches than those who suffer from diabetes and asthma combined," Nagy says. "While they may not be treated as seriously as some other afflictions, we have to remember that a person with migraine is not able to function. That means missing work and not getting anything productive done. In fact, the World Health Organization equates a day with a migraine as being functionally equivalent to a day of quadriparesis."
Nagy is currently seeing patients in the outpatient clinic at 400 Parnassus Ave. But when the entire team is assembled, they will be seeing inpatients and outpatients at UCSF Medical Center at Mount Zion.
UCSF Medical Center