Adjunctive Therapies for the Treatment of Headache (Podcast)

Headache disorders are one of the leading causes of disability worldwide. Many people who experience chronic headache struggle with physical pain, diminished productivity and financial burdens. Although there are many therapies available, finding an effective treatment when first-line therapies fail can be challenging.

“Once we start looking at some of these other treatments that are more than just basic, it’s kind of the Wild West,” says Desimir Mijatovic, MD, a pediatric and adult pain medicine specialist in Cleveland Clinic’s Center for Comprehensive Pain Recovery. “We’re just trying to do what’s best for these patients — whether they’re adults or kids — to get them some relief.”

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Mijatovic discusses adjunctive therapies for the treatment of headaches. He touches on:

• Headache presentation in children versus adults
• Medical management and preventive treatments
• Adjunctive therapies, including botulinum toxin injection, ketamine and radiofrequency ablation
• The role of external and implanted nerve stimulators
• The decision process for selecting headache therapies
• Important intersections between chronic pain management and psychiatry

Click the podcast player above to listen to the 22-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: The art of medicine is really the difficult part of medicine. You have a lot of tools in your belt for treating headache. How do you decide what therapy you’re going to use?

Dr. Mijatovic: You are right — it definitely is an art. You have to look at the whole picture before you can make some of these decisions. Any time we think about an obvious neuralgia — where the patient has a clear occipital neuralgia with tenderness, shooting pain, tingling, all those things — that obviously sparks the thought that it’s time to try the next level of therapy. Other times patients have tried a lot of other treatments and they’re now interested in something interventional. So, patient preference is a big thing.

Unfortunately, I see a lot of patients, both adults and kids, who have a list of medications they’ve tried without success, and it may be 20 medications long. They have a hard time finding interventions in their area or where they are coming from. And so it’s usually worth a try to give them some benefit. Again, most of these new interventions can be done very safely and very easily. A lot of them are done in the office, so it’s easy for everybody involved. And so I think it’s worth a try for a lot of these people.