News from the Scientific Meeting Part II

Another important study was discussed by Sylvia Lucas, MD from the University of Washington.  Her team has been looking at headaches that develop after head trauma.  Not only are such headaches more common than what we previously thought but, those with the milder injuries had the most headaches.  No one knows why this is true yet.

Another interesting experience for me happened outside a main venue. My wife and I were having breakfast and at the table adjacent to us were a group of headache specialists from around the country. One physician seemed upset as he spoke very loudly about his recent experience.  He had been the director of the headache clinic at a major university medical center for ten years.  The medical center had a new CEO come in. This CEO called in this headache specialist and told him that the medical center needed to trim the fat so they were eliminating all the nonprofitable sections. So, she offered him to find a new specialty as they were closing the headache clinic.

“New specialty?” he asked. “I am a headache specialist and that is all I’ve ever been or ever want to be.”

The CEO then told him to back his bags . . . and he was fired on the spot.  He is going to set up a new private headache practice in his city, but there is a lesson here.

The odd thing is that headache is the most common source of suffering in the world. Up until about twenty years ago it was considered a mental illness, rather than a true neurological condition. This stereotype, I think, is the reason that headache work has been and remains so underfunded. The research is moving at a snail’s pace due to lack of funding.

There is a tremendous shortage of headache specialist and that will only grow.  In our state there were about six identifiable headache practices and two are shutting down or have shut down recently.  The demand for our services is going through the roof . . . yet headache work is about the least profitable in medicine.  The reason for that is that headache treatment is very complex and takes long appointments.  In the urgent care (I use to moonlight in urgent care while I was at the Mayo Clinic headache department) setting, I could see a patient with a laceration, clean it up, sew it up and get them on the road in thirty minutes and the insurance company would pay our urgent care clinic well for that time. But you need the same amount of time to sort through a patient’s headache story on a follow up, yet it is tough to get the insurance companies to pay anything for that time. I figure that almost 50% of our medical services have been done for free as we have never been paid.

I do have a model that I think would work and that is hiring Nurse Practitioners or Physician Assistants, such as myself, who have had many years of training in headache to create a new clinic or two, such as in Everett and Port Angles. In this model, the care would be second to none (but the training has to be good) and the clinic could be supported easier. It cost 1/3 to 1/2 as much to support a NP or PA as a neurologist who has been trained in headache medicine. But the problem is finding such outstanding people . . . they are rare. But more than that, some day the specialty of headache medicine needs to have the respect as other conditions, then treatment would be much more available.

I’m sorry about typos but we are so busy right now that if I post here, I have about five minutes to do it . . . and without the luxury of proofreading.