The New Headache Clinic at Cascade Neurologic

The dust is starting to clear and I have time to come up for air, long enough to start posting again.

As many know, on December 31, the Pacific Rim Headache Center had to cease to exist. It was meant to be an oasis of compassionate and excellent care for the headache sufferer.  We are proud of the work we accomplished there. We took care of over 3,000 patients from the entire Pacific Northwest, Canada, Alaska and other places during this time. It was a great success in every way, but getting insurance companies to pay for patient visits.

The transition to Cascade Neurologic has had a few bumps. The biggest one is that Dr. Moren was unable to reach an agreement with Cascade Neurologic and is not seeing headache patients any where at this juncture. That is a shame. I am very happy to take over the care of his patients until he can find a place to work.

One of the hardest things to understand in making a transition like this, is that health insurance companies and malpractice insurance companies don’t see this as a continuation of my prior practice. They see this as a brand new practice. Therefore, a patient must be seen here to establish before we can continue offering them care. This is their rules, not mine.

I gave Pacific Rim Headache Center every once of energy that I had. In the end I walked away with a significant debt. I also suffered severe exhaustion from that experience and am taking a different path from this point until retirement, otherwise I know that I can’t last. I seriously considered giving up medicine completely after this experience, but it is hard to start over in a new field at age sixty.

There is no question that I love taking care of headache and face pain patients, no matter the complexity. With my thirty-five years of experience, my constant reviewing of studies and attending virtually every headache meeting in the world, I rarely run out of ideas.

In my prior practice, I would say that 80% of my patients were wonderful patients that I enjoyed working with. Again, treatment failure is not an issue and I never mind seeing a patient who is not doing well. I never mind seeing a patient who has traveled the entire country, seeing every headache clinic. Those patients, and others like them, I welcome with open arms.

But I am going to limit my practice going forward, seeing fewer patients but focusing more on those I can help. There are some patients I no longer want to see (I will describe below). I will discourage these patients from coming to see me (as I am dong here), and I will quickly ask them to move on if I witness this attitude with them. My passion is helping people to get well. If someone is motivated to get well, they are welcome to come here. If they are not, then they are taking up valuable time that I can give to someone who does want to get well.

Here are the patients I prefer no longer to see.

  1. If you are hooked on narcotics, even if your headaches are real, and you refuse to acknowledge that and get help, don’t come to me. I will not be just someone’s source for narcotics.
  2.  If you have been in an accident and you are deeply involved with the drama of that accident and possibly monetary rewards, please stay away. Certainly, there are good people who have been injured and now have bad headaches and want to get better. I am happy to work with those people. But I’ve had too many patients who show no signs of wanting to get better (do nothing I ask them to do, come late to appointments or no show) but want to take up my time filling out forms and more forms so they can sue someone and get money. If your only interest is to document your pain for a lawyer, please don’t come here.
  3. If you have horrible headaches, but your naturopath or someone else has convinced you that your headaches are caused by allergies, “toxins,” hormone imbalances, electromagnetic waves, cranial bones that have moved around (none of which are true) and even those other providers have done nothing to help you, don’t come and see me if you insist that I keep doing the same things that have failed. If you have a belief system that all medications are evil or dangerous (which is also not true) and they “only treat the symptoms” please don’t come here.  I use every complimentary and alternative treatment that proven to be safe and effective. I usually use them first. The people who have misinformed you have no idea what they are talking about. They have never been to a research meeting, read research journals or have been trained in headaches. For most severe headache patients, medications must be tried to get well and we are treating the cause, the real cause. It is a waste of my time for a patient to do nothing I’ve asked them to do, but to come to every appointment only to spend the entire time arguing that they need just one more test or one more unproven treatment that they heard about at the health food store. I am open to patients trying anything but if they refuse to try the things that we know work, then they can’t blame me for not getting better.
  4. As a father of five, I love children and I love working with children with headaches. Children have the same type of headaches as adults. The really bad headaches that children have are usually either; a) migraine, b) new daily persistent headache or c) post concussion headache. We know the mechanism of migraine, and it is very complicated and usually based on genetics. We also know how to treat it. No one on this planet knows what causes new daily persistent headache. We don’t fully understand why some kids have persistent headaches after trauma either. All of these headache types are hard to treat, but most eventually get better. It is very common for a worried parent to get very frustrated about the headaches and eventually see the headache provider, not as the team member who is doing their best to help them, but as a punching bag. They want to come to every visit to vent their full rage at the provider and then call frequently to vent more anger. There is no one that cares more about my patients, especially those who are children, than I do. There are few people on this planet who have had more experience in helping children get well. However, if you need me just as your punching bag, please don’t come here. Hate the headaches, but if you start to hate all medical providers, who are doing their best to help you, soon you will have no help.