The NeuroHealth Headache Center is committed to improving the care of patients with headache disorders. Our goal is to diagnose and provide relief to a growing population of chronic sufferers. Studies show that lifetime prevalence of headache in men is 93%, and in women is 99%.
Headed by neurologist Gary A. L’Europa, MD, the Headache Center is the only facility of its kind in the area. A fellow of the American Headache Society, Dr. L’Europa is dedicated to the study and treatment of headaches and has specialized in neurological disorders for more than 20 years.
He is joined in his practice by a talented and experienced team of headache specialists that includes:
- Carol Robinson, MS, RNP
- Kathleen Franchina, MS, RNP
- Amy Bruno, MS, RNP
- Sara DelVecchio, MS, RNP
- Lois Botelho, RN
Because NeuroHealth employs a multidisciplinary approach to the diagnosis and management of headache disorders, your care team may also include staff from the NeuroHealth Rehabilitation Center. Our physical therapists will work closely with you to assess and treat any mechanical factors contributing to your headaches.
NeuroHealth is equipped to conduct advanced diagnostic testing on-site, and our staff is trained to administer a variety of sophisticated therapies including trigger point injections and Botulinum toxin (BOTOX®) injections for the treatment and management of chronic headache pain.
Anatomy of a Headache
Surprisingly enough, the exact mechanism by which headache occurs is not known. There are numerous theories, but no one universally agreed upon cause. What we do know for certain is the basic anatomy of a headache. We know the pain you feel is real and we know the physiology behind the pain.
Headache sufferers may feel as though their brain hurts, but in reality actual brain matter itself is entirely insensitive to pain. Instead, it’s the three membranes that cover the brain, called the meninges, that are sensitive to pain.
According to the most widely accepted theory of headache, pain-sensing nerve cells called nociceptors release chemicals called neuropeptides. These neuropeptides cause the vascular smooth muscle surrounding cranial blood vessels to relax, which in turn causes vessel dilation and increased blood flow. Neuropeptides also promote inflammation and tissue swelling. The combination of increased pain sensitivity and tissue and vessel swelling is what causes headache pain. The pain may be confined to one area, or it may be generalized and encompass the entire head.
In the final analysis, most headache sufferers don’t care about the physiology of pain – they simply want relief. Diagnosing your headache type and identifying those triggers that affect you personally is the key to alleviating pain.
In 1988, The International Headache Society (IHS) developed a classification system to assist physicians in the differential diagnosis of headache. This classification system has since become the standard for headache diagnosis and research the world over. The classification criteria, updated in 2004, divide headaches into 14 categories:
- Tension-type headache
- Cluster headaches and other trigeminal autonomic cephalalgias
- Other primary headaches
- Headache associated with head trauma
- Headaches associated with vascular disorders
- Headaches associated with nonvascular intracranial disorder
- Headache associated with substances or their withdrawal
- Headache associated with infection
- Headache attributed to disorder of homeostasis
- Headache or facial pain attributed to disorder of cranium, neck,
eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures
- Headache attributed to psychiatric disorder
- Cranial neuralgias and central causes of facial pain
- Other headaches, cranial neuralgia, central or primary facial pain
So what does all this mean? To your doctor, this classification system means he or she can begin to categorize and treat your headache based on established and proven criteria. To you, the headache sufferer, it means that there are many different types of headaches and diagnosing your particular disorder is the first step to finding relief.
Patient’s First Visit
At NeuroHealth, we believe the best outcomes are achieved through a multidisciplinary approach to care. Our care teams are made up of neurologists, nurse practitioners, nutritionists, and physical, occupational, speech and behavioral therapists.
A new patient should plan to spend three to four hours at the Headache Center during the initial visit. Here’s what you can expect from your care team:
- Review complete medical and headache pain history. The first thing we’ll do is review the characteristics of your headaches – the location, frequency and duration. We’ll also explore your family medical history, sleep habits, environmental factors and other potential headache triggers. (Be sure to complete the patient medical history form and HIT-6™ Headache Impact Test, and bring both with you to your first appointment. Also bring the results of any recent tests or scans, and a headache diary if you have one.)
- Conduct a physical and neurological exam. Your physician will conduct a neurological exam which includes evaluation of mental function, cranial nerves, motor/sensory function, reflexes, and walking and balance. He or she may also recommend diagnostic tests to rule out certain causes.
- Conduct a preliminary psychological assessment. Depression is far more prevalent among people with headache disorders than it is in the general population. The psychiatrist on your patient care team will evaluate you for signs of anxiety and depression and assess your ability to cope with chronic pain. He or she can also help identify any stress-related or psychological triggers associated with your headache.
- Conduct a nutritional assessment. Certain foods and eating habits can either trigger or aggravate headache symptoms. Your patient care team will evaluate your current diet and look for any correlation.
- Review previous and present headache therapies. Every headache sufferer is unique and responds differently to therapy. By focusing on what has or hasn’t worked for you in the past, your neurologist can begin to narrow the field of prospective treatments.
- Review Headache Workbook. Monitoring your pain and its pattern is important in determining the optimal path of treatment. That means you as patient can and should play an active role in managing your own health. At NeuroHealth, we’ve designed a patient workbook to educate you about your disorder and what you can do to improve your quality of life. We encourage headache sufferers to keep a headache diary – you’ll find a sample in your workbook.
- Map out a road to recovery. Our goal is to determine the cause of your headache pain and devise a plan to help you prevent and/or manage it. Accurate diagnosis is critical to formulating a successful treatment plan. Remember that it may take several visits and specialized testing to arrive at a diagnosis. It may also take a combination of therapies and a period of trial and error before we find the ideal treatment plan for your specific disorder. Your first visit is the first step toward creating a customized treatment plan especially for you.