The UofL Physicians – Comprehensive Headache Program provides a unique and comprehensive treatment approach for individuals throughout the Kentuckiana region who have conditions such as headaches, migraines, facial pain, post-traumatic headache and concussion-related issues. Led by neurologist Dr. Michael Sowell, it is the only program in the region to combine patient care with research into the causes and new treatments for headache disorders. When the program was established in 2002, it was the first headache program in the state of Kentucky.
Headache – defined as pain or discomfort in the head or scalp – is a common, and potentially debilitating, problem. According to the National Headache Foundation, over 45 million Americans suffer from chronic recurring headaches, and of these, 28 million suffer from migraines. About 20% of children and adolescents also experience significant headaches.
Most people have headaches from time to time, but if you have a headache more days than not that can impact the quality of life for you and your family. They can affect your mood, making you irritable, distracted or impatient, and make it difficult to focus on or enjoy many aspects of your life.
The UofL Physicians – Comprehensive Headache Program can help. We treat adults and children and provide a multidisciplinary, integrated approach to the evaluation and management of a patient’s condition. We are committed to the following goals:
- Meeting a large community, social and economic need
- Addressing the unmet medical needs and increasing patient access to highly qualified specialists
- Incorporating medical, psychological, behavioral, imaging, procedural and other specialties in the approach to diagnosis and management
- Working across medical disciplines (such as neurology, neurosurgery, psychiatry, pain management, internal medicine, physical medicine and rehabilitation, and geriatrics) to advance research, contribute new knowledge and bring new treatments to patients
Diseases and conditions
As a patient of UofL Physicians, you have access to a large group of some of the most experienced and highly trained doctors in the region, across medical disciplines. At the Comprehensive Headache Program, we collaborate with other doctors within UofL Physicians to diagnose and provide effective pain management for all types of headaches, from mild and nagging to severe and debilitating. We treat primary headaches such as migraines that have no obvious cause, as well as those caused by serious underlying medical conditions.
Some of the conditions we treat are:
- Migraine headache
- Chronic migraine
- Chronic daily headache
- Pseudotumor cerebri syndrome
- Cluster headache
- Medication overuse headache
- Cervicogenic headache
- Tension-type headache
- Post-traumatic headache
- Post-concussion syndrome
- Sports-related concussion
- Trigeminal neuralgia
- Occipital neuralgia
There are several types of headaches. In fact, 150 diagnostic categories have been established. The most common types are:
Migraine is the most common form of headache, but not all headaches are migraines. The term “migraine” refers to a headache usually (but not always) on one side of the head. It typically lasts from two to 72 hours and is often associated with nausea and/or vomiting and sensitivity to light and/or sound. The pain is typically throbbing.
A tension-type headache may be the second-most-common headache type after migraine. They are often referred to as “hatband” headaches because they typically are painful around the back of the head, the temples and the forehead as if the sufferer were wearing a tight hat. They tend to be pressure-like at onset and can last hours to days. Tension-type headaches can co-exist with migraine, and one can transform into or trigger the other.
A cluster headache is not a simple collection of headaches that come together. Instead, it is a type of headache that is relatively short-lived (compared with migraine), usually lasting between 15 minutes and three hours. It is always one-sided and is associated with symptoms such as a stuffy nose on one side, tearing, a small pupil or a droopy eyelid. A cluster headache tends to occur several times a day for a period of days to weeks, then disappears for an amount of time, usually weeks to months. Treatment for cluster headaches differs significantly from treatment for other headache types. As cluster headaches are some of the most painful headaches, it is important to have a treatment plan in place before one begins.
A hypnic headache is a rare headache that occurs in people between the ages of 40 and 80. It is unique in that it occurs exclusively at night, typically lasting between 15 and 60 minutes. It also tends to occur at the same time and is not limited to one side or associated with a runny nose, tearing or other features of cluster headaches.
We also treat headaches and other issues related to concussions and other traumatic brain injuries.
Concussions, while a type of traumatic brain injury, are common. The U.S. Centers for Disease Control and Prevention estimates that 1.6 million to 3.8 million concussions occur each year. Some of the most common symptoms of a concussion are:
- Facial pain
- Memory issues
- Problems with memory or concentration (feeling “slowed down” or “in a fog”)
- Balance problems
- Sensitivity to light or sound
- Blurred vision
- Emotional symptoms (nervousness, irritability, sadness)
- Neck pain
- Difficulty sleeping
Treatments and services
At the UofL Physicians – Comprehensive Headache Program we want each patient to feel listened to and informed, and feel confident their headache can be effectively managed without compromising a true quality of life. Many of our patients have tried numerous unsuccessful treatments before coming to us, but we are committed to helping each find his or her own balance between medical therapies, lifestyle adjustments and alternative treatments. Through a combination of these, patients gain power over their condition.
Our program includes the expertise of neurologists, neurosurgeons, pain management doctors, psychologists and psychiatrists, among others, working together to treat the disorder and associated conditions.
The treatments and services we offer include:
- Pharmacological treatments: After a detailed history and physical exam, a treatment plan will be developed to include both preventive and acute medications tailored to each patient’s individual needs.
- Neuroimaging: State-of-the-art neuroimaging techniques, such as MRI and CT scans, are available at the UofL Physicians – Chestnut Street Outpatient Center and UofL Hospital.
- Psychological and behavioral therapy: People who suffer from chronic headaches often experience anxiety and depression. When appropriate, referrals can be made for psychological or psychiatric consultation or, in some instances, biofeedback therapy.
- Physical therapy: Chronic tension-type and cervicogenic headaches often are associated with constant muscle tension and guarding. Patients may find relief through physical therapy to increase the mobility of the neck and shoulders. After treatment, patients are instructed on long-term exercises.
- Botulinum toxin injections: Patients meeting certain criteria may benefit from botulinum toxin injections. Such injections may weaken muscles and have proven to benefit individuals with chronic migraine.
- Trigger point injections: Headaches often are associated with very tender or painful areas in the neck, particularly near the base of the skull. In selected cases, patients may get significant relief from a long-acting anesthetic injection at the tender site.
- Pericranial nerve blocks: Patients with pain originating from various scalp regions may experience a painful, tingling sensation in the neck that radiates to the back of the head or other areas. An injection of a local anesthetic can provide relief for this type of pain.
- Neurosurgical referral: UofL Physicians has access to some of the most experienced and highly trained neurosurgeons in the region. Some patients suffering from pseudotumor cerebri or trigeminal neuralgia who have not benefited from medical treatment may be candidates for various surgical treatments for these difficult-to-manage headache disorders.
As researchers and teachers at the University of Louisville School of Medicine, we have a passion for and commitment to developing new treatments and cures. As part of our effort, our patients have the opportunity to choose to participate in clinical trials.