An Approach to Intractable Headache by Dr. Charles Argoff, Professor of Neurology at Albany Medical College

I am Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York.

I'd like to describe a person in my practice and share a pearl to use when you approach similar patients in your own practice. Individuals are often referred to me because they are thought to have intractable pain, intractable headache, and so on. This patient was a 41-year-old woman who was referred to me because of her intractable headache. She had previously been seen by her primary care physician who had taken multiple preventive measures, but I'll describe that in more detail later.

During her mid 30s, she began to experience regular migraine headaches. Her primary care doctor advised her to use various over-the-counter medications because her headaches were only occurring once or twice a month, and not necessarily associated with any specific trigger.

During her late 30s, her headaches became more frequent. She then had such a severe headache that she was seen at a local emergency department. Her primary care doctor advised the emergency department by phone to obtain an imaging test and blood work, all of which were negative with respect to any specific intracranial abnormality or any structural explanation for her headache. The emergency physician sent her home with a prescription for Fioricet®, which is a combination of butalbital, acetaminophen, and caffeine.

http://www.medscape.com/viewarticle/749316

The link includes an interesting video