What can you expect if you visit a headache clinic, such as Dr. Lee Kudrow's California
Medical Clinic for Headache in Encino?
First comes a detailed interview by trained nurses, about headaches, other illnesses, drug use and general health. The patients then fill out a Minnesota Multiphasic Personality Inventory, a psychological profile, that can assist in diagnosing the type of headache.
He has found, for example, that victims of migraine and cluster headaches typically have a normal personality profile. Men who have both migraine and muscle-contraction headaches, however, tend to "present themselves as hysterical . . . They express a great deal of concern about body functioning and are moderately depressed." Women in these groups exhibit less "psychic distress" than men.
Kudrow usually does not look for brain abnormalities. Typically, only about 2% of chronic headaches are caused by tumors and similar problems. Most of his patients, furthermore, have been to other physicians, who already have performed such tests. The exception is when the headaches have started suddenly .
Kudrow does perform a neurological exam, however, to be sure that nerves and muscles are functioning properly. Looking into the patients' eyes, he makes sure that their pupils are both the same size and watches the blood vessels pulse in their retinas.
He then asks patients to wriggle their tongues, to follow his finger with their eyes, to shrug their shoulders and resist his pushing on them, to squeeze his fingers tightly. The patients walk a straight line, walk on their toes, walk on their heels, close their eyes and touch their fingers to their noses. He pushes them from behind to see if they regain their balance easily. He runs a key along the bottom of their feet to see if their toes curl satisfactorily.
Kudrow then spends about 40 minutes with his patients, explaining what is known about their type of headache and reassuring them. If the patient is taking birth-control pills or other hormonal medications, Kudrow may adjust the dosage to minimize the amount used.
If the patient has been using over-the-counter analgesics, Kudrow will require that their use be stopped completely. If the patient is not using analgesics, he may prescribe a prophylactic drug to prevent headaches.
In either case, the patient is given a headache diary and told to keep it filled out completely, listing all drugs taken, length and severity of headaches, and other pertinent information. The patient brings the diary back after a month, and the medication will be adjusted if necessary to improve its effectiveness. This process continues until the headaches are no longer a problem.
Kudrow used this approach on the 15,000 patients he has treated and says he can eliminate headaches in 80% of those with migraines, 80% of those with muscle contraction headaches and virtually 100% of those with cluster headaches.