Finding Freedom from Headache Pain

Finding Freedom from Headache Pain
Paul Rizzoli, MD, and Elizabeth Loder, MD, MPH

This story appears in the Summer 2016 issue of Brigham and Women's magazine.

For more than a decade, Ed Holleran thought nothing could be done for his migraines. When as many as 50 nausea-inducing headaches each month destroyed his focus at home and work, he tried controlling them on his own with over-the-counter pain relievers.

“I went through years suffering without meaningful treatment,” says Holleran, who founded and led a large, New England-based cable company while battling migraines almost daily.

Half of adults experience one or more headaches each year, according to the World Health Organization. For many, the pain subsides quickly with little or no treatment. But for people like Holleran, who deal with chronic headaches, the pain is persistent.

“Headache disorders are chronic illnesses, like asthma or arthritis,” says Elizabeth Loder, MD, MPH, chief of the Division of Headache and Pain at Brigham and Women’s Hospital and Brigham and Women’s Hospital (BWFH). “Sadly for many patients with chronic headaches like migraine, they often lurch from crisis to crisis, and aren’t aware they can manage the condition in between bad episodes.”

Now retired, Holleran has been coming to the John R. Graham Headache Center at BWFH since 2006. His migraines are down to a few episodes a year.

“Saved’ isn’t too big a word to describe how I feel, knowing what it is like to be headache free now,” he says.

Silent sufferers

Headache disorders strike women and men at any age, and there is no known cure. Like Holleran, many people endure years of chronic pain before finding relief.

“Our patients usually go to their primary care or local emergency room first, and from there might be referred to a neurologist, or even a dentist or eye specialist,” says Paul Rizzoli, MD, FAAN, FAHS, clinical director of the Graham Center. “The overwhelming majority of our patients are people who have been tested, treated, and still haven’t had the outcomes they wish. And research suggests that half of people with a headache disorder in this country never see anyone for it at all.”

Holleran felt lucky to find help. “Thankfully, my primary care doctor referred me to Dr. Rizzoli,” he says. “Now I’ll go two or three months until another migraine. Imagine if I had found [the Graham Center] sooner! I am in good hands now.”

Taming pain

Loder and Rizzoli have seen patients with headache disorders respond well to a variety of approaches: acupuncture, relaxation techniques, psychosocial support, and medications.

“In my career, I’ve seen the development of several breakthrough drugs for severe headaches, but at the same time, a decline in reimbursement for alternative therapies to help patients cope,” says Loder.

Following the national trend, opioid use for headache treatment has also risen. While these drugs can benefit many headache patients, they carry a higher risk of adverse effects.

“For people who have daily or almost-daily headaches, opioids can backfire and make the headache worse,” says Loder. “We always de-emphasize opioid use in headache medicine, even though it’s difficult to get approval for alternative treatments we know could help our patients.”

To broaden the field of treatment for headache disorders, Graham Center faculty and fellows are exploring the safety and usefulness of alternative therapies. In one study of patients with light sensitivity, Rizzoli’s team will test a light-filtering glass that changes how the wavelength of light travels to the eye. Another trial has studied the effects of using mindfulness and stress-reduction techniques to avoid triggering migraines.

“We already have great management for these conditions,” says Loder. “And we think more and better treatments are on the horizon.”