BEIRUT: Most people experience occasional headaches, easily treated with an over-the-counter painkiller, but sufferers of migraines or other chronic headache syndromes may need treatment for life.
The American University of Beirut Medical Center’s dedicated Headache Clinic, opened in September last year as part of the hospital’s new Neuroscience Outpatient Center, takes a holistic approach toward offering sufferers a long-term solution to their problems.
The clinic, which is the first of its kind in Lebanon, will be headed by Dr. Ashraf Makki from March. In the meantime, Assistant Professor of Neurology Dr. Nuhad Abou Zeid estimates that she has treated between 50 and 100 patients with chronic headaches in the four months since the clinic opened.
“The main population that we target is people with [primary] headache syndromes ... things like migraines, which are very common in the population,” Abou Zeid told The Daily Star. “These are people who have a lifelong disease, so they need a place [where] they will be educated about their disease and it’ll be managed over time.”
Prior to the opening of the clinic, patients desperate for a solution would hop from one doctor to another, often visiting both mainstream and alternative practitioners and mixing multiple types of medication.
“Sometimes they were doing stuff that could be dangerous, using things that were not approved, or taking medications in weird doses. It’s really important to have a chart and to have a longitudinal follow-up to know what medicines they have taken, and if it didn’t work, why,” Abou Zeid said.
The new clinic takes a holistic approach toward managing headache syndromes, encouraging patients to make basic lifestyle changes that could help them avoid the need for medication.
“There’s a lot of things you can do for migraines before you hand out a prescription,” Abou Zeid said. “For example, migraines have triggers. If you identify the triggers and you eliminate them then maybe the patient will not have to take pills.
“Chocolate can be a trigger, stress, sun exposure, certain kinds of cheese, certain kinds of processed meat – if the patient doesn’t know that these are triggers then they don’t know to avoid them, and then they’ll be taking medicine when they could have fixed the problem without it.”
Patients who visit the clinic are given a headache diary, she explained, so that they can track which days of the month they are affected. Patients are given help to identify their personal triggers and are educated in the importance of getting enough exercise and sleep, both of which have proven to aid in eliminating headaches.
“If you don’t get REM sleep, you get something called tension headaches,” Abou Zeid said. “Migraines are genetic, they run in families, whereas tension headaches are muscular, so they’re a result of the stresses of our modern society. Tension headaches can be cured, because if you reduce the muscle tension the pain will go away.”
“I can’t tell you how prevalent tension headaches are,” Abou Zeid added, “especially in Lebanon with all the stress [factors]. ... Anxiety [causes] tension headaches, so does insomnia. ... It’s kind of a disrupted life syndrome.”
Migraines and tension headaches are the most prevalent among Lebanese patients, but the clinic also treats other syndromes, such as cluster headaches and other less common afflictions. While lifestyle factors are important, many patients also need medication to manage their condition, Abou Zeid said.
“If you have the headache three times a week you’re not going to take pain medicine. ... It’s not good for you. It can create what we call rebound headaches,” she said.
“We try to avoid rebound by using preventive therapy, which is a long term treatment. ... You take it every day, [whether] you have pain or not. ... Some people have to stay on a preventive treatment forever.”
Blood pressure medicine, anti-seizure medicine and anti-depressants are all used to treat migraines, she explained. In the meantime, the clinic is expanding to offer as many avenues for treatment as possible.
“I’ve been contacted by a person who does acupuncture for headaches,” Abou Zeid said. “There’s more alternative and holistic stuff that we can use, but I’m just trying to figure out the basics now.
“We’re trying to build referral centers [so] if somebody has tension headaches and they have some psych issues we can send them to a psychologist and if they have a disk problem or something we can send them to physical therapy. We’re trying ... to build a more holistic approach in terms of multidisciplinary care, not just educational booklets or directions about lifestyle modification.”