Migraines, headaches, pain, and HOPE!
I spent last week in Dallas at Dr. John Claude Krusz's clinic, ANODYNE Headache and PainCare. Dr. Krusz and I have written Ask the Clinician for almost five years now, but this was the first chance I'd had to visit his clinic and observe him with patients.
Dr. K's patients were very gracious; all of them allowed me to sit in on their appointments. Listening to him review a new patient's medical history was a great reminder of how much other issues can impact Migraine, headaches, and pain. Dr. K. asks all of his patients about their sleep patterns and whether they or anyone in their family have a history of problems with thryoid, diabetes, or other endocrine disorders. Sleep is always one of the first issues he addresses, telling patients that good sleep is essential to their treatment.
The clinic is quiet and comfortable. One of Dr. K's patients described a visit as, "almost like going home." That's important. When people are comfortable, it's easier for them to talk about their pain, and it actually makes treatments more effective. From the waiting room to the treatment rooms, the walls are soft colors and filled with art. There are plenty of comfortable chairs -- for the patients and for those who may accompany them.
There are several treatment rooms for IV infusion therapy (See IV Treatment of Refractory Migraines) that have also been made comfortable. Patients have a choice of lying down or sitting back in a recliner during treatment. There are plenty of colorful throws to snuggle up in.
Of course, most patients come to the clinic in pain. Dr. Krusz specializes in headache and Migraine and in pain management, a good combination. All efforts are made to reduce a patient's pain before they leave their appointment. There are two in particular that impressed me and reminded me just how much hope there is for us.
Kristen's mother brought her to the office because her husband was at work. Kristen has been fighting chronic Migraine, and that day, she rated both her nausea and her pain at an 8 on a scale of 10. She's one of the unfortunate Migraineurs for whom abortives don't work. She's making progress, but her treament regimen isn't at its best yet. That day, Dr. Krusz decided to treat her with IM droperidol, an antinausea medication. He brought in a small syringe and administered half the dose. In a few minutes, Kristin felt a bit of relief. He gave her four small doses, after which both the nausea and headache were greatly reduced, and she was ready to go home. Since the medication had worked in the office, Kristen now had another tool in her arsenal.
Susan was a new patient with trigeminal neuralgia (TN). She wasn't really sure when she had last been pain-free, but it had been at least two years. She had been to several other doctors, but had not found successful treatment. For Susan, Dr. Krusz decided to try an IV infusion of ketamine. Ketamine is usually used as anesthesia, but in smaller doses, can be a good treatment for pain. He warned Susan that he coudln't promise a zero pain level, but would do his best. When I first looked in on Susan after her treatment, I was concerned because she had tears in her eyes. But the tears were because she was totally pain-free! At that point, there was no telling how long she would remain pain-free, but the success of the IV infusion not only relieved her pain, but also gave a clue regarding what kind of medications might work for her long-term.
I've learned a great deal working with Dr. Krusz. The week spent in his clinic was phenomenal and and something I wish each of you could experience. Living with Migraines and headaches can be frustrating and discouraging. I hope that Kristen's and Susan's experiences will give you hope. We're a long way from having a lot of answers about Migraine, but so much progress has been made and is continuing to be made. It can indeed take a lot of time and patience to find an effective treatment regimen, but it can be done.