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Standardizing Headache Care Across Penn Medicine

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Katherine Hamilton treating headaches for patients

Rather than house its Headache Program in a centralized, brick-and-mortar “institute,” Penn Neurology is standardizing models of headache care across the health system through a variety of initiatives.   

“Penn Medicine is everywhere, and headache is a condition that is commonly seen at all our sites,” says Katherine Hamilton, MD, Assistant Professor of Clinical Neurology and Director of the Penn Headache Program. “Broadening and providing headache care across multiple medical specialties and settings is our big-picture goal.”

Headache is one of the most common medical conditions in adults, with more than 150 different types identified by the International Headache Society. Tension headaches are most prevalent, but migraines are also very common and a significant cause of disability and missed workdays. Overall, headache is the third leading cause of disability in the world, a fact that often goes unrecognized, according to Dr. Hamilton. 

The Penn Headache Program's Purpose 

“The purpose of the Penn Headache Program is to develop better approaches to care and standardize treatment of common types of headache, such as migraine and tension-type headaches. It’s also to recognize and manage those rarer headaches, such as cluster and low intracranial pressure headaches,” says Dr. Hamilton, who completed a headache fellowship at Montefiore Medical Center in New York. 

Realizing that other specialists besides neurologists play a role in headache care, Dr. Hamilton has taken a multidisciplinary approach to building the program. The program has developed a particularly close partnership with Penn physical therapy. 

“I’ve worked very closely with our physical therapists to create a group that specializes in headache,” she says. “They play an important and growing role on the care team because issues like neck tension and musculoskeletal issues are major contributors to headache. This is often under recognized and under-treated. We have successfully raised awareness about this PT group across Penn Medicine, and referrals have steadily increased.”

Other Penn specialists who are now collaborating and coordinating their care of headache patients include neurosurgeons, pain specialists, interventional radiologists, and oral and maxillofacial surgeons from Penn’s School of Dental Medicine. 

“We have started holding case conferences to discuss our complex patients,” Dr. Hamilton says. “For example, low intracranial pressure is a rare condition that can cause headaches, but it is often missed. It has a specific treatment, and we are working with interventional radiologists to help diagnose and manage that condition. That’s just one example of how we’re bringing people together and using all of Penn’s resources.” 

Dr. Hamilton has also connected with the Pediatric Headache Program at Children’s Hospital of Philadelphia. “There are only a few pediatric headache centers in the U.S., so this is a great resource to have,” Dr. Hamilton says. “I regularly collaborate with them, and we have created a streamlined process for transitioning pediatric patients to adult care.”   

Headache Education and Research 

Two other important components of a robust headache program are education and research. Dr. Hamilton is working to increase both at Penn. 

“It’s important to educate neurologists and non-neurologists about the latest evidence-based treatments,” she says. “We have taken initial steps in this direction by educating Penn residents in neurology and other select specialties, including Ob/Gyn, psychiatry and ophthalmology. We also have plans to create a headache fellowship in the future.”

On the research front, Penn is growing its capabilities. This includes research into how migraine care is delivered across the Penn system and the addition of a headache faculty member who performs basic research on the migraine phenomenon of light sensitivity.

“It’s very rewarding working with headache patients,” Dr. Hamilton says. “Headache may seem to some like a frustrating problem because there is usually no blood test or imaging test to diagnose it…it’s purely a subjective symptom. I think for this reason, it’s often not given the seriousness it deserves. Fortunately, there has been an explosion in new treatments for headache so most patients can find relief.” 

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