About Dr. Hanna

Diagnosis &
Methods

Causes & Triggers "Headaches"

Contact Info
& Cost

Welcome

Diagnosis & Methods

Diagnosis
At the outset, in our setting it is crucial to establish that the headache being presented is Not due to any ominous condition.  (This is the definition of a “Primary” Headache).  Prior studies (MRI’s, CAT Scans of the head, etc.) would have been shown to be normal.  “Blood analysis” (such as comprehensive metabolic profiles, thyroid profiles, etc.) would have been shown to be normal.  Medical records are reviewed.  Then and only then, are we certain that our patient does not have an ominous condition causing their headache.
 
Subsequently, we proceed to study the behavior of the headache.  This is crucial to identify what type of headache we are dealing with.  For example, if it is a “migraine” headache, we must attempt to uncover what type of migraine it is, as “migraines” present in several different subtypes.  Such subtypes should be treated differently for the best possible outcome.  For example, the “Common Migraine” should be treated differently from the “Classic Migraine”.  In other words, the physician should precisely know what type of headache they are dealing with.  This is the key to successful headache management.  This is the reason that often our initial evaluation can take as long as two hours.  In our setting, this is done in a one on one fashion.  This physician listens and attempts to answer as many questions as she can.  The process is painstaking, but it pays off in successful management; having a headache free life.  Both the patient and physician welcome the opportunity for exchange of information.  For many, it is the first time they have been listened to by a physician for this long.

Our Methods
The clinic uses a multi-disciplinary approach for the treatment of headache patients.  This is essential, as most of our patients have multiple dimensions to their headaches.  For example, if a certain patient has neck pain, possibly the use of physical therapy may be appropriate.
 
In terms of medication, a variety of preventive headache medications are utilized, depending upon the type of headache being presented.  Medications we use are safe, well tolerated and have no adverse effects from long-term use.  As a rule, they are non-habituating.  Preventive medications are preferred, especially since they do not produce the so called: “Rebound-Headache Phenomenon”.  Furthermore, the preventive medication of choice is unique to the type of headache at issue.  Therefore, the medication of choice in our setting is not based on random trial and error, as is often the case.
 
In general, after the initial evaluation, options for the patient are presented, and the pros and cons of each are discussed.  Other concomitant problems are also discussed, whether they may include neck problems or tempomandibular issues.  We often encounter anxiety, depression and poor sleep.  Those problems are addressed.  Nutritional counseling is stressed and is an important component of the program.  Issues of sleep are discussed, as good sleep hygiene is crucial for headache management.
 
Patient education is a crucial aspect of our program, and is one of the reasons we have a successful outcome among our patients.  Our goal is self-empowerment for the patient.  Self-empowerment allows the patient to master their headache, as opposed to the converse.  The patient learns that headache intensity and frequency is under their control, to a large extent.  They learn how to minimize most of their triggers; once they identify them.  Engagement in overall wellness is key.  Good eating and sleeping habits, exercise, rest, avoidance of overexertion, relaxation, stress management are all important; our patient soon discovers.  The patient soon realizes that working with this physician is much like a journey of self discovery.  The element of mystery is soon removed from headache.  The patient is, again, in control.