UC Health Unveils Collaborative Headache and Facial Pain Program

CINCINNATI—A new program at the University of Cincinnati (UC) Neuroscience Institute promises a personalized approach to pain for the thousands of people in the Cincinnati region and beyond who suffer from migraines, cluster headaches and facial pain.

The Headache and Facial Pain Program, which opened this week, will call upon specialists from multiple disciplines to help patients reduce or eliminate the pain that is unique to them.

"This program is one of the only multidisciplinary headache and pain centers in our region,” says Vincent Martin, MD, a UC Health headache specialist, professor of medicine in the UC College of Medicine and co-director of the program.

"In the past, headache and facial pain have been treated separately and without much integration. This is the first program regionally to combine services that include neurology, internal medicine, neurosurgery, neuro-oncology, otolaryngology (ear, nose and throat), oral surgery and integrative medicine to maximize the treatment of both headache and facial pain.”

The program is the newest addition to the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health. Co-director of the program’s facial pain component is Ellen Air, MD, PhD, an assistant professor of neurosurgery who also sees patients at UCNI’s Epilepsy Center and the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders.

Although facial pain and headache are frequently distinct, they also can be present simultaneously, Martin says. "Facial pain is more in the cheekbones, jaw or in the nasal region, while headaches are in the forehead, top of the head, sides of head and back. These disorders tend to overlap. We know that patients with headache can have facial pain and vice versa.”

Patients who call to make an appointment will be referred to the most appropriate specialist within the program. For example, a patient with temporomandibular joint disorder, or TMD, may receive treatment from an oral surgeon who is an expert in that field, while a patient with sinus infections that produce headache or facial pain will be treated by an ear, nose and throat specialist.

A subset of patients with facial pain who suffer from trigeminal neuralgia will be referred to a neurosurgeon. Trigeminal neuralgia, which affects one in every 25,000 people, is an often misdiagnosed condition that has been described as the "suicide disease.” Also known as tic douloureux, it occurs when the trigeminal nerve is compressed by an artery, vein or tumor. The resulting inflammation causes extreme pain and muscle spasms in the face.

John Tew Jr., MD, a neurosurgeon with the Headache and Facial Pain Program and professor of neurosurgery, surgery and radiology, has described the pain of trigeminal neuralgia as being akin to "biting down on a red-hot poker.”  Patients with trigeminal neuralgia typically experience life-changing relief after surgical treatment, which is tailored to the individual patient.

Says Air: "Trigeminal neuralgia is one of several types of facial pain that our team of experts is uniquely positioned to effectively diagnose and treat.”

Martin and other headache specialists will see many of the patients who suffer from painful and disabling headaches, including migraines. About 16 percent of women and 5 percent of men suffer from migraine headaches, Martin says. About three to seven individuals per 100,000 experience cluster headaches, a rare and even more severe disorder.

Headaches, by their nature, are more likely to be tamed than cured.

"Because headache is a disease of the nervous system, there’s not a cure,” Martin says. "What you can do is dramatically reduce the frequency, severity and disability of the headaches and make them less impactful on life.

"There are rare instances where you can get rid of the headaches completely. But for the most part our objective is to manage the disease effectively. We give our patients the tools to cope with their condition so that they don’t miss work, family functions or social events that they might miss if they were not adequately treated.”

Coping means not only finding the right medications but also prevention. Identifying headache triggers that can be avoided is a primary aim. 

Research by Martin and his team is shedding light on the intricacies of headache triggers. "We are looking at how hormones trigger headache, how sinus disease and allergies trigger headache,” Martin says. "We are investigating hyperflexibility and headache, and we are studying how some diseases—asthma, rhinitis, depression, anxiety—are interrelated with headache.”

Martin and his team made international news earlier this year with groundbreaking findings that lightning strikes may affect the onset of headache and migraines for those who suffer from them regularly.

The best news for patients who suffer debilitating headaches is that 90 to 95 percent can be helped through treatment and behavioral changes.

"Most of the people I see have already been to many different doctors and are still suffering,” Martin says. "It is important for people with headaches to know that there is hope. And we believe that with our multidisciplinary approach to the problem, we can offer treatments that others have not tried in the past.”