Headaches: A spectrum of pain presents a dilemma for doctors

This widespread problem continues to present physicians with challenges in diagnosis and treatment.

By Kathleen F. Phalen, AMNews correspondent. Oct. 15, 2001.

Emergency physician Stephen Epstein, MD, remembers his early days at Beth Israel Deaconess Medical Center's emergency department in 1996. There was a steady stream of headache pain regulars, and primary care doctors sometimes would provide residents with instructions to treat the most severe and chronic sufferers with Demerol.

"The [primary care physicians] didn't know what else to do. They just threw up their hands," says Dr. Epstein, a spokesman for the American College of Emergency Physicians. "They were at their wits' end."

But that course of treatment only exacerbated the vicious spiral of inadequately treated pain and debilitation common in headache management. As many as 45 million Americans complain of this baffling malady, accounting for 42 million primary care visits a year. Nearly 28 million of these headaches are actually migraine.

Still, headache is vastly undertreated and misdiagnosed. The financial cost in lost work and productivity is staggering -- about $10 million annually. And worse, patients face disability in their professional and personal lives, not to mention the constant threat of unbearable pain.

Dr. Epstein says some patients were coming into the emergency department for narcotics several times a month, some weekly. "Demerol [meperidine hydrochloride, Sanofi Pharmaceuticals Inc.] is a lousy drug. I might say to the patient, 'The best thing for your headache is Compazine [prochlorperazine, SmithKline Beecham Pharmaceuticals],' " he recalls. "And they'd say, 'My doctor sent me here for Demerol.' " [...]