The first center of its kind on the West Coast, the UCSF Headache Center provides patients with comprehensive care to relieve the most debilitating headaches. This includes inpatient treatment for people with severe unremitting or recurring headaches for whom first-line therapies have failed. The service has alleviated pain for thousands of patients with intractable headaches, including migraine, cluster, post-traumatic and other types of headaches.
“Our inpatient headache unit offers intensive therapy for patients who have not responded to any preventive or acute therapies, providing relief that had previously been elusive despite thorough evaluation and appropriate treatment,” said neurologist Morris Levin, MD, director of the UCSF Headache Center. “Outcomes have been life-changing for many of these patients.”
Breaking the circuit of repetitive migraines
A 32-year-old man with migraine headaches noted a significant increase in frequency throughout the year, which coincided with elevated stress at home and at work. His pain is generally frontal or hemicranial and is sometimes accompanied by nausea and mental fog.
His frequent headache attacks led him to use oral sumatriptan on a near daily basis. He’d tried several preventive strategies, including Botox injections and calcitonin gene–related peptide (CGRP) monoclonal antibodies, but nothing was effective.
He was referred to the UCSF Headache Center, where he was recommended for inpatient treatment. After undergoing repetitive infusion therapy with dihydroergotamine for five days, he improved and was discharged. Over the next several weeks, he experienced further improvement with fewer headache attacks and he used much less sumatriptan.
“Triptans are very useful for stopping headaches, but sometimes when patients take them too frequently – three days a week or more – their migraine condition actually worsens, due to what are called ‘medication overuse headaches’,” Levin said. “Infusion therapy can break the circuit of these repetitive headaches. Dihydroergotamine is a very good migraine medication and works particularly well for triptan overuse, but it is difficult to use at home. It’s really only effective intravenously.”
Other infusion medications used at the inpatient headache unit include chlorpromazine and divalproex sodium. UCSF headache specialists the determine the right infusion medication for each patient.
Inpatient treatment effective for majority of patients
The UCSF Headache Center team conducts ongoing research, exploring the basic mechanisms of headache and how existing and emerging treatments might provide relief. At the 2024 annual meeting of the American Headache Society, team members presented research showing that adult patients with chronic severe headaches are likely to have had adverse early childhood experiences. These findings may help inform future treatment approaches.
The team is also investigating patient outcomes. According to Levin, their research shows that approximately two-thirds of patients with refractory headache disorders who receive inpatient care do well after treatment.
“At the inpatient unit, we see patients who’ve tried many different interventions, all of which have failed. Some patients have difficulty stopping the acute medications they’re overusing, and some have such severe or frequent headaches, or both, that they’re disabled,” Levin said. “Patients may have concurrent medical problems that need to be monitored, and other patients are just so demoralized that they really are on the verge of self-harm. Admitting them to our unit is a very effective way of delivering the highest level of care and making big improvements quickly.”
Neurology and neurosurgery research and treatment take place within the UCSF Weill Institute for Neurosciences.
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UCSF Headache Center
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