Thousands of patients with severe unremitting or recurring headaches who have not responded to multiple medications and interventions have been relieved of their pain at the UC San Francisco Inpatient Headache Unit at St. Mary’s Medical Center.
One of the few such inpatient centers in the world, the UCSF Inpatient Headache Unit treats patients with headache disorders through intravenous infusions of medications such as dihydroergotamine, chlorpromazine and valproate. Patients experiencing frequent and severe migraine, cluster, post-traumatic and other headaches have had their pain alleviated through this service, which is offered by the UCSF Headache Center.
These inpatient treatments have significantly improved the quality of life for many patients, as these three cases describe.
Headache-free after more than 20 years
A 45-year-old woman who had been suffering from disabling headaches nearly every day since she was in her 20s came to the UCSF Headache Center for treatment. “Everyone in my family has them,” she said. Her headaches have led to job loss and family discord, leaving the patient demoralized and intensely frustrated. Prophylactic medications had not been effective and most acute medications provided only temporary relief. The patient had been taking nonsteroidal or triptan medication daily for two months. She reported feeling depressed and suicidal but is otherwise healthy.
The UCSF Headache Center team determined that further outpatient therapy was unlikely to help due in large part to the patient’s analgesic-overuse headaches. She agreed to inpatient infusion therapy and was given dihydroergotamine three times a day for five days. The patient developed some manageable adverse effects and an initial flare of headaches, but one week after discharge she reported being headache-free on most days and has dramatically reduced her acute medications.
Veteran relieved of service-related headaches, vertigo and nausea
A 31-year-old U.S. Army veteran who had experienced occasional migraine attacks since adolescence suffered from daily severe headaches for a year since returning from deployment in the Middle East. During his military service, he sustained a concussion after falling from a troop carrier, and after this event his headaches became increasingly frequent. The patient often suffered from vertigo and nausea. All these symptoms led to his discharge from the Army. He also complained of insomnia and depression.
When the patient failed to respond to multiple medications, the UCSF Headache Center team proposed four-day inpatient therapy with intravenous infusions of chlorpromazine. He tolerated this well and reported a significant reduction in headache pain, nausea and vertigo during the infusion therapy. The patient’s improvement has persisted since the treatment.
Breaking the cycle of cluster headaches
A 57-year-old man with a history of cluster headaches was in a cluster-headache cycle for six weeks without relief from his usual treatment with prednisone, verapamil, oxygen and occipital nerve blocks. He was admitted to the UCSF Inpatient Headache Unit at St. Mary’s Medical Center for intravenous dihydroergotamine infusions. After the third infusion, the patient’s cluster-headache cycle stopped.
“Headache disorders are the most common illnesses we see as neurologists,” said Morris Levin, MD, neurologist and director of the UCSF Headache Center. “Thanks to some significant advances, we have more useful management strategies at our disposal for migraine and related disorders than ever before. Calcitonin gene-related peptide (CGRP) monoclonal antibodies help many patients achieve significant reductions in headache frequency and severity, and small-molecule CGRP antagonists provide new options for relieving acute headache pain.
“But there remain many patients who have not responded to any preventive or acute therapies,” he added. “The UCSF Inpatient Headache Unitoffers intensive therapy for these patients, providing relief that had previously been elusive despite thorough evaluation and appropriate treatment. Outcomes have been life-changing for many of these patients.”
UCSF Medical Center is ranked No. 1 in the nation for neurology and neurosurgery by U.S. News & World Report’s 2021-2022 Best Hospitals survey.
All UCSF neurology and neurosurgery research and treatment takes place within the UCSF Weill Institute for Neurosciences.
To learn more
UCSF Headache Center
(415) 353-8393 | Fax: (415) 353-9539
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