Interdisciplinary management of headache disorders

Chronic pain related to headache disorders causes significant burden of disease not only for the patients having these conditions, but also on society as a whole and often is associated with high utilization of health care systems. Despite advances in treatment, however, most patients with chronic headache continue to be undertreated or misdiagnosed. Appropriate evaluation using an in-depth history and physical examination, with imaging or laboratory studies as indicated by the findings of the examination, is paramount in selecting appropriate therapeutic options for treatment. Several studies on the effect of interdisciplinary care in patients with headache have shown improved outcomes for pain intensity, medication use, overall disability and work absence, and general mental health. Thus, it is recommended that care for patients with chronic headache disorders be interdisciplinary. Interdisciplinary care should include neurologic care and pharmacotherapy, physical therapies, complementary and alternative medicine, and psychological therapies. Consideration for interventional pain procedures or surgical procedures is recommended for patients with appropriate diagnoses or for those with pain refractory to conservative management.