HEADACHE CLINIC

HEADACHE OUTPATIENT CLINIC

The Special Outpatient Clinic of the 1st Neurological Department of the Eginition Hospital, 21 Papadiamantopoulou street, 11528, houses the HEADACHE OUTPATIENT CLINIC of the Medical School of the National & Kapodistrian University of Athens. The clinic is staffed by Prof.DIMITRIOS MITSIKOSTAS  and functions every Monday and Thursday from 09.30 to 13.30.

For appointment call: +30 2107289448
e-mail: eidikaiatreianeurologias[at]med.uoa[dot]gr

INTRODUCTION

Primary headaches are the most common neurological disorder with an annual prevalence of more than 29% in the Greek general population¹, whereas chronic headaches with an almost daily incidence of headache attacks have an annual prevalence of 4% in Greece¹. A recent study by the Hellenic Headache Society found that chronic migraine has a 1% annual prevalence and that about 74,000 Greeks have almost daily headaches that greatly reduce their functionality. Accordingly, 640,000 Greeks suffer from migraine headaches that reduce their functionality, but only 6% receive prophylactic treatment². At the global level, headaches are the second most common / serious public health problem in modern culture that causes disabilities with dramatic impacts on personal and public life ^3,4. To address them, the European Confederation of Headaches (EFF) has proposed organizing special headache centers stratified into three categories, 1st Grade, 2nd Grade and 3rd Grade. This Outpatient Headache Clinic of the 1st Neurology Department (National and Kapodistrian University of Athens) is tertiary and operates in accordance with EHF5 recommendations⁵.

STAFF

The medical and paramedical staff of the Headache Clinic reaches the headache patient through a network of specialist physicians and health care providers to treat headache pain. Patients are treated on an outpatient basis, but when required, they are treated in Ward A of the 1st Neurological Department of the University of Athens at the Eginition Hospital. The Headache Clinic is staffed by 4 neurologists, 2 psychologists, 1 nurse and 1 secretary and will work with specialist neuroscientists, neuropsychologists, psychotherapists, pain physicians, dentistry physicians and one stomatologist (see table 1 below)

TABLE 1.

OPERATION

The Clinic operates every Monday and Wednesday, at the Department of Outpatients Clinics of the Egintion Hospital on 21 Papadiamantopoulou street, on request, from 09.00 to 15.00. Five new cases are reviewed each time, and five old, or they are treated with special treatments (e.g. botulinum toxin, or occipital nerve block). A special electronic file for all patients is kept (CephalalgiaDB). Patients are monitored with specific headache diaries and examined with a specially designed interview. They are also subjected to specific pain, headache (MIDAS) and emotional (Hamilton anxiety and depression scales) scales on which progress in treatment is monitored, quantified and evaluated. Novel treatments including monoclonal antibodies or oral agents targeting the CGRP pathways, along with 5-HT1F agonists are including in the treatment options for the people who attend the Headache Clinic, along with neurostimulation devices.

RESEARCH

Phase II, III and IV clinical trials (Table 2) as well as self-funded research programs on migraine, type-tension headache and cluster headache are performed at the headache clinic.

UNDERGRADUATE EDUCATION

The clinic provides theoretical & practical training to undergraduate students of the School of Medicine National and Kapodistrian University of Athens, according to the educational program of the 1st Neurology Department. 

POSTGRADUATE EDUCATION (MASTERS ON OROFACIAL PAIN AND ON PALLIATIVE PAIN MAMAGEMENT)

In collaboration with the Dental School of the National and Kapodistrian University of Athens, the Headache Clinic offers postgraduate students training in the Oral and Maxillofacial Pain (6 months internship). It is also planned to create a special postgraduate master's degree program, which will also provide postgraduate students with training. Postgraduate students of the Master Program for Palliative Pain Management are also participating in educational program of the Headache Clinic, along with the training neurologists at the 1st Neurological Department of the National and Kapodistrian University of Athens.

External neurologists who provide hands-on training in headache management will also be included in the Practitioner trainees, subject to approval by the Director of the Department (Prof. L. Steanis).

PATIENTS & PSYCHOTHERAPY GROUPS

Psychotherapy has a special place in the treatment of chronic headaches⁶. Special psychotherapy groups are therefore included in the treatment plan of the practitioner, as established by the associate psychologists and psychiatrists. Patients are also able to organize themselves either in autonomous groups or within the Hellenic Headache Society Alliance. Specific volunteering programs in cooperation with Chief Nurse (C. Chrissovitsanou) will also be developed.

SPECIAL CENTER FOR RARE NEUROLOGICAL DISEASES

The headache clinic in collaboration with Ward A of the 1st Neurology Department is the center of the following rare diseases:

• CADASIL Syndrome (ORPHA code 136)
• Paroxysmal Hemicrania (ORPHA code 157835)
• SUNCT (ORPHA code 57145)
• Hemiplegic Migraine (ORPHA code 569)
• TOLOSA HUNT syndrome (ORPHA code 64686)
• Hemicrania Continua (ORPHA code 443070)

References

1. Mitsikostas DD, Tsaklakidou D, Athanasiadis N, Thomas A. The prevalence of headache in Greece: correlations to latitude and climatological factors. Headache. 1996 Mar;36(3):168-73.
2. Constantinidis TS, Arvaniti C, Fakas N, Rudolf J, Kouremenos E, Giannouli E, Mitsikostas DD. A population-based survey for disabling headaches in Greece: Prevalence, burden and treatment preferences. Cephalalgia. 2021 Jun;41(7):810-820. doi: 10.1177/0333102421989630. Epub 2021 Feb 1. PMID: 33525903.
3. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386(9995):743-800.
4. Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16:58.
5. Steiner TJ, F. Antonaci F, Jensen R, Lainez MJA, Lanteri-Minet M, Valade D.  Recommendations for headache service organisation and delivery in Europe. J Headache Pain 2011; 12:419-26.
6. Penzien DB, Irby MB. Biobehavioral treatments of migraine. Handb Clin Neurol. 2024;199:155-169. doi: 10.1016/B978-0-12-823357-3.00031-8. PMID: 38307643.

(page revised in APRIL 2024)