Cedars-Sinai Medical Center

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Formulary Expanded; FDA Warns About Immune Globulins, Spinal Catheters, Cardiac Drugs

Pharmacy Focus

The Pharmacy and Therapeutics Committee added ticagrelor (Brilinta®) to the formulary and took other actions Oct. 1. Also, the U.S. Food and Drug Administration has cautioned about human immune globulin products, the use of spinal catheters in patients taking anticoagulants and two cardiac stress test agents.

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CME Newsletter - November 2013 (PDF)

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Headache Clinic Has Painless Opening

Although headaches are considered by the World Health Organization to be the third-most-disabling illness, surpassed only by heart disease and cancer, the study and treatment of headache pain remains less than ideal.

In an effort to fill that gap, the Cedars-Sinai Headache Clinic in the Department of Neurology opened its doors Aug. 1 with Ronald Andiman, MD, as its director.

"Headache is not a fatal disease, but it causes a huge amount of suffering," said Andiman (pictured at right), a board-certified neurologist who has been on staff at Cedars-Sinai for more than 30 years. Andiman is also certified in the subspecialty of headache medicine by the United Council of Neurological Subspecialties.

"People who suffer from headache, which is not a visible illness, are often disparaged or not taken seriously," Andiman said. "As a result, a large percentage never seek medical care for headache and, consequently, are undertreated."

Serious headaches include cluster headaches, paroxysmal hemicrania, hypnic headaches and migraines. Headaches can last anywhere from a few hours, which is common for hypnic headaches, to several days, as is sometimes the case with severe migraines.

About 15 percent of women and 7 percent of men suffer from migraines. Chronic headaches, defined as 15 or more headaches per month, affect about 4-5 percent of the population, according to the WHO.

"We find that patients will take over-the-counter medications on a frequent basis, and the act of doing that actually leads to rebound headaches," Andiman said. "This, in turn, leads to further medication overuse, a cycle that can often make the headache pain even more persistent than it already was."

Although for decades medical options for severe headaches were limited, the advent of new medications and a new understanding of the physiology of headache beginning in the 1990s led to significantly more effective treatment, Andiman said.

Cedars-Sinai Headache Clinic

  • Hours: Thursdays, 1-5 p.m.
  • Location: Advanced Health Sciences Pavilion, Suite A6600

The clinic is taking referrals for patients experiencing severe or chronic headaches. Serious headaches include cluster, paroxysmal hemicrania, hypnic and migraine headaches.

"There are many headache types and not one treatment that fits all," he said. "It's very important for the physician to make an accurate diagnosis, and only then can the appropriate treatment be applied." Though there are many headache categories, there are as many headaches as there are patients, and management must be individualized.

Teaching patients about the origins of their headaches is a crucial part of treatment. For instance, migraines can be triggered by foods such as red wine, cheese and chocolate, or even by certain preservatives. But headache sufferers often don't make the connection between the food they eat and the migraine that starts the next day.

The Headache Clinic, located in the Advanced Health Sciences Pavilion, is open Thursday afternoons. Andiman is its primary physician, and hospital residents rotate through as part of their training.

Though much work remains to be done in headache research, with education and medical treatment, patients can get significant relief, Andiman said.

"I have had patients who had daily headaches for 20 years who now are having only occasional, easily managed headaches."