Paper Title
THE TREATMENT OF RESISTANT, CHRONIC, HEADACHES AND FACIAL PAIN PATIENTS IN A COMPREHENSIVE MULTIDISCIPLINARY CLINIC

Abstract
Background and aims: Medically unexplained symptoms including chronic non-remitting pain may comprise up to 25% of a tertiary neurological clinic population, causing severe disability to the patients, and a challenge to the physician facing patients who "tried already everything". We hereby report our experience treating these patients with a multidisciplinary approach. Methods: Resistant headache or facial pain was defined as non-remitting pain for at least 1 year; not attributed to another disorder, with ahistory of multiple consultations; failure of adequate treatments; accompanied with physical disability and impairment of working and social abilities. A multidisciplinary team establishes the treatment, consisting of drug treatment and at least 2 of the following: physical treatment (clinical massage, acupuncture or reflexology), hypnosis or biofeedback and psychotherapy (short or long term). Results: Out of 1682 patients (66% women; average age 45 years) seen at the headache clinic during the last 18 months, 81(4.8%) were referred to the multidisciplinary clinic (75% women; average age 50 years). Chronic tension type headache comprised 66% of the complaints, the rest being chronic migraine (21%), atypical facial pain (9%) and chronic cervical pain (4%). Changes were noted after 4-8 weeks of treatment, manifesting as improvement in the general well-being in 30% of the patients or reduction in the headache severity or frequency in 20% of the patients. Conclusions: Multidisciplinary approach is helpful treating patients with non-remitting headache, considered previously 'beyond help'. Enlarging treatment modalities may improve treatment outcome in these patients.