Neurology &
Neurological Sciences
The Stanford Headache Program

Stanford Headache Program

Rob Cowan, MD, FAAN, FAHS
Rob Cowan, MD, FAAN, FAHS
Director of the
Stanford Headache Clinic

A nationally-renowned leader in headache care has arrived at Stanford Hospital & Clinics to direct its first headache clinic, a multidisciplinary care program designed to integrate the latest thinking in diagnosis and therapy for this very common and often disabling disorder.

"Only recently has headache been recognized as a serious issue," said Dr. Cowan. "While there are several world-class headache experts on the west coast, Stanford is the first west coast academic medical center to develop an integrated, fully multidisciplinary program including an accredited Fellowship in headache medicine, both interventional and complementary/alternative approaches, and research. Stanford is bringing its tremendous resources to a problem that affects 60 million Americans and costs the economy $30 billion a year in lost productivity."

Joining Dr. Cowan is Meredith Barad, MD. "Headache management has really improved over the last decade," said Dr. Barad, a Headache Clinic neurologist with additional training in a pain management fellowship. "That’s a rare and value skill set for headache care," Cowan said. In the summer of 2012, Sheena Aurora, MD, one of the worlds leading clinical researchers and an outstanding clinician joined the team, which also includes Carol Barch, NP and Jeffrey Obrart, RN. "This is a rapidly growing program that represents a joint effort between the Departments of Neurology and Pain Medicine, and we are working hard to create a world class service for the growing number of headache patients in Northern California and throughout the world."

Dr. Cowan has put his research on hold for a year while he focuses on building the faculty and programs within the Headache Division. When he returns to his academic pursuits, he will continue to focus on changes in the brain's chemistry during migraine, and he remains a strong advocate for patient rights and patient education, often traveling to Washington to speak with Congress about funding and other issues in headache medicine.

Dr. Barad's special interest is in medication overuse headaches and multidisciplinary treatment.  "Headache management has really improved over the last decade,” Barad said. “We are no longer throwing opiates at the pain; studies show they don’t work."

Dr. Aurora’s focus in on novel treatments for migraine and other primary headache disorders. She is the principle investigator on a variety of clinical trials and brings with her a long and broad experience in clinical care. Her research interests focus on imaging studies and the non-pain aspects of severe migraine.

What is effective, Cowan said, and what Stanford will offer, are “physical therapists who understand that people with migraines are sensitive to touch, psychologists who understand that a migraine is a genetic condition that sits at the interface of mind and body, nutritionists who understand that it’s not just what you eat, but when you eat it, and neurosurgeons, pain specialists,sleep experts, endocrinologists, gynecologists and primary care doctors who recognize the unique needs of patients who experience severe headaches.”

Migraine is a very complex condition that requires complex care, he said. “We don’t have a cure, so the goal is to manage it as a chronic condition. Our goal is for headache to become a footnote rather than a focal point in your life.”

The Stanford Headache Clinic’s treatment approach integrates medical, behavioral and complementary medicine. It focuses on prevention, lifestyle changes, physical therapy, stress management, nutritional counseling and planning for immediate response with appropriate medication when a headache occurs. It also includes consultations for intervenional treatments, as well as craniosacral work, acupuncture, massage and yoga with Stanford’s Center for Integrative Medicine. Patients will also be asked to keep headache diaries to help pinpoint what triggers their pain, and if they wish, receive invitations to participate in clinical trials of new medications and delivery systems.

“Research has proven that complex painful conditions, like headache, are best treated with an integrated team,” said Sean Mackey, MD, PhD, Chief of Stanford’s Pain Management Division. “That’s why I am so excited to have Dr. Cowan join Stanford. We can combine the expertise of a world-class headache specialist with that of the team at the Stanford Pain Management Center. We can offer state of the art resources to improve the lives of our patients.” 

When Stanford launched a national search for a headache neurologist to direct the clinic, Cowan quickly emerged as an exceptional candidate. “I was impressed with Dr. Cowan’s very modern, multidisciplinary approach, something that takes into account what we’ve learned about the mechanisms of headache. Dr. Cowan also met our goal of a headache neurologist who could integrate well with the overall Stanford Pain Management Center, led by Dr. Mackey,” said Frank Longo, MD, PhD, chairman of Stanford’s Department of Neurology and Neurological Sciences. “We are thrilled to have him. Stanford has never had a dedicated headache program; we clearly needed one--and we wanted it to be the best.”

Cowan chairs the section on Refractory Headache for the American Headache Society and is vice president of the Headache Cooperative of the Pacific. He is board certified in psychiatry, neurology and pain medicine; he holds a subspecialty board certification in headache medicine. He is the author of more than 50 journal articles, a best-selling book on headache and neurology textbook chapters. He also lectures internationally.

The Headache Clinic represents another step toward the integration of pain care as an important element in patient care. A limitation of many headache clinics is their lack of integration within overall multidisciplinary pain programs such as Stanford’s Pain Management Center, Cowan said.

Stanford obtained certification for a fellowship in headache medicine, one of only 17 in the country, and the first on the west coast. Most medical training does not include substantive teaching about migraine and other forms of chronic headache, Longo said. “That’s especially remarkable, proportionately--it’s one of the most common chief complaints in medicine, and might be the most common in the neurosciences. Unless one has specialized training, it’s a very intimidating area.”

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