Starting Points and Potential Barriers

For clinicians interested in creating an MDT, a good starting point is to “create more awareness about chronic daily headache through seminars, roundtables, monthly meetings, and close collaboration with like-minded colleagues in other disciplines,” suggested Dr Sahai-Srivastava. In creating a program, the team should “develop formal inclusion and exclusion criteria for interdisciplinary treatment, and establish clear protocols for patient flow and interdisciplinary communication,” Dr Krause advised. “This form of treatment has many moving parts, so organizational issues take on a greater than ordinary importance.”

Among several potential barriers to solid multidisciplinary care in this population is identifying multiple team members who are willing to collaborate frequently and commit to the necessary case conferences to discuss each patient on a regular basis, says Charly Gaul, MD, PhD, director of the Migraine and Headache Clinic Königstein in Taunus, Germany. Cohesiveness is essential, as “all members of the team should have the same underlying concept for the therapy, otherwise, the patient will select what fits most to his or her own theory and beliefs,” he told Neurology Advisor. For this reason, Dr Krause added that minimizing staff turnover is ideal, and no member of the team should be viewed as simply support staff.

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Convincing patients to adopt functional improvement as a goal instead of analgesia may also be difficult. “Naturally patients seek pain relief first, and are sometimes skeptical that they can improve functionality even at their current pain levels,” Dr Krause said. Reimbursement may be another challenge, as insurance companies may not recognize the value of comprehensive treatment rather than attempts at a quick-fix approach. 

Next Steps

Dr Krause believes that future research should go beyond documenting the effectiveness of care to address how to precisely “triage chronic patients into various levels of care, so that each patient receives the least costly care sufficient to improve their pain, functioning, psychological status, and quality of life.” Long-term outcome data are also needed, according to Dr Gaul. “It is currently unknown which parts of the approach are most effective — education, relaxation training, cognitive behavioral therapy, physiotherapy, endurance training, drugs — and it can be challenging to decide which therapies are needed and which can be skipped.”

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