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A Conversation With ... Dr. Roger Cady

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Tell us about Headache Care Center, which you opened in 1997.
What we have here is an interdisciplinary clinic model, and that basically means we see very complicated headache patients from all over the United States. These are people who have very disabling migraine. We have two physicians, Dr. Kent Dexter and myself, two psychologists … who do the nonpain-management of headaches and helping learn to do things … that can protect them from migraine. We have physical therapists and a superb nursing staff that does a lot of the education of patients. … Through Clinvest, we have a research staff of about 12 people working in clinical research. We probably are doing about 20-plus studies at any one point in time. The other thing we do is a lot of education (for) thousands of doctors each year on headaches and a host of other primary care disorders.

In a city with two major health systems, why are you in an independent practice?
There are excellent health systems here, and I think the best answer I can give is that I don’t think either of those health care systems would have allowed me to do the things that I think are really important. That’s not to be negative, but this clinic isn’t about volumes. It’s about quality and individualization of care, and I really don’t think being able to do the research and the other things would have been possible. … The vast majority of our referrals are from neurology practices in town, with patients referred from both systems.

What led you to open the center?
I came to Springfield (and) started working as the medical director of the Shealy Institute back in 1986. It was a very active general pain practice, very behaviorally oriented, very holistic. … In 1989, we started doing some research for a brain chemical called seratonin. Our interest in this was looking at what happened to brain chemicals during certain positive behavior- – for example if they exercised, laughed or watched a humorous movie, or did meditation -– and we measured the change of the chemicals in their blood and spinal fluid. (In) about 1990, we presented this information at the Southern Medical Association’s annual meeting, and the research won an award. What transpired out of that was that I was aware that a company called Glaxo was doing research on a new drug for migraine that mimics seratonin. This introduced me to some people at Glaxo just prior to the development of a whole new series of drugs called triptans. Glaxo asked me if I would participate in a clinical trial, and we published a paper in the Journal of the American Medical Association, which really ushered in these drugs to treat migraine … actually targeting the causes of migraine. At that point, my practice was shifted from general pain to headache patients.

What’s the difference between headaches and migraine?
That’s probably the most often-asked question I get. A headache is just one symptom … . If people have migraine, they are sick. Not only do they have headaches, they often have nausea and vomiting. They’re sensitive to light, sound, touch, odor, all the sensory information that’s around them. … If people have the genetics to have migraine, and they have frequent (episodes), it becomes a very debilitating disease process.

How can you help migraine sufferers?
We have medication to help people, but medication is just simply a tool. It’s not an answer, and it’s always going to work better if people are participating and doing things for themselves. … Migraine is a biologic disorder. People inherit a nervous system that is more vigilant, more aware, more easily stimulated by the environment (but) a major part of it has to do with lifestyle. If you skip meals, alter sleep patterns or are under a lot of stress, these are the times that your biology will create this attack of migraine. A lot of what we’re doing is helping people look at these important aspects of their health.

What has Clinvest’s research discovered?
We were one of the first clinics to present research to demonstrate that a lot of headaches, such as sinus headaches … really turn out to be migraine, and in the past, where people may have been treated with antibiotics or surgery or other things, were far better to be treated as migraine patients. We’ve made some important contributions into mechanisms for how Botox is used for headaches. And we’ve even done some work on alternatives, looking at the combination of feverfew and ginger as a treatment for migraine. It’s a plant product extract. 
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