Left: Cristina Cabret-Aymat MD Middle: (L-R) Duren Ready MD, Cristina Cabret-Aymat MD, Jennifer Padilla MD, Rachel Samson RN ,
Linda Kirby-Keyser MD, Yaitza Spears (Administrative Assistant) Right: Dr. Duren Ready MD
may schedule an appointment without a referral, if their
evaluation is allowed by their insurance carrier. Patients
of all ages are seen at the Clinic. Children are evaluated
by Drs. Kirby-Keyser or Dr. Ready. As in most headache
specialty centers, the majority of patients are experiencing
migraine. However, patients with all types of headaches
are examined, including those with cluster headache,
hemicrania continua, new daily persistent headache,
most common neuralgias such as trigeminal, and
post-traumatic headache. For those patients presenting
with a secondary headache disorder, the staff attempt
to identify the underlying condition and determine the
most appropriate intervention(s) needed to achieve a
satisfactory resolution of the headache.
Almost all of the patients will attend a “headache class”
prior to their examination at the clinic. At the time of the
class, a headache intake form is provided and that form
will serve as a starting point for the initial visit. During
the initial visit, a headache history is obtained and a
physical examination is performed. Once the diagnosis is
established, it is discussed with the patient, a treatment
plan is agreed upon, and a follow-up appointment is
scheduled. A typical day at the Clinic involves four new
patient evaluations and at least eight follow-up visits.
Certain days of the week are dedicated to procedures,
such as onabotulinum toxinA injections for chronic
migraine prevention. Some appointment times are
reserved for urgent needs such as rescue medications.
Biofeedback is provided at the Clinic as Dr. Kirby-
Keyser is a certified biofeedback practitioner. If deemed
appropriate, patients are admitted to the neurology
department at the hospital. Typically, the patients will
receive during the admission, multiple intravenous,
procedural, physical, and psychological interventions in
order to maximize the benefits of an inpatient stay and
improve the headaches.
When asked about the existence of a particular
treatment philosophy at the Clinic, the staff concurred
that they believe that the most effective headache care is
provided through a collaborative relationship between the
clinician and the patients. This relationship requires that
the patients learn about their disease. The goal for the
patient should be to learn enough about their headache
disorder so that they may direct their headache physicians
to manage the needed treatment. They have found that
a patient does best when they are close to their primary
care provider. As a result, patients are discouraged from
traveling great distances to the Headache Clinic.
The addition of Dr. Padilla as the fourth headache
specialist decreased wait times for appointments for
headache clinic referrals. They are seeking a partner for
their “sister” clinics within the Baylor Scott & White
system in order to improve headache care.
When asked why she chose headache medicine, the
Clinic director, Dr. Cabret-Aymat stated: “I became
interested in headache medicine as a neurology resident
while working with my attending at the time, Dr. Brian
McGeeney. Migraine patients presented to clinic and
hospital with their whole lives disrupted, feeling ignored
and misunderstood most of the time because a lot of
them felt very few people truly understood the scope of
migraine disease. I went to my first headache meeting in
Stowe, VT, at the Headache Cooperative of New England
Symposium, and as I sat there listening to headaches
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National Headache Foundation
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