31 Jan The Headache Clinics: The Diamond Headache Clinic in Chicago
The Diamond Headache Clinic is the first comprehensive and private headache center in the world that is dedicated solely to the diagnosis and treatment of headache pain. The Clinic was founded in 1972 by Seymour Diamond, MD, who had begun practicing headache patients in 1963 as part of his family practice. In 1972, he limited his practice to the management of headache patients. The following is based on an interview with Doctor Merle Diamond, the Managing Director and President, and Mr. Konrad Kothmann, the CFO/COO.
Merle Diamond, MD
Dr. Merle Diamond receive a B.S. with honors from the University of Michigan in Ann Arbor, MI, and was awarded her M.D. from Northwestern University Medical School in Chicago. She completed residencies in Emergency Medicine/Internal Medicine at the McGaw Medical Center of Northwestern University. She is a former fellow of the American College of Emergency Physicians and currently is a Diplomate of the American Board of Internal Medicine. She received the Certificate of Added Qualification in Headache Medicine in 2001, and the Subspecialty Certification for Headache Medicine from the United Council of Neurologic Subspecialties in 2007.
She joined the staff of the Diamond Headache Clinic in 1989 after serving as an attending physician and clinical instructor at Northwestern University Hospital in Chicago, and as an attending physician at Evanston and St. Francis hospitals, both in Evanston, IL. Currently, Dr. Diamond is an attending physician in Internal Medicine and Director of the Diamond Headache Inpatient Unit at Presence-Saint Joseph Hospital, Chicago. She is a Clinical Assistant Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science/Chicago Medical School. Also, she is a Lecturer in the Department of Medicine (Neurology), Loyola University of Chicago’s Stritch School of Medicine.
Dr. Merle Diamond serves as Director of the courses sponsored by the Diamond Research & Educational Foundation, and is a member of the Board of the National Headache Foundation. She has written numerous articles on the topic of headache, particularly migraine in women and the emergency department treatment of migraine and headache. She was an Associate Editor of Headache and Migraine — Biology and Management, which was published in 2015 by Elsevier.
George J. Urban, MD
The Co-Director of the Clinic is George J. Urban, MD, who joined the staff in 1990. Dr. Urban is a native of Presov, Czechoslovakia. Dr. Urban graduated from Safarik University Medical School in 1974, and from there, completed a residency and fellowship in Neurology at the Municipal Hospital, Kosice, Czechoslovakia. He emigrated to the US in 1985, first settling in San Francisco and then moving to the Midwest. He completed a residency in Internal Medicine at Rosalind Franklin University of Medicine and Science in North Chicago, IL.
Dr. Urban is currently on the staff of Presence-Saint Joseph Hospital and is a Clinical Instructor in the Department of Medicine at Rosalind Franklin University of Medicine and Science, and a Lecturer in the Department of Medicine (Neurology) at Loyola University of Chicago’s Stritch School of Medicine. He received the Certificate of Added Qualification in Headache Medicine in 2016.
Alexander Feoktistov, MD, PhD
Alexander Feoktistov, MD, PhD, is Director of Research at the Clinic. He joined the medical staff of the Clinic in 2011 originally arrived at the Clinic in 2001 as a Fellow. He received his M.D. with honors at Moscow Medical Academy, Moscow, Russia, where he also completed a residency in neurology. In 2002, Doctor Feoktistov received a Ph.D. in neurology from the Department of Neurology at the Moscow Medical Academy. He received board certification in neurology and psychotherapy in Russia, and served as Deputy of Medical Director at the Professor Alexander Vein Pain Clinic in Moscow. In 2001, Doctor Feoktistov received a Presidential award for a 1-year fellowship of his choice. He was approved to study headache at the Diamond Headache Clinic in Chicago, working directly with Seymour Diamond, MD and the other physicians. From 2002 to 2007, he remained on staff at the Diamond Headache Clinic, conducting research and assisting in clinical duties. In 2007, Doctor Feoktistov started a residency in medicine at Saint Joseph Hospital, Chicago. From 2010 through 2011, he completed a fellowship in pain medicine at Cleveland Clinic Foundation.
Dr. Feoktistov received board certification in Internal Medicine from the American Board of Internal Medicine (ABIM), in 2010, and has received Certification of Headache Medicine from the United Council of Neurological Subspecialties in 2012. He is also a certified Diplomate in Pain Medicine by the American Board of Pain Medicine. In addition to his research activities at the Clinic, he provides interventional pain procedures including BOTOX injections, nerve blocks, and facet blocks.
Bradley Torphy, MD
Bradley Torphy, MD, joined the staff in 2012. Dr. Torphy graduated from Indiana University in Bloomington, IN, with a double major BA in Biology and History. Prior to attending medical school, he held numerous positions with the Johnson & Johnson Corporation. He graduated from Xavier University School of Medicine, where he received the President’s Scholarship. He completed his residency at the University of Illinois College of Medicine, which is affiliated with Presence-Saint Joseph Hospital, Chicago, where he served as Chief Resident. Prior to joining the Clinic, Dr. Torphy practiced at MacNeal Hospital in Berwyn, IL, where he was named Physician of the Year by the inpatient nursing staff.
He is actively involved in headache research, and has presented these findings at numerous national and international headache conferences. In 2016, he received the Certificate of Added Qualification in Headache Medicine (CAQ). Currently, he is an instructor of Clinical Medicine at Rush medical College, ,Chicago.
Certified Physician Assistants
The other health care providers at the Clinic include certified Physician Assistants, Christine Lantin, Lana Tymouch, and Caitlin Johnson. Ms. Lantin joined the Clinic staff in 1997. Ms. Lantin’s mission is to ensure that a patient’s treatment plan is executed in a closely guided way. She sees patients at the Clinic and also provides phone consultations for the patients of Dr. Merle Diamond. Ms. Lantin received her MMA in Physician Assistant Studies at Midwestern University, Downers Grove, IL.
Ms. Tymouch joined the staff in 2002 after completing PA training at Cook County Hospital/Malcolm X College in Chicago. She sees patients at the Clinic, and also provides phone consultations for patients of Dr. George Urban. her focus of interest at the outpatient clinic is IV treatment, which is prescribed for patients with migraine or cluster headache conditions.
Mmes. Lantin and Tymouch received the Certificate of Added Qualification in Headache Medicine in 2016.
Ms. Johnston is a graduate of the Rush University Physician Assistant program in Chicago, IL, where she completed an additional 9 months of advanced clinical training in internal medicine. She joined the Clinic staff in 2015 where she works closely with Dr. Merle Diamond, caring for patients in both the clinic and the inpatient unit. Ms. Johnson focuses on creating integrative treatment plans with a special emphasis on yoga and meditation.
Diamond Headache Clinic Staff
At the Diamond Headache Clinic, the staff includes: Konrad Kothmann, the CFO/COO; Brian Wolf and Amy Hatton, Procedure Coordinators; Harriet Marcelles, Staff Operations Manager; Sonia Rodriguez, New Patient Coordinator; Dr. Elena Feoktistov, Research; and, Steven Mui, Project Coordinator for Research and Technology.
In 1981, Dr. Seymour Diamond established a self-constrained inpatient unit for refractory headache patients. The 43-bed Unit is now located at Presence-Saint Joseph Hospital, Chicago, and is located across from Lincoln Park. In addition to the Clinic physicians and physician assistants, the staff of the inpatient unit is multidisciplinary. It includes the Director of Behavioral Medicine, Andrew Beaty, PsyD, who joined the staff in 2012. Dr. Beatty earned his doctorate in clinical psychology from the Chicago School of Professional Psychology. He completed his pre-doctoral internship and post-doctoral fellowship in clinical psychology at the Isaac Ray Center/Cermak Health Services of Cook County. He holds academic appointments at Midwestern University/Behavioral Medicine Department and the Chicago School of Professional Psychology. Dr. Beatty specializes in health psychology and provides individual therapy, group therapy, and neuropsychological assessment to patients and their families.
Richard Wenzel, PharmD
Richard Wenzel, PharmD serves as an integral part of the Diamond Headache Inpatient Unit’s multidisciplinary approach as the Staff Pharmacologist. Dr. Wenzel joined the staff in 1999. He received his Doctor of Pharmacy at the University of Illinois. In addition to his responsibilities to the entire hospital, Dr. Wenzel provides classes for the inpatients on the Unit to reinforce education about the medications that they are using. He has designed written and video patient educational material, as well as pharmacy and nursing staff development, and provides drug information to physicians and other health care professionals. He serves as a Clinical Assistant Professor at the University of Illinois-Chicago, Department of Pharmacy Practice. Academic posts at other Colleges of Pharmacy include Midwestern University (Downers Grove, IL), Drake University (Des Moines, IA), University of Iowa (Iowa City, IA), University of Arizona (Tuscon, AZ), and Southern Illinois University (Edwardsville, IL).
The health care team at the Unit includes nurses, medical assistants, biofeedback technicians, physical and activity therapists, counselors, and a dietician. These individuals are involved in the various aspects of the inpatient’s experience on the Unit, and are knowledgeable in the care of the headache patient.
Patients of all ages experiencing disabling headaches, including children, are evaluated at the Clinic. A referral from a health care practitioner (HCP) is not necessary although the Clinic physicians would be happy to coordinate care with your local HCP. Patients have visited the Clinic from all 50 states, and the physicians have treated international patients. The majority of the patients at the Clinic are middle-aged women, suffering from severe, daily, and debilitating headaches. Many patients have coexisting conditions associated with their headaches, including mental health disorders (anxiety, depression, bi-polar disorder) and obesity.
The Diamond Headache Clinic does not specialize in one particular headache type. Headache conditions that are assessed include: chronic migraine with or without aura; cluster headache; hemicrania continua; medication-overuse headache; New Daily Persistent Headache; post-traumatic headache; menstrual headaches; hemiplegic migraine; chronic tension-type headaches; and, pediatric migraine.
A typical day at the Clinic starts at 8:30am, when patients begin to arrive. On average, 60 to 80 patients are evaluated at the Clinic per day. For the health care team, their day has started earlier when rounds are made at the Inpatient Unit. During that time, the hospitalized patients will be assessed and clinical decisions will be made for patients based on their progress and individual requirements.
At the initial visit, the new patient should expect to spend 2 to 3 hours meeting with the healthcare team with the goal of establishing a multidisciplinary individualized treatment approach. After providing a comprehensive headache history, each patient undergoes a thorough evaluation, including a physical and neurological examination. Laboratory studies that are usually required include complete blood count, thyroid testing, urinalysis, and EKG. An MRI or CT scan of the head or neck may be required or repeated. The team will review the patient’s medical and surgical history, conduct a nutritional assessment, and discuss life-style and stress questions in order to determine any triggers or contributing factors to the patient’s headache pattern. Utilizing the total evaluation, the physician can establish an appropriate diagnosis and therapeutic regimen. Treatment may include a series of outpatient procedures, specific preventive and abortive agents, and lifestyle modifications in the areas of diet, recreation, and sleep hygiene. Interventional procedures may be prescribed, such as facet blocks, nerve blocks, Botox injections, TPI (trigger point) injections, and SPG (sphenopalatine ganglion) blocks. Alternative therapies may be considered, including acupuncture, biofeedback, massage therapy, physical and recreational therapy, and psychological intervention.
If admission to the Diamond Inpatient Headache Unit is recommended, the inpatient stay will likely range from 7 to day 10 days. Hospitalization may be started on the same day as the initial visit. If indicated when scheduling the new patient visit, the patient may be advised that admission is possible and they should be prepared to be hospitalized. A follow-up visit will be 4 to 8 weeks after the first appointment.
At the Clinic, each staff members strives to make the patient’s every visit as comfortable and convenient as possible. They appreciate that preparation for the initial visit may be overwhelming, and provide pre-visit, useful information regarding the Clinic, treatment options, procedures, etc.
When giving general advice to a headache patient, the staff would reassure them that they understand the distress, history of unsuccessful treatments, and out-of-control symptoms. They want each patient to feel that they have been listened to and informed, and will receive a renewed sense of confidence in their ability to manage the headache, and live their “best life.”
When asked if the Clinic anticipates significant growth or changes during the next few years, the COO/CFO, Konrad Kothmann, replied: “Currently, there are so many exciting things going on in the world of headache medicine. The new CGRP Antibody drugs will be coming to the market within the next few years and will be a game changer. Not only are the clinical results amazing in the early stage trials, but there will also be an increase in funds spent on education and patient awareness which will hopefully bring many silent sufferers out into the open where they will seek treatment. A significant challenge for headache patients in many parts of the world, especially rural areas, is difficulty in obtaining local quality care. Diamond Headache Clinic, in an effort to serve more patients, is currently exploring several options to meet this need. Whether they may be operating satellite clinics around the country, or by participating in telemedicine, we expect to evolve to make care more accessible to individuals who need it.”
Dr. Merle Diamond was asked why she decided to practice headache medicine. Her response was: “I was tired of the craziness of the Emergency Department and wanted more patient contact. The gift was that I was not even sure that I would like headache medicine but I did it to join my father in practice. It turned out to be the best thing that ever happened in my medical practice. I love patients, their families, and participating with them in their health journeys. The joy I feel when patients do well is so great, it is beyond words.”
The entire health care team at the Diamond Headache Clinic adheres to the same principles, centered on listening and remaining open-minded to patients and to treatment opportunities. The Clinic’s mission and philosophy are best described in the words of the founder, Seymour Diamond, MD: “This is a place that’s always been and always will be about providing continuum of care. Our patients need us to persevere at every stage of the process—to accurately diagnose their condition; to adjust their treatment; to continue our follow-up; and, to show them an opportunity for life beyond headache.”