About This Case
This is a case of a fourteen year old girl with worsening headaches. The case covers four months, beginning with entries into her video diary ("vlog" or "video blog"). She explores several approaches to headache management in a series of encounters with health professionals.
Morgan Smith is a 14-year-old high school freshman who has had increasing headache pain for several months. She is an A student, who is a very good athlete and also enjoys being in theatricals at school. She is well-liked and has a large group of friends who are into keeping video diaries. Sasha is her best friend.
Emily Smith is the mother of three children: Morgan, aged 14, and 10-year-old twins, Brian and Sandy. She and her husband have been married for 18 years. Her husband is a bank manager and she was a third grade teacher until Morgan was born. Since then, she has been a stay-at-home mom who is very involved in her children's activities including being a volunteer school aide and a frequent chaperone for school trips.
Karen Wilkes has been the nurse at Morgan's high school of 600 students for 2 years. Prior to that, she was a community health nurse in a nearby city for 15 years. The "Nurse's Office" consists of Ms. Wilkes' office, which has two visitor chairs as well as a refrigerator, a scale, and other equipment; a half bathroom; and a room with an exam table and a single bed separated by a curtain. An additional room, which once contained the exam table and equipment, was converted into a counseling office last year.
Dr. Ergil is a prominent licensed acupuncturist (LAc), who has taught acupuncture and the principles of Chinese medicine at several institutions over the past 30 years. He recently received a doctorate in Acupuncture and Chinese Medicine (DACM). Dr. Ergil sees patients with chronic intractable pain at the local VA hospital.
Dr. Connolly is a pediatric neurologist who has a special interest in migraine headache in children and adolescents. She has been practicing at the university medical center for 3 years since completing her fellowship training, which included an introduction to the use of complementary therapies in pain management. She and Cyndi Grayson, nurse practitioner, have developed a systematic approach to in-school management of headache.
Cyndi Grayson has been a pediatric nurse practitioner in neurology for the past 6 years. Prior to becoming a nurse practitioner, she was an office nurse for 5 years and a school nurse for 8 years. She is particularly sensitive to the issues involved in managing headache in the school setting. Working with Dr. Connolly to develop a comprehensive but adaptable approach, she has incorporated strategies that can be individualized to meet the needs of a particular student within a given school setting.
Dr. Hunt has a doctoral degree in clinical psychology. She has been in practice for 10 years at the university medical center. Part of her training included becoming a cognitive behavioral therapist, a skill that she has been teaching to psychology trainees since she joined the faculty. Her research is focused on how use of CBT can reduce the need for anxiolytics in the management of insomnia.
Dr. Sahler is an adolescent medicine specialist who has received specific training in the use of biofeedback to manage anxiety in addition to chronic pain syndromes such as headache, abdominal pain, and joint and muscle pain. She has used biofeedback with patients as young as 10, but younger patients can sometimes benefit from the approach as well. She encourages patients to use mood rings or Biodots® to practice relaxation between computer-based sessions (see the Learn More section on Biofeedback).
David Hutchinson is a community pharmacist who has worked at the pharmacy in the Smiths' neighborhood for 8 years. He has a special interest in patient counseling and has developed brief handouts about self-care of common symptoms such as headache and difficulty sleeping. The handouts include non-pharmacologic approaches (such as sleep hygiene) as well as over-the-counter remedies. He also always includes a section titled, "When to call your doctor..."
Introducing Morgan's Mom