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Building an Interventional Headache Practice: Expert Recommendations

Author Melissa Malena covers Building an Interventional Headache Practice: Expert Recommendations on BackTable MSK

Melissa Malena • Jul 4, 2024 • 39 hits

The subspecialty of interventional headache medicine encompass a variety of treatment options that can offer significant pain relief for patients, especially those with occipital and cervicogenic pain. Dr. Dan Ngyuen, former president of the American Society for Spinal Radiology, and Dr. Jacob Flemming, host of BackTable MSK, share their insights on building an independent, headache-centered, clinical interventional radiology practice.

This article features excerpts from the BackTable MSK Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.

The BackTable MSK Brief

• To build a headache-centered interventional practice, form personal relationships with headache experts at local medical centers and introduce them to your practice’s offerings.

• Along with outside practitioner referrals, patient-directed digital marketing can help introduce patients to one’s practice.

• The American Society for Spine Radiology (ASSR) offers multidisciplinary continuing education programming featuring anesthesiologists, neurosurgeons, and interventional pain specialists, as well as neurological, musculoskeletal, and interventional radiologists.

• Occipital and cervicogenic headaches are good pathologies to target when starting to utilize headache interventions; these conditions have high interventional success rates and can help build practitioners' comfort levels.

Building an Interventional Headache Practice: Expert Recommendations

Table of Contents

(1) Building A Headache-Centered Clinical Practice

(2) Offering Headache Interventions: Where to Start?

(3) The American Society of Spine Radiology (ASSR): Continuing Education for the Headache Interventionist

Building A Headache-Centered Clinical Practice

Finding success in your interventional headache practice depends largely on establishing reliable sources of headache patient acquisition. Building a patient base requires patients and other physicians be made aware of the unique therapies that are offered by an interventional specialist. Without knowledge that such treatments exist, patients and practitioners will not seek them out, nor consider them as viable therapeutic options.

Dr. Nguyen recommends forming personal relationships with providers within the local area, starting with physicians who specialize in headaches. Medical centers will often have at least one such physician and are a great place to start. Although referrals are very important, patient-directed digital marketing also helps to build a clinical interventional radiology practice.

[Dr. Jacob Flemming]
When you started your practice in Oklahoma City, what was your approach to raise awareness that you were offering these therapies? What physicians did you approach and how are patients coming to you now?

[Dr. Dan Nguyen]
Yes. When I came here, as anyone else, no one knew of you. I just start with the basics of what I know at that time. What I knew was exactly what you say is spontaneous intracranial hypotension. I start with the group of practitioners that deal with this the most, which is most of the time the headache doctor. There's not too many of them in most cities, but each main center will have one or several of those.

That's how I started. I introduced myself and said, "Okay, well, there's this entity, and then the conversation led to other areas, like what I'm doing today. Getting that face to face interaction with someone, the old-fashioned way. It's very effective. Most of them I give them my cell number freely. I say, "Text me, call me, whatever you need to do that." From there, I also obviously had to learn about the patient directed digital marketing for my kids and how we can do that part of that too.

Before you know it, people know there's someone here in Oklahoma that does this thing. It infiltrates very quickly because there's not too many of us doing that too. Everyone's searching for a partner in this arena and that's how it builds up from here, organically, so to speak, with some intent. Sometimes you can go to this center and I offer to do a grand rounds on headaches and I talk about different things. It's a combination of things. Since I'm not in a medical center, so to speak, I have to purposely go out and develop my relationship with different people in this area. That's how I started.

[Dr. Jacob Flemming]
Excellent. A bit of deliberate practice building with respect to the headache, but it sounds like as things have gone on, you're getting a mixture of both physician referred and self-referred patients.

Listen to the Full Podcast

Image-Guided Headache Interventions with Dr. Dan Nguyen on the BackTable MSK Podcast)
Ep 30 Image-Guided Headache Interventions with Dr. Dan Nguyen
00:00 / 01:04

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Offering Headache Interventions: Where to Start?

For interventional radiologists looking to offer headache interventions as part of their practice, Dr. Nguyen recommends composing an overall analysis of one’s existing practice. Identify the practice’s strengths, weaknesses, opportunities, and threats. When weaknesses are identified (e.g. imaging, anatomy, etc), seek mentorship to grow stronger in those capabilities. Webinars and classes are also an excellent option for continuing education and staying updated on the latest interventional techniques. For the first few cases, Dr. Nguyen suggests treating occipital or cervicogenic headaches to develop a baseline of experience and interest in the interventional headache space.

[Dr. Jacob Flemming]
Excellent. It's, definitely, something, there's a huge need for it in most communities, and I think it's something that specialists with the skill set of interventional radiologists could definitely be offering. On that note, that's my last question for interventional radiologists who want to start offering headache interventions for their patients. What would be some words of advice for them, good first cases or areas to focus on and strategies to build referrals and early successes?

[Dr. Dan Nguyen]
Yes, well, that's a good question. I struggled with this four years ago as well, so this is very fresh on my mind how I did it. Not necessarily the only way or the right way, but I stepped back when on my drive here to Oklahoma from the East Coast, I thought, "How am I going to do this?" I've taken some business classes during my leadership time at the university and I learned this thing. I don't know, most people may have heard it, SWOT Analysis. It's Strength, Weakness, Opportunity, and Threats.

You take that approach first, you look at your strength. What do you have now that you would say is a strength? Do you have the personality, the facility, the people in the team that can do that? Do you have the skill to feel confident doing that? You want to make a certain list of that. Then I look at next, "What's my weakness? What am I weak in? Ultrasound? What am I weak in? Understanding anatomy?"

Just maybe review things I haven't seen in some time in this light. "What can I do to strengthen?" The idea here is to try to convert those weaknesses into strengths after you reassess and make alterations for additional courses, webinars, or sometimes develop some kind of mentor that can point you in direction to correct your weaknesses. Then I look at my opportunity, look around your practice area. Who's doing this thing that you can partner with? Who else is doing this thing in your area?

You can look at the websites for some of the practices around, see if they do that. Perhaps, like I spoke earlier, pay them a visit. Talk to them, give some grand rounds, develop personal relationships to open those opportunities up. Then, lastly, look at the threats. Is someone else doing better than we are? What we have to do to overcome that efficiency or supplies or which is more national reimbursement? What we used to do, now no longer we can't do because of reimbursement.

Another idea that I've had since then is, so instead of SWOT, S-W-O-T, it's now SWOTH. Add H to it is hunger. Hunger, I put it there because do not be complacent. You have to be open to new ideas, knowledge, and techniques in treating patients. You always want to improve your outcomes, so you have to stay hungry all the time. I go through a self-assessment every couple of months. What can I do to improve this practice and how to make it better?

In terms of what you say about some of the first cases you do, we're all familiar as radiologists, how to, with the myelogram and interpretation of it, there's a lot of new techniques that develop out there to diagnose and treat SIH. You will meet them at an ASSR meeting or ASNR meeting, but there's other dedicated headache meetings across the country that talk about that.

I think that's a good start because that's your baseline comfort zone. I think the other things you probably could start early with probably good success is occipital headache and cervicogenic headache. Those are relatively, a lot of them out there, and you can do some of that early on and get pretty good success from there.

The American Society of Spine Radiology (ASSR): Continuing Education for the Headache Interventionist

Dr. Nguyen emphasizes the importance of crosstalk within the interventional pain field, as this is where new therapies and other advancements take place. Since the COVID pandemic, the ASSR has made strides forward in interdisciplinary discourse through its programming, including contributions from anesthesiologists, neurosurgeons, interventional pain specialists, and neurological, musculoskeletal, and interventional radiologists. According to Dr. Flemming, ASSR has many specialty discussions not covered in general interventional radiology societies, including headache interventions, that can educate providers on how to better treat patients in pain.

[Dr. Dan Nguyen]
I learned so much from my surgical colleagues doing spine and neurosurgical colleagues, how they do it and the approach they do, I incorporate into my practice on the other areas of the body. My goal, one day, is with my recent opportunity from a national society perspective, is trying to have a little more crosstalk with the interventional pain, especially with the ASSR or any of the ASNR, trying to get more interventional pain integration into our programming and work through between several society to try to get a better outcome. We learn so much from each other and that's how we're going to grow as a whole. I can't agree any more with that. Dr. Narouze was one early mentor of mine trying to introduce me to this area. I really respect him.

[Dr. Jacob Flemming]
I, absolutely, agree with all that. I just have to say the ASSR meeting, I believe it was '21 during your tenure as President. That was in the midst of COVID, so things were pretty virtual. I'm sorry, it may have been 2020 or 2021, but it was a fortuitous occurrence for me because I remember I was on Twitter and I saw that the ASSR shared, "Our annual meeting is going on. It's virtual. $25 for residents."

That was the quickest and best $25 I've spent. It was an amazing meeting. I learned so much just about how many different interventions are coming out in the spine and the spine related world. I really loved the interdisciplinary nature of it. We had anesthesiologists, neurosurgeons, interventional pain specialists, and, of course, many different neuro and musculoskeletal and interventional radiologists sharing these different aspects about their practice and the cutting edge.

For me, that was a huge moment in my training, realizing that not everything interventional radiology is necessarily showing up at the more mainstream IR meetings. I tell almost everyone I know that ASSR is one of the best meetings you can go to for this area just because it's so broad. I do want to commend you. It was an excellent meeting, especially given the circumstances with COVID throwing everything out of the loop and not being able to be in New Orleans directly. I really hope to see the ASSR continue that momentum and advance this area in that interdisciplinary aspect.

[Dr. Dan Nguyen]
I'm so happy you said that because it was nerve-wracking when I could not have a meeting in New Orleans. I was waiting so long for that and I had so many great plans for that when that was pulled underneath me. I was very disappointed. Then the opportunity came at that point to make the meeting bigger. I purposely made it bigger than usual.

I want to integrate as many multidisciplinary people into that meeting. Like I said, I had Dr. Deer, Dr. Saeed from the Aspen. We had people from neurosurgical, orthopedics. It was just people that share the same passion in treating a certain body part. That was my goal. I said, "I'm going to make this bigger instead of a typical two session, I will double that."

We were able to get a lot of people into the meeting and get a very multidiscipline discussion about certain pathology other than headache and spine, but many other ways and imaging too. A lot of those colleagues told me, "Wow, I didn't realize you guys have such a society. I thought you guys would just stay in imaging." I go, "No, no. That's our strength, that's our core, but we do many other things." I'm hoping to see that this upcoming year as well.

[Dr. Jacob Flemming]
Excellent, we'll definitely look forward to that. There's no question that the future of medicine is multidisciplinary and benefiting from that cross-pollination that you've talked about. I think that it's a positive sum game for the different specialties in the world of spine to be communicating together, sharing techniques and insight. That way we can all better take care of patients.

Podcast Contributors

Dr. Dan Nguyen discusses Image-Guided Headache Interventions on the BackTable 30 Podcast

Dr. Dan Nguyen

Dr. Dan Nguyen is an interventional radiologist specializing in interventional pain management with Neuroradiology & Pain Solutions of Oklahoma.

Dr. Jacob Fleming discusses Image-Guided Headache Interventions on the BackTable 30 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Cite This Podcast

BackTable, LLC (Producer). (2023, September 6). Ep. 30 – Image-Guided Headache Interventions [Audio podcast]. Retrieved from https://www.backtable.com

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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