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Doctor returns to treating instead of teaching

May 19, 2006|by DON AINES

CHAMBERSBURG, Pa. - After a quarter of a century teaching medical students about headaches, Dr. Jeffrey R. Donat has returned to diagnosing and treating them as a member of Cumberland Valley Neurosurgical Consultants.

"This is what I can offer to the community because there are a huge number of people with headaches," Donat said recently. "My first job is always to make sure it's not an organic problem, like a brain tumor or an aneurysm," he said.

Before coming to Chambersburg last year, Donat taught neurology at the University of Saskatchewan in Canada, for 25 years.

"I got homesick for America," the native North Dakota said.

Most people are not referred to a specialist by their family physician for the garden-variety headache, but "migraines make up the single biggest group of people that need to see a neurologist," Donat said. About 20 percent of women will experience migraines at some point in their lives, he said.

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"Pain medications may actually aggravate a migraine," Donat said. Those diagnosed with migraines are now often treated with a class of drugs called tryptans that work on the brain hormone seratonin which affects blood vessels in the brain.

"They can turn off a migraine very effectively," Donat said. To reduce the frequency of migraines, medicines used to treat epilepsy are sometimes prescribed, he said.

The cause of migraines is still somewhat of a mystery, but Donat said research indicates nerve impulses cause inflammation of the blood vessels near the brain's surface. Migraine triggers can include a drop in barometric pressure, red wine and chocolate, he said.

Symptoms of the onset of a migraine can include change of mood, cravings, excess energy and an aura, he said.

"They can see flashing lights, not always, but often," he said. Effective treatment includes training patients to take medications at the first sign of a migraine.

Another type of headache commonly treated by neurologists is the tension headache, Donat said. These are not to be confused with headaches brought on by stress, he said.

"They are constant. They're always there," he said. "A lot of tension headaches are in the cranial muscles."

Physiotherapy, aerobic exercise and some types of antidepressants can be useful in treating tension headaches, he said. Exercise can release endorphins, natural hormones with a narcotic effect, he said.

Cumberland Valley Neurosurgical consultants also work with people with epilepsy and dementia, Donat said. A relatively new treatment for epilepsy is vagus nerve stimulation, where a silver dollar-size device is implanted with a wire running up the neck to the nerve.

The procedure works best "for people with intractable seizures that don't respond to medication," he said. While expensive, he said it can be cheaper in the long run than medications and hospitalization for seizures.

Dementia cases, where memory loss is severe enough to impair function, affects about 20 percent of people 80 years of age or older, Donat said. Alzheimer's disease is the most common form of the disorder.

"Treating Alzheimer's disease was inconceivable when I was a resident, but huge strides are being made," he said. "It's an exciting time to be a neurologist."

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