Building an Interventional Headache Practice: Expert Recommendations

[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.

[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.