Scripps Clinic physician hones in on hardcore headache sufferers

Dr. Emily Rubenstein Engel is on a mission.

No one, the Scripps Clinic neurologist insists, should go through life suffering from chronic headaches, including migraines.

“So many patients come to me in despair, feeling like nothing can be done, and it’s just the furthest thing from the truth,” the Carmel Valley resident said in a recent interview. “This is a common and treatable health problem.”

Associate director of Scripp’s Dalessio Headache Center, Engel offers hope to thousands of patients she sees at her offices in Scripps Green Hospital on Torrey Pines Mesa and the clinic’s Rancho Bernardo campus.

In addition to migraines, she takes patients with cluster headaches, dizziness, vertigo and seizure disorders as well as with trigeminal and occipital neuralgia.

Many of her clients have come to her after being misdiagnosed and prescribed treatments that fail to address chronic headaches, which Engel said are usually neural rather than anatomical symptoms and do not stem from sinus conditions as commonly thought.

To emphasize her point, the title she gives to her public talks is “Everything You’ve Been Told About Headaches is Wrong.”

“The anatomy tends to confuse people including doctors,” she said. “It’s a lack of knowledge and we’re trying to raise awareness. It’s unacceptable in my opinion, because it’s so treatable.”

Common causes of migraines, she said, are diet, dietary changes, inappropriate use of painkillers, and hormonal changes, such as the pre-menopausal phase among women and testosterone loss among men in their 40s.

Many migraine patients are being treated successfully with Botox, which the U.S. Food and Drug Administration approved as a treatment for chronic headaches in 2010. Nerve-blocking medications also are prescribed in some cases.

While used for years to treat involuntary muscle contortions, Botox had the side effect of reducing skin wrinkles. Then, patients started reporting their ongoing headaches had ceased.

Engel said about 2,000 of her patients are taking the treatment, which involves regular injections, and there are no apparent negative side effects.

Being able to alleviate suffering, Engel said, is what motivated her to focus her career on patient care as she advanced through her studies and clinical assignments toward a career in neurology.

At Scripps, where she started working 15 years ago, Engel developed a fascination with the treatment and prevention of headaches.

“Early on in my career, I found headache to be a particularly interesting and fulfilling part of my practice because these patients are very treatable,” she said. “I was saddened by the fact that so many of them were suffering unnecessarily for so long.”

A native of the East Coast, she attended UCSD as an undergraduate student, followed by Hahnemann Medical College in Philadelphia, an internship and residency at UCLA, and a fellowship at UCLA Medical Center’s Harbor University.

Landing the job at Scripps was what brought Engel back to the San Diego area, while her parents now live here as well. She and her husband have 9- and 11-year-old sons attending Ocean Air Elementary School.

Among her career highlights, she was president of the San Diego Neurology Society from 2010 to 2012.

What she likes best about her vocation is being able to help people.

“I feel really lucky I’m in a field with a disease that’s treatable,” she said.