HMFP Comprehensive Headache Center Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Instructor in
|
|
- Augustus Mills
- 6 years ago
- Views:
Transcription
1
2 HMFP Comprehensive Headache Center Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Instructor in Anesthesia and Neurology Harvard Medical School
3 Limited time to cover a huge amount of material A high-speed approach to clinical headache management Not a presentation of the latest research Will cover principles and treatment options Patient education is the most valuable treatment modality Flexibility is essential
4 Anxiety, depression, bipolar disorder, borderline personality disorder Stress is a consistent/common headache trigger 1) Psychotherapy/cognitive behavioral therapy 2) Biofeedback 3) Yoga/meditation 4) Exercise 5) Pain psychology
5 3 months or longer of taking acute medication more than twice a week 1) Limit acute medication use to no more than twice a week (identify an appropriate alternative) 2) Begin headache prevention 3) Taper the overused medication (washout can take several months)
6 1) Consistent sleep schedule (treat insomnia) 2) Regular meals with healthy snacks 3) Limit caffeine use 4) Stress management 5) Obesity
7
8 Prevention indicated if a patient is experiencing two or more headaches a week Be aware of medication failures (inadequate treatment trials) Headache prevention can take 2-3 months to work and doses must be adequate Titrate dose slowly Combination therapy
9 Standard of therapy for many chronic medical conditions (diabetes, hypertension, HIV) Targets multiple pathophysiologic mechanisms Can address comorbidities such as depression, anxiety, bipolar disorder, insomnia Use non-pharmacologic methods as well
10 Beta-blocker plus TCA (depression and insomnia) Beta-blocker plus SNRI (depression and fibromyalgia) Beta-blocker plus topiramate (obesity) Topiramate plus tizanidine (insomnia) Personal preference
11 1) Topiramate: dose 50 mg bid. SE s include paresthesias, decreased appetite, cognitive dysfunction, kidney stones. Teratogenic (D) and can interfere with birth control. Especially useful in chronic migraine. FDA approved for episodic migraine. 2) Tizanidine: dose 6-8 mg/bedtime. SE s include sedation, rare transaminitis, nightmares. 3) Verapamil: dose 360 mg/day. SE s include hypotension, edema, constipation.
12 4) Valproate: dose 1,000 mg daily. SE s include gastric distress, hair loss, weight gain, tremor, rare transaminitis. Teratogenic (X for migraine prophylaxis, D for other indications). Effective in chronic daily headache. FDA approved for episodic migraine. 5) Amitriptyline: dose mg/bedtime. SE s include sedation, dry mouth, weight gain.
13 6) Propranolol: dose mg/d. SE s include hypotension, exercise intolerance, fatigue, depression. Contraindicated in asthma. FDA approved for episodic migraine. 7) Botulinum toxin Type A: dose 155 units every three months. Well-tolerated. Often used in combination therapy. FDA approved for chronic migraine. Insurance approval can be problematic. 8) Gabapentin: dose mg/d. Few side effects/drug interactions.
14 9) Pericranial nerve blocks. 10) Nutraceuticals (nutrition/pharmaceutical) 1) Riboflavin (Vitamin B2): dose 400 mg/d. 2) Magnesium (citrate): dose 600 mg/d.
15
16 Acute treatment should be kept to no more than twice a week Treat early Tailor treatment: injectable therapy for rapid onset headaches; intranasal, injectable, or rectal routes for headache with severe nausea/vomiting Consider combinations: Triptan plus NSAID, Triptan plus antiemetic, combination of all three
17 It may not be possible to completely abort every headache (functionality) Less convenient but more effective nonoral medications may be necessary (nonoral formulations are generally more effective)
18 1) NSAIDs: ibuprofen ( mg), naproxen sodium ( mg), flurbiprofen (100 mg), ketoprofen (50 mg), indomethacin (25-50 mg oral, 50 mg suppository). SE s include gastrointestinal bleeding, nausea, abdominal pain, renal disease, heart attack, and stroke. 2) Dihydroergotamine: intravenous, intramuscular, subcutaneous: mg at headache onset; intranasal: 0.5 mg in each nostril, repeat in 15 minutes. Useful if combined with an NSAID or antiemetic. SE s include nausea, vomiting, muscle cramping.
19 3) Triptans: sumatriptan (oral, nasal spray, injection, transdermal), zolmitriptan (oral, nasal spray), rizatriptan (oral), naratriptan, frovatriptan, eletriptan, almotriptan (oral). SE s include chest discomfort and dizziness. Can combine with an NSAID. Contraindicated in patients with known cardiac disease, uncontrolled hypertension, and pregnancy. Insurance limitations. Serotonin syndrome.
20 4) Dopamine antagonists: a) prochlorperazine 5-10 mg po tid or 25 mg rectally; sedation and akathisia; b) metoclopramide 5-10 mg po tid, less sedating and well-tolerated; c) promethazine mg po or rectally tid; sedation. Keep use to twice a week or less to prevent dystonia and dyskinesia. 5) Corticosteroids: useful for prolonged or severe headaches. Decadron 4 mg tid for 2-3 days, prednisone taper. Limit use to every three months.
21 6) Opioids: Controversial and very limited use for headache. Strict parameters when used in patients with true contraindications to appropriate therapy. Can be used in pregnancy. 7) Butalbital combination products: Avoid, please. Or use with strict limitations, if at all. 8) Acetaminophen: useful when combined with an antiemetic. Safe in pregnancy.
22 Diphenhydramine/hydroxyzine Dopamine antagonists Intranasal lidocaine Intravenous magnesium sulfate Occipital nerve blocks
23
Goals. Primary Headache Syndromes. One-Year Prevalence of Common Headache Disorders
Goals One-Year Prevalence of Common Headache Disorders Impact of primary headache syndromes Non pharmacologic Rx of migraine individualized to patient triggers Complementary and alternative Rx of migraine
More informationHow do we treat migraine? New SIGN Guidelines
How do we treat migraine? New SIGN Guidelines Managing your migraine Migraine Trust, Edinburgh 2018 Callum Duncan Consultant Neurologist Aberdeen Royal Infirmary Chair SIGN Guideline 155 Premonitory Mood
More informationTreatments for migraine
Treatments for migraine Information for patients and carers Department of Neurology Aberdeen Royal Infirmary Contents Page About this leaflet Abortive medication for migraine Painkillers Antisickness medication
More informationManagement of headache
Management of headache TJ Steiner Imperial College London Based on European principles of management of common headache disorders TJ Steiner, K Paemeleire, R Jensen, D Valade, L Savi, MJA Lainez, H-C Diener,
More informationMIGRAINE UPDATE. Objectives & Disclosures. Learn techniques used to diagnose headaches. Become familiar with medications used for headache treatment.
MIGRAINE UPDATE Karen L. Bremer, MD November 16, 2018 Objectives & Disclosures Learn techniques used to diagnose headaches. Become familiar with medications used for headache treatment. Disclosure: I am
More informationStrategies in Migraine Care
Strategies in Migraine Care Julie L. Roth, MD Rhode Island Hospital Assistant Professor, Neurology The Warren Alpert Medical School of Brown University March 28, 2015 Financial Disclosures None. Objectives
More informationCOMBINATION THERAPIES PREVENTATIVE THERAPIES BETA BLOCKERS
ACUTE THEAPIES TIPTANS TICYCLIC ANTIDEPESSANTS When starting acute treatment, healthcare professionals should warn patients about the risk of developing medication-overuse headache. ASPIIN Aspirin (900
More informationTreatment of Primary Headache Syndromes
Presenter Disclosure Information 2:45 3:45pm Treatment of Primary Headache Syndromes SPEAKER Gerald W. Smetana, MD The following relationships exist related to this presentation: Gerald W.Smetana, MD,
More informationÇiçek Wöber-Bingöl HEADACHE UNIT FOR CHILDREN AND ADOLESCENCE
Headache in children and adolescents Çiçek Wöber-Bingöl HEADACHE UNIT FOR CHILDREN AND ADOLESCENCE Dept. of Psychiatry of Childhood and Adolescence Medical University of Vienna, Vienna, Austria Impact
More informationADVANCES IN MIGRAINE MANAGEMENT
ADVANCES IN MIGRAINE MANAGEMENT Joanna Girard Katzman, M.D.MSPH Assistant Professor, Dept. of Neurology Project ECHO, Chronic Pain Program University of New Mexico Outline Migraine throughout the decades
More informationFaculty Disclosures. Learning Objectives. Acute Treatment Strategies
WWW.AMERICANHEADACHESOCIETY.ORG Acute Treatment Strategies Content developed by: Lawrence C. Newman, MD, FAHS Donna Gutterman, PharmD Faculty Disclosures LAWRENCE C. NEWMAN, MD, FAHS Dr. Newman has received
More informationShort Clinical Guidelines: Headache, Key Points for Diagnosis and Treatment
Clinical Highlights 1. Headache is diagnosed by history and physical examination with limited need for imaging or laboratory tests. 2. Warning signs of possible disorder other than primary headache are:
More informationIndex. Prim Care Clin Office Pract 31 (2004) Note: Page numbers of article titles are in boldface type.
Prim Care Clin Office Pract 31 (2004) 441 447 Index Note: Page numbers of article titles are in boldface type. A Abscess, brain, headache in, 388 Acetaminophen for migraine, 406 407 headache from, 369
More informationDisclosures. Triptans for Kids 5/16/13
5/16/13 Disclosures Triptans for Kids Amy A. Gelfand, MD GelfandA@neuropeds.ucsf.edu Departments of Neurology and Pediatrics UCSF Child Neurology and Headache Center I receive grant funding from: NIH/NINDS
More informationPrevention and Treatment of Migraines CAITLIN BARNES, PHARM.D. CANDIDATE AMBULATORY CARE JOE CAMMILLERI, PHARM.D. NATOHYA MALLORY, PHARM.D.
Prevention and Treatment of Migraines CAITLIN BARNES, PHARM.D. CANDIDATE AMBULATORY CARE JOE CAMMILLERI, PHARM.D. NATOHYA MALLORY, PHARM.D. Objectives Present patient case Review epidemiology/pathophysiology
More informationManagement options for Migraine. Prof. Dr. Khwaja Nazimuddin Head Dept. of Internal Medicine BIRDEM
Management options for Migraine Prof. Dr. Khwaja Nazimuddin Head Dept. of Internal Medicine BIRDEM Assessment The Migraine Disability Assessment Score MIDAS Complete loss of work Partial loss of work Off
More informationUpdate on Diagnosis and Management of Migraines
Update on Diagnosis and Management of Migraines Joel J. Heidelbaugh, MD, FAAFP, FACG Clinical Professor Departments of Family Medicine and Urology University of Michigan Learning Objectives To distinguish
More informationFaculty Disclosure. Karen L. Bremer, MD. Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest.
Faculty Disclosure Karen L. Bremer, MD Dr. Bremer has listed no financial interest/arrangement that would be considered a conflict of interest. HEADACHE UPDATE Karen L. Bremer, MD November 10, 2017 karen.bremer@creighton.edu
More informationHeadache A Practical Approach
Headache A Practical Approach Integrated Pain Symposium December 1, 2017 Alyssa Lettich. MD Neurosciences Institute/Neurosciences Clinical Program Medical Director Headache and Pain Development Teams Disclosures:
More information10/13/17. Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD
Christy M. Jackson, MD Director, Dalessio Headache Center Scripps Clinic, La Jolla Clinical Professor, Neurosciences UCSD } Depomed Consultant 2014 to present } Avanir Consultant 2014 to present } Amgen
More informationDubai Standards of Care (Migraine)
Dubai Standards of Care 2018 (Migraine) Preface Migraine is one of the most common problem dealt with in daily practice. In Dubai, the management of migraine is done through various different strategies.
More informationClinical Learning Days November 10, 2017
Migraine Clinical Learning Days November 10, 2017 Alyssa Lettich. MD Neurosciences Institute/Neurosciences Clinical Program Medical Director Headache Disclosures: none Learning Objectives: At the conclusion
More informationAdult & Pediatric Patients. Stanford Health Care, Division Pain Medicine
Acute Treatment Strategies in Adult & Pediatric Patients Theresa Mallick Searle, MS, RN BC, ANP BC Disclosures Speakers Bureau: Allergan, Depomed Acute Treatment Strategies in Adult & Pediatric Patients
More informationSIGN on the pharmacological management of migraine
GUIDELINES SIGN on the pharmacological management of migraine STEVE CHAPLIN In February 2018, the Scottish Intercollegiate Guidelines Network (SIGN) published a new guideline on the pharmacological management
More informationปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา
ปวดศ รษะมา 5 ป ก นยาแก ปวดก ย งไม ข น นพ.พาว ฒ เมฆว ช ย โรงพยาบาลนครราชส มา 1 CONTENT 1 2 3 Chronic Daily Headache Medical Overused Headache Management Headaches are one of the most common symptoms List
More informationOH, MY ACHING HEAD! I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE MANAGING HEADACHE IN THE OUTPATIENT SETTING SECONDARY HEADACHES
1 JUSTIN A. OSSMAN, MD CHATTANOOGA FAMILY MEDICINE UPDATE OH, MY ACHING HEAD! MANAGING HEADACHE IN THE OUTPATIENT SETTING 2 I HAVE NO DISCLOSURES OR CONFLICTS OF INTERESTS TO DECLARE OBJECTIVES International
More informationMigraine Management. Jane Melling Headache nurse Mater Misericordiae Hospital
Migraine Management Jane Melling Headache nurse Mater Misericordiae Hospital Migraine facts Among the most common disorders of the nervous system 3 rd most prevalent medical disorder on the planet (lancet
More informationHeadache Questionnaire
Date: All Headache Patients We would appreciate your cooperation in filling out this form. In our evaluation of headache, your history is typically our most valuable tool for diagnosis and subsequent treatment.
More informationPage: 1 of 6. Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm) injection, Emgality (galcanezumab-gnim)
Page: 1 of 6 Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Last Review Date: November 30, 2018 Description Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm)
More informationTABLE 1. Current Diagnostic Criteria for Migraine Without Aura 2 A. At least 5 attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours
ANSWERS CONCISE TO FREQUENTLY REVIEW ASKED QUESTIONS FOR CLINICIANS ABOUT MIGRAINE Answers to Frequently Asked Questions About Migraine IVAN GARZA, MD, AND JERRY W. SWANSON, MD Migraine is a common primary
More informationPreventive treatment of migraine. Rebecca Burch, MD Brigham and Women s Faulkner Hospital Harvard Medical School Boston, MA
Preventive treatment of migraine Rebecca Burch, MD Brigham and Women s Faulkner Hospital Harvard Medical School Boston, MA No disclosures Disclosures Many preventive treatments for migraine are not FDA-approved
More informationMedication For Migraine Chart: Table 1: Acute Treatment when the attack begins
Medication For Migraine Chart: Table 1: Acute Treatment when the attack begins Page a Analgesics (painkillers) Non-steroidal antiinflammatory drugs (NSAIDs) Prescription required Brand Name Formulation
More informationCase Presentation. Case Presentation. Case Presentation. Truths about Headaches (2017) Most headaches were muscle-tension headaches
Agenda Case presentation Migraine Morphology Primary and Premonitory Phase Secondary Headache Aura Headache Primer on Pain Medication Overuse Headache Case Presentation RT is a 25 year old woman with daily
More informationONZETRA XSAIL (sumatriptan) nasal powder
ONZETRA XSAIL (sumatriptan) nasal powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationWhat You Should Know About Your HEADACHE. Learn more about headache types, triggers, and treatments, when to get help, and how to help yourself
What You Should Know About Your HEADACHE Learn more about headache types, triggers, and treatments, when to get help, and how to help yourself Introduction The purpose of this brochure is to give you a
More informationMEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache
MEASURE #3: PREVENTIVE MIGRAINE MEDICATION PRESCRIBED Headache Measure Description Percentage of patients age 18 years old and older diagnosed with migraine headache whose migraine frequency is 4 migraine
More informationMigraine Acute treatment
Migraine Acute treatment Elizabeth Loder, MD, MPH Professor of Neurology, Harvard Medical School Chief, Division of Headache, Department of Neurology, Brigham and Women s Hospital, Boston, MA Disclosures
More informationVestibular Migraine. Information for patients and carers. Department of Neurology and Otolaryngology Aberdeen Royal Infirmary
Vestibular Migraine Information for patients and carers Department of Neurology and Otolaryngology Aberdeen Royal Infirmary What is vestibular migraine? Migraine is a disabling headache disorder that affects
More informationI have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation.
I have no financial relationships to disclose. I will not discuss investigational use of medication in my presentation. In 1962, Bille published landmark epidemiologic survey of headache among 9,000 school
More informationCurrent Migraine Treatment Therapy. Daniel Kassicieh, DO, FAAN
Current Migraine Treatment Therapy Daniel Kassicieh, DO, FAAN Migraine a Disease Process Migraines are a chronic disease process similar to many other chronic medical conditions Migraine has a low mortality
More informationNon-opioid and adjuvant pain management
Non-opioid and adjuvant pain management ALLISON JORDAN, MD, HMDC MEDICAL DIRECTOR OF PALLIATIVE CARE SERVICES CHRISTIAN AND ALTON MEMORIAL HOSPITALS ASSOCIATE MEDICAL DIRECTOR, BJC HOSPICE ASSISTANT PROFESSOR
More informationAcute Migraine Treatment in Adults
PL Detail-Document #301104 This PL Detail-Document gives subscribers additional insight related the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER November 2014 Acute Migraine Treatment
More informationMigraine in Children. Germano Falcao, MD Pediatric Neurology 03/07/2014
Migraine in Children Germano Falcao, MD Pediatric Neurology 03/07/2014 Headaches in Children One of the most common concerns reported by children 3% for children age 3-7 years 4-11% for children age 7-11
More informationAbortive Agents. Available Strengths. Formulary Limits. Tablet: 5mg, 10mg ODT: 5mg, 10 mg 25mg, 50mg, 100mg. 5mg/act, 20mg/act
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Migraine Therapy P&T DATE: 9/12/2017 CLASS: Neurological Disorders REVIEW HISTORY 12/16, 9/15, 2/15, 2/10, 5/07 LOB: MCL
More informationAcute Migraine Treatment: What you and your family should know to help you make the best choices with your doctor
Acute Migraine Treatment: What you and your family should know to help you make the best choices with your doctor TAKE CONTROL OF YOUR MIGRAINES! ABOUT THIS PATIENT GUIDE: Migraine attacks are often debilitating
More informationMaternity. Migraine in pregnancy Information for women
Maternity Migraine in pregnancy Information for women You have been given this leaflet as you have a diagnosis of migraines. It contains advice to help you manage your migraines safely during your pregnancy.
More informationSUMAVEL DOSEPRO (sumatriptan succinate) solution for injection
SUMAVEL DOSEPRO (sumatriptan succinate) solution for injection Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit
More informationMEASURE #1: MEDICATION PRESCRIBED FOR ACUTE MIGRAINE ATTACK Headache
MEASURE #1: MEDICATION PRESCRIBED FOR ACUTE MIGRAINE ATTACK Headache Measure Description Percentage of patients age 12 years and older with a diagnosis of migraine who were prescribed a guideline recommended
More informationHeadaches in Pregnancy Before, During, and After
Headaches in Pregnancy Before, During, and After Robert Kaniecki, MD Director, UPMC Headache Center Assistant Professor of Neurology University of Pittsburgh Headaches and Pregnancy Pre-pregnancy counseling
More informationDisclosures. Objectives 6/20/2018. No disclosures. Tools & Tips for Headache Management in Special Populations: The Young & Old, Pregnant & Lactating
Tools & Tips for Headache Management in Special Populations: The Young & Old, Pregnant & Lactating Lauren Doyle Strauss, DO, FAHS Child Neurology Residency Director @StraussHeadache No disclosures Disclosures
More informationOpioids Limitation For Quantity and Dosage
Opioids Limitation For Quantity and Dosage Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationCOLUMBIA UNIVERSITY HEADACHE CENTER: NEW PATIENT QUESTIONNAIRE
COLUMBIA UNIVERSITY HEADACHE CENTER: NEW PATIENT QUESTIONNAIRE HEADACHE CHARACTERISTICS Frequency and Severity 1. At what AGE did you get your first headache, of ANY kind? 2. At what AGE did your headaches
More informationWhat is new in the migraine world! Modar Khalil Consultant neurologist Hull Royal Infirmary
What is new in the migraine world! Modar Khalil Consultant neurologist Hull Royal Infirmary Overview Understanding the burden Commonly used terms Acute therapy What we currently have What we are going
More informationThe best defense is a good offense. Optimizing the Acute Treatment of Migraine. Disclosures 11/10/2017
Optimizing the Acute Treatment of Migraine Brian M. Plato, DO, FAHS Norton Neuroscience Institute Louisville, KY Disclosures Speakers Bureau (personal): Allergan, Depomed, Avanir Research Funding (paid
More informationConcussion. James R. Borchers, MD, MPH
Concussion James R. Borchers, MD, MPH Associate Clinical Professor Director, Division of Sports Medicine, Department of Family Medicine Head Team Physician, Athletic Department Jameson Crane Sports Medicine
More informationTriptans Quantity Limit Program Summary
Triptans Quantity Limit Program Summary FDA APPROVED INDICATIONS AND DOSAGE 1-13,14,23,24 Agents Amerge (naratriptan) 1, 2.5 tablets Axert (almotriptan) 6.25, 12.5 tablets migraine attacks with/without
More informationSUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP)
9 SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF CHRONIC NON-TERMINAL PAIN (CNTP) SUMMARY OF ARIZONA OPIOID PRESCRIBING GUIDELINES FOR THE TREATMENT OF ACUTE PAIN NONOPIOID TREATMENTS
More informationAnti-Migraine Agents
DRUG POLICY BENEFIT APPLICATION Anti-Migraine Agents Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions
More informationHeadaches: An Approach to Evaluation & Management
Florida Osteopathic Medical Association 17 th Annual Primary Care & Cardiovascular Symposium Headaches: An Approach to Evaluation & Management Kenneth Hentschel, DO, PhD, FAANEM St. Vincent s Spine & Brain
More informationGet ahead of the ACHE: Monoclonal Antibodies in Migraine Prevention
Get ahead of the ACHE: Monoclonal Antibodies in Migraine Prevention Amanda Janisch, PharmD PGY2 Ambulatory Care Pharmacy Resident MCHS SWMN, Mankato, MN 2018 MFMER slide-1 Disclosures No financial interest
More informationIshaq Abu Arafeh Consultant Paediatrician Royal Hospital for Children, Glasgow Forth Valley Royal Hospital, Larbert
Ishaq Abu Arafeh Consultant Paediatrician Royal Hospital for Children, Glasgow Forth Valley Royal Hospital, Larbert Childhood headache: Is it really difficult to manage? It shouldn t be... But it can be...
More information10/17/2017 CHRONIC MIGRAINES BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES PATIENT CASE EPIDEMIOLOGY EPIDEMIOLOGY
BOTOX: TO INJECT OR NOT INJECT? IN CHRONIC MIGRAINE PROPHYLAXIS OBJECTIVES JENNIFER SHIN, PHARMD PGY2 AMBULATORY CARE PHARMACY RESIDENT COMMUNITYCARE HEALTH CENTERS PHARMACOTHERAPY ROUNDS OCTOBER 20, 2017
More informationControlling Migraine Pain
Migraine Stats Controlling Migraine Pain Alan Zacharias, M.D. Associated Neurologists, Boulder Community Health 303-622-3365 Women 15% Men 5% Usually starts in 2 nd and 3 rd Decade Major Impact on days
More informationMy patient s pain in the head, is a pain in Greg Jicha, M.D., Ph.D.
My patient s pain in the head, is a pain in the @%$*&# Greg Jicha, M.D., Ph.D. Kentucky Neurologic Institute University of Kentucky, Lexington, KY Migraine is More Common than Asthma & Diabetes Combined
More informationKnock Out Opioid Abuse in New Jersey:
Knock Out Opioid Abuse in New Jersey: A Resource for Safer Prescribing GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN IMPROVING PRACTICE THROUGH RECOMMENDATIONS CDC s Guideline for Prescribing Opioids
More informationUnderstanding Migraines and Treatment Options. Simplified Diagnosis of Migraine. Migraine Prevalence American Migraine Study II
Understanding Migraines and Treatment Options Deborah C. Zajac, RN-BC Center for Headache and Pain Neurological Institute Cleveland Clinic Simplified Diagnosis of Migraine Any person with a stable pattern
More informationHeadache. Section 1. Migraine headache. Clinical presentation
Section 1 Headache Migraine headache 1 Clinical presentation It is important to recognize just how significant a problem migraine headache is. It has been estimated that migraine affects 11% of the United
More informationReflections on NICE Headache Guideline. Dr Kay Kennis GPwSI in Headache, Bradford
Reflections on NICE Headache Guideline Dr Kay Kennis GPwSI in Headache, Bradford Overview The process of guideline development illustrated with the headache guideline Reflections on the process Key recommendations
More informationHeadaches in the Pediatric Emergency Dept
Headaches in Children February 23, 2011 Jinny Tavee, MD Associate Professor Neuromuscular Center Cleveland Clinic Foundation Cleveland, OH 1 Headaches in the Pediatric Emergency Dept Burton Gutierrez Kan
More informationHeadache evaluation and management after concussion. Assistant Professor
Headache evaluation and management after concussion Juliette Preston, M.D. Assistant Professor OHSU Headache Center OVERVIEW Introduction Definition Acute post-traumatic headache Red flags Persistent post-traumatic
More informationHow could I be having migraine when I don't have a headache?
Migraine Your doctor thinks you may have migraine. Classic migraine attacks start with visual symptoms (often zig-zag colored lights or flashes of light expanding to one side over 10-30 minutes) followed
More informationM0BCore Safety Profile. Pharmaceutical form(s)/strength: ordispersible tablet SE/H/PSUR/0022/002 Date of FAR:
M0BCore Safety Profile Active substance: Zolmitriptan Pharmaceutical form(s)/strength: ordispersible tablet P-RMS: SE/H/PSUR/0022/002 Date of FAR: 15.03.2014 4.3 Contraindications Zolmitriptan is contraindicated
More informationHeadache. Headache Case. Migraine Headache. Eric Kraus, MD. Types» Without aura (common)» With aura (classic)
Headache Eric Kraus, MD Headache Case This 23 year-old female has headaches behind the right eye that cause her to lay down in a quiet room. They have a throbbing quality and she may vomit. Migraine Headache
More informationISSN doi: /head VC 2015 American Headache Society Published by Wiley Periodicals, Inc.
ISSN 0017-8748 Headache doi: 10.1111/head.12746 VC 2015 American Headache Society Published by Wiley Periodicals, Inc. Review Article Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic
More informationTriptan Quantity Limit
*- Florida Healthy Kids Triptan Quantity Limit Override(s) Quantity Limit Approval Duration 1 year Oral Tablets Axert (almotriptan) tablets Relpax (eletriptan) tablets 6 tablets (6.25 mg) 12 tablets (12.5
More informationMigraine is a primary headache disorder ... REPORTS... Migraine: Diagnosis, Management, and New Treatment Options
... REPORTS... Migraine: Diagnosis, Management, and New Treatment Options R. Michael Gallagher, DO; and F. Michael Cutrer, MD Abstract Objective: The safety and tolerability of medications used to treat
More informationAdolescent Alcohol & Drug Use: Epidemiology, Prevention, Early Intervention, & Treatment
Recording Handout Original Broadcast Friday, October 12, 2018 12:30 to 1:30 (acific) Adolescent Alcohol & Drug Use: Epidemiology, revention, Early Intervention, & Treatment Featuring: Stacy Sterling, DrH,
More informationAntidepressant Pharmacology An Overview
Figure 1. Antidepressant Pharmacology An Overview Source: NEJM 2005;353:1819-34 Figure 2. 1 Figure 3: Antidepressant Pharmacology pictures: Weak inhibition Bupropion NOTE: CYP enzymes noted are those inhibited
More informationHeadache: A case-based approach
Headache: A case-based approach Rebecca Burch, MD John R. Graham Headache Center Department of Neurology Brigham and Women s Faulkner Hospital Harvard Medical School Boston, MA Disclosure of Financial
More informationA synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline. Scottish intercollegiate Guidelines Network SIGN
A synopsis of: Diagnosis and Management of Headaches in Adults: A national clinical guideline Scottish intercollegiate Guidelines Network SIGN November 2008. PETER FRAMPTON MSc MCOptom BAppSc (Optom)(AUS)
More informationSIGN 155 Pharmacological management of migraine. A national clinical guideline February Evidence
SIGN 155 Pharmacological management of migraine A national clinical guideline February 2018 Evidence KEY TO EVIDENCE STATEMENTS AND ECOMMENDATIONS LEVELS OF EVIDENCE High-quality meta-analyses, systematic
More informationThe Pediatric Headache Handbook
The Pediatric Headache Handbook For the Primary Care Physician Brought to you by the Division of Pediatric Neurology cardinalglennon.com Classification of headache patterns in children Acute onset of worst
More informationCYCLIC VOMITING SYNDROME. C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis
CYCLIC VOMITING SYNDROME C. Prakash Gyawali, MD Professor of Medicine Washington University in St. Louis Case 26 year old male Symptoms began at age 19 yr 5-6 day episodes of recurrent, severe vomiting
More information10/31/2017 PRIMARY CARE AND HEADACHE DISCLOSURES WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Primary Care 67%
PRIMARY CARE AND HEADACHE Sonja Potrebic MD PhD Regional Headache Specialist Kaiser LAMC 1 WHERE DO THOSE WITH HEADACHE SEEK MEDICAL CARE? Column1 Primary Care 67% Primary Care Headache Specialty Other
More informationLost in Translation: Making Sense of Clinical Treatment Guidelines
Lost in Translation: Making Sense of Clinical Treatment Guidelines Charles E. Argoff, MD, CPE Disclosures: Charles Argoff Financial Disclosure: Consultant: Teva, Daiichi Sakyo, Pfizer, Nektar, Purdue,
More informationHeadaches in Children and Adolescents. Paul Shillito
Headaches in Children and Adolescents Paul Shillito Topics For Discussion What s different about childhood migraine Chronic daily headache (CDH) Tumours and other things to worry about Management of childhood
More informationTools & Tips for Headache Management in Special populations: The Young & Old, Pregnant & Lactating, and those with Heart or Kidney Disease
Tools & Tips for Headache Management in Special populations: The Young & Old, Pregnant & Lactating, and those with Heart or Kidney Disease Lauren Doyle Strauss, DO Wake Forest Baptist Medical Center lstrauss@wakehealth.edu
More informationVenlafaxine hydrochloride extended-release and other antidepressant medicines may cause serious side effects, including:
Medication Guide VENLAFAXINE XR (venlafaxine hydrochloride) (Extended-Release Capsules) Read the Medication Guide that comes with venlafaxine hydrochloride extended-release before you start taking it and
More informationABORTIVE AGENTS. Average cost per 30 days. Form Limits SEROTONIN AGONISTS $ $ Reserved for treatment failure to either Sumatriptan PA; QL
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Migraine Therapy P&T DATE: 12/11/2018 CLASS: Neurological Disorders REVIEW HISTORY 9/17, 12/16, 9/15, 2/15, 2/10, LOB: MCL
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
CGRP Page 1 of 8 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: CGRP (calcitonin gene-related peptide) Prime Therapeutics will review Prior Authorization requests
More informationMIGRAINE A MYSTERY HEADACHE
MIGRAINE A MYSTERY HEADACHE The migraine is a chronic neurological disease that is characterized by moderate to severe episodes of headache that is mostly associated with other central nervous system (CNS)
More information10/19/2018. Disclosures MIGRAINE PROPHYLAXIS. Objectives. Definitions Slide. What do you think the aooe stands for at the end of erenumab-aooe?
Disclosures MIGRAINE PROPHYLAXIS Erenumab-aooe (AIMOVIG TM ) Calcitonin Gene Related Peptide Receptor Antagonist No conflicts of interest to disclose Chelsey Roscoe, PharmD PGY1 Resident - CTVHCS 2 3 Definitions
More informationErgotamine/Dihydroergotamine Products
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
More informationIncidence, prevention and treatment of migraine
International Journal of Community Medicine and Public Health Alsaaid M et al. Int J Community Med Public Health. 2018 Nov;5(11):xxx-xxx http://www.ijcmph.com pissn 2394-6032 eissn 2394-6040 Review Article
More informationCurrent practice and future directions in the prevention and acute management of migraine
Current practice and future directions in the prevention and acute management of migraine Peter J Goadsby, Till Sprenger Migraine is a common and disabling brain disorder with a strong inherited component.
More informationOutpatient Headache Care Guideline
1 Outpatient Care Guideline Inclusion criteria: children > 3 yrs with headaches Is urgent emergency department, neuroimaging, or Neurology consultation indicated? Referral to ED if: New severe headache
More informationGI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics. Dr. Alia Shatanawi
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics Dr. Alia Shatanawi 11-04-2018 Drugs used in Irritable Bowel Syndrome Idiopathic, chronic, relapsing disorder characterized by abdominal discomfort
More informationUnderstanding. Migraine. Amy, diagnosed in 1989, with her family.
Understanding Migraine Amy, diagnosed in 1989, with her family. What Is a Migraine? A migraine is a recurring moderate to severe headache. The pain usually occurs on one side of the head. It is typically
More informationLong-Term Care Updates
Long-Term Care Updates September 2017 By Lindsay Slowiczek, PharmD Migraines are often considered to be a condition affecting younger or middle-aged patients, during which patients experience episodic,
More information1. On how many days in the last 3 months did you miss work or school because of your headaches?
The Migraine Disability Assessment Test The MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches have on your life. The information on this
More information