Jessica Ailani MD FAHS Director, Georgetown Headache Center Associate Professor Neurology Medstar Georgetown University Hospital
|
|
- Reginald Bond
- 5 years ago
- Views:
Transcription
1 Jessica Ailani MD FAHS Director, Georgetown Headache Center Associate Professor Neurology Medstar Georgetown University Hospital
2 Honorarium from Current Pain and Headache Reports; Section Editor Unusual Headache Syndromes Honorarium for Speaking from Allergan and Avanir
3 Relate how hormones can play a role in migraine Evaluate patients with migraine related to hormones and diagnose menstrual migraine vs. menstrual related migraine Apply evidence when choosing treatment options for menstrual migraine Evaluate the use of oral contraceptives in patients with migraine
4 Women s health concern 3 month prevalence 19.1% 1 28 million women in the US have migraine 2 1 in 4 will experience a migraine in their lifetime 2 Triggered by Hormones 60% of woman with migraine report association with menses [range between 3-76%] 3,4 Migraine risk is greatest between day -2 to day +3 4 Twofold increase risk of migraine on 1 st 3 days of bleeding compared to rest of cycle 4 1. Burch R, et al. The prevalence and burden of migraine and severe headache in the United States: updated statistics from government health surveillance studies. Headache 2015;55: Pavlock JM, et al. Burden of migraine related to menses: results from the AMPP study. Journal of Headache and Pain 2015;16:24 4.MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
5 Menstrual migraine can be more severe and difficult to treat 1 Higher burden and impact on functioning compared to non-menstrual migraine 1 Longer duration migraine 2 More frequently with severe nausea 2 Menses can be a trigger for migraine without aura, but not usually migraine with aura 3 1.Pavlock JM, et al. Burden of migraine related to menses: results from the AMPP study. Journal of Headache and Pain 2015;16:24 2.Vetvik KG et al. Are menstrual and non menstrual migraines attacks different? Curr Pain Headache Rep 12: MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
6 Puberty: Average age in girls, lasting up to 4 years Increase in sex steroids Menarche: Average age Menopause: Average age 51 Hormones can fluctuate for 4-5 more years Can be precipitated by several years of hormonal fluctuation (Peri menopause) MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
7 Three phases in 2 cycles Ovarian cycle Follicular phase- gradual rise in estrogen Ovulation- peak in estrogen prior Luteal phase- fall in estrogen Fall in estrogen in late luteal phase may trigger migraine Prostaglandins may play a role in menstrual migraine- increase threefold in luteal phase Uterine cycle Menses- sudden drop in estrogen prior Prostaglandins increase in the first 48 hours of menses Proliferative phase Secretory phase MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
8
9 24 yo woman presents with headaches related to menses. She notes every month she gets a headache the day prior to her period. The headache is throbbing over her left temple and into her eye. Pain is severe with nausea, light sensitivity and trouble concentrating. She will occasionally vomit. She is usually bedridden the first day. Headache dulls with ibuprofen, but does not resolve, and can last for 3 days. She misses 1 day of work per month due to headache.
10 What is the diagnosis? What should we ask her to do to confirm the diagnosis? What should we advise her?
11 Headache only with menses Are menses predictable? Is headache onset predictable? Keep a calendar for 3 months to confirm headache with every menses People can under or overemphasis link to menses Want to document start of migraine is consistent with each or most cycles Important to ask about current and prior OCP use Important to ask about other medical conditions to help guide your treatment plan GI/CV/Renal disease Confirm aura or no aura
12 Attacks in a menstruating woman fulfilling criteria for migraine without aura Documented and prospectively recorded evidence over at least 3 consecutive cycles has confirmed that attacks occur exclusively on days -2 to +3 of menstruation in at least 2 of the 3 menstrual cycles and at no other times of the cycle Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3 rd edition (Beta).
13 At least five attacks fulfilling criteria B-D Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated) Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia Not better accounted for by another ICHD-3 diagnosis. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3 rd edition (Beta).
14 Mini prevention Treating daily prior to start of symptoms and for some time after migraine resolves [Not for entire month] Can be done with NSAIDS or Triptans or Hormones Keeping calendar, regular and predictable menses, good response to the medication that will be used as preventive
15 Naproxen 550mg BID starting 7 days prior to menses to day 6 of menses 1 Only NSAID with strong evidence 2 Small study with nimesulide 100mg TID for 10 days during menses 3 Other NSAIDS can be tried Avoid with GI/Renal/CV disease Monitor for possible development of medication overuse Less likely with NSAIDS 4 1.Sances et al. Naproxen Sodium in Menstrual Migraine Prophylaxis: A Double-Blind Placebo Controlled Study. Headache 1990;30: Nierenburg HC et al. Systematic Review of Preventive and Acute Treatment of Menstrual Migraine. Headache 2015;55: Giacovazzo M, et al. Nimesulide in the treatment of menstrual migraine. Drugs 1993;46: Bigal ME, et al. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population based study.
16 Level A Frovatriptan 5mg BID day 1, then 2.5mg BID day 2-6, starting 2 days prior to start of migraine No increased risk of post treatment migraine Level B Naritriptan 1mg BID for 6 days, starting 3 days prior to menstrual migraine Can increase risk of migraine immediately following treatment Zolmitriptan 2.5mg BID/TID for 7 days, starting 2 days prior to menses Not assessed for post treatment migraine Poor evidence Open label studies using sumatriptan Results positive Nierenburg HC et al. Systematic Review of Preventive and Acute Treatment of Menstrual Migraine. Headache 2015;55: MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
17 Estradiol gel 1.5mg daily for 7 days, starting between 2-5 days prior to menses Goal to maintain luteal phase estrogen level Increased risk of post treatment migraine Level C Nierenburg HC et al. Systematic Review of Preventive and Acute Treatment of Menstrual Migraine. Headache 2015;55: MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
18 Extended cycle birth control Use of combined oral contraceptives Skip placebo Stop OCP for 3 days then restart if breakthrough bleeding occurs Use estrogen supplementation during placebo (10mcg oral ethinyl estradiol, 0.9mg oral conjugated equine estrogens, 100mcg estradiol patches, 2g estradiol gel) Levonorgestrel-releasing intrauterine system (IUD) Limited to no menses Nierenburg HC et al. Systematic Review of Preventive and Acute Treatment of Menstrual Migraine. Headache 2015;55: MacGreggor A. Migraine management during menstruation and menopause. Continuum lifelong learning in Neurology 2015;21:
19 Calendar for 3 months, menstrual correlation should be there for 2 out of 3 months Migraines and menses should be predictable Instead of daily preventive, consider mini prevention around menses Consider patients wishes and co-morbidities when it comes to nsaids vs. triptans vs. hormones Watch for medication overuse headaches (esp. triptans)
20 28 yo woman with a history of pure menstrual migraine. Now she notes that along with migraine with menses for 3 days, she is getting migraines up to 5 other days a month. These are not as severe as menstrual related migraine, but still left sided with nausea and light sensitivity. She notes triggers of sleep deprivation, stress, skipped meals, and weather changes.
21 What is her diagnosis now? What makes this case more challenging? What are some concerns we should have about her use of abortive medications? Can an oral contraceptive improve her migraines?
22 Menstrual migraines Migraines at other times of the month Frequency of migraines places her at risk for medication overuse headaches and chronic migraine She should calendar ALL headaches with treatment Is she using OTC meds for regular headaches How many days do you NOT have a headache in the month
23 Attacks, in a menstruating woman, fulfilling criteria for Migraine without aura Documented and prospectively-recorded evidence over at least three consecutive cycles has confirmed that attacks occur on days 2 to +3 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the cycle. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3 rd edition (Beta).
24 Lifestyle changes Regular sleep (sleep and wake times), eating regularly (3-5 meals per day), stress management (Mindfulness based stress reduction/regular exercise) Consider daily prophylactic When headaches are 4 or more days a month, with some disability 1 Guidelines for migraine prevention 2 Divalproex/sodium valproate, Metoprolol, Propranolol, Timolol, Topirmate, Petasites Mini prevention may still be an option with menses Keep good calendar documenting treatment Limit triptan use to less than 10 days a month Limit other OTC use, especially combined analgesics OCP less likely to help as will not impact non menstrual migraines 1. Estemalik E, et al. Preventive treatment in migraine and the new US guidelines. Neuropsychiatr Dis Treat 2013;9: Silberstein SD, et al. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults. Neurology 2012;78:
25 Encourage patients to keep headache calendar Document ALL headaches Document ALL meds used (OTC included) Prevent migraines Lifestyle changes Prophylaxis Limit overuse of abortive medications OCP unlikely to help
26 32 yo woman with history of menstrualy related migraine has noticed since after the birth of her second child, she is having migraines now occurring monthly. With her headache calendar, she is able to recognize they are occurring during the time she takes the birth control pills that are a different color from the rest of the pack. She has been doing well with migraines the rest of the month. The migraine that occurs monthly is severe and lasts for 3 days. She is bedbound and does not find her mini prevention with naproxen to be helpful.
27 What is her diagnosis? What is the effect of OCP on migraines? What can we advise?
28 Placebo pill triggering migraine Mini prevention with NSAID no longer effective Occurring every month Has been on this OCP since prior to first pregnancy
29 Headache or migraine developing within five days after daily consumption of exogenous estrogen for three weeks or longer, which has been interrupted (usually during the pill-free interval of combined oral contraception or following a course of replacement or supplementary estrogen). It resolves spontaneously within three days in the absence of further consumption. Diagnostic criteria: A. Headache or migraine fulfilling criterion C B. Daily use of exogenous estrogen for 3 weeks, which has been interrupted C. Evidence of causation demonstrated by both of the following: 1. headache or migraine has developed within 5 days after the last use of estrogen 2. headache or migraine has resolved within 3 days of its onset D. Not better accounted for by another ICHD-3 diagnosis. Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders 3 rd edition (Beta).
30 Low dose estrogen or patch during placebo pills Reduce the drop in estrogen, reduce chance of migraine Skip placebo pills, scheduled menses every 3 months NSAIDS or Triptans during placebo pills Change to extended cycle pills vs. Levonorgestrel-releasing intrauterine system Use an OCP with fewer placebo days Consider stopping OCP and see what happens to migraine
31 OCP can help pure menstrual migraine, but has the potential to worsen migraines vs. not affect migraines Sometimes trying a different type of OCP can improve migraines Sometimes 3 month break off OCP can help determine if it is triggering more migraines
32 Combined OCP associated with twofold increased risk of stroke This is in older preparations with higher dose estrogen Unclear risk with current lower estrogen preparation pills Still, screen for CV risk factors in patients you are considering OCP Migraine with aura associated with twofold increased risk of stroke Risk vs. benefit when using OCP in patients with migraine with aura Avoid high dose estrogen Consider progesterone only pill vs. Levonorgestrel-releasing intrauterine system
33 Decided to change to mini prevention with frovatriptan, worked well with use for 5 days a month, starting day prior to start of placebo pill and stopping on day 2 of new OCP pack She had been off OCP while trying for pregnancy and felt migraines were worse (menstrual migraines were beginning to last for 5-7 days) She had tried extended cycle OCP in the past and noted frequent breakthrough bleeding past the 3 months of initiation Was considering 3 rd pregnancy in 2 years, wanted to avoid IUD
34 Estrogen withdrawal headache related to abrupt cessation of estrogen that has been continuous for 3+ weeks Consider extended cycle vs. continuous OCP to skip estrogen drop Consider mini-prevention during placebo, especially if patient does not want to change OCP Consider trial off OCP for 3 months to see what occurs with migraine
Ana Podgorac Belgrade, May 2012
Headache and reproductive life Ana Podgorac Belgrade, May 2012 52 years old woman, English teacher in primary school, married, mother of two, with a history of migraine without aura. Over the last 6 months
More informationHeadache Master School Japan-Osaka 2016 (HMSJ-Osaka2016) October 23, II. Management of Refractory Headaches
Headache Master School Japan-Osaka 2016 (HMSJ-Osaka2016) October 23, 2016 II. Management of Refractory Headaches Case presentation 1: A case of intractable daily-persistent headache Keio University School
More informationA case of a patient with chronic headache. Focus on Migraine. None related to the presentation Grants to conduct clinical trials from: Speaker bureau:
Chronic Daily Headache Bassel F. Shneker, MD, MBA Associate Professor Vice Chair, OSU Neurology The Ohio State University Wexner Medical Center Financial Disclosures None related to the presentation Grants
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 information100% Effective Natural Hormone Treatment Menopause, Andropause And Other Hormone Imbalances Impair Healthy Healing In People Over The Age Of 30!
This Free E Book is brought to you by Natural Aging.com. 100% Effective Natural Hormone Treatment Menopause, Andropause And Other Hormone Imbalances Impair Healthy Healing In People Over The Age Of 30!
More informationChronic Migraine in Primary Care. December 11 th, 2017 Werner J. Becker University of Calgary
Chronic Migraine in Primary Care December 11 th, 2017 Werner J. Becker University of Calgary Disclosures Faculty: Werner J. Becker Relationships with commercial interests: Grants/Research Support: Clinical
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 informationDisclosures. Learning Objectives. Treatment Of Menstrual Migraine 11/10/2017. Research grants Aralez, Allergan
Treatment Of Menstrual Migraine Christine Lay, MD Director, Centre for Headache Associate Professor University of Toronto Disclosures Research grants Aralez, Allergan Unrestricted educational grants Aralez,
More informationThe 45-year-old woman with monthly headaches. Anne MacGregor Barts and the London School of Medicine and Dentistry
The 45-year-old woman with monthly headaches Anne MacGregor Barts and the London School of Medicine and Dentistry Learning Objectives Use of diary cards for establishing patterns of attacks Importance
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 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 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 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 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 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 informationMigraine much more than just a headache
Migraine much more than just a headache Session hosted by Teva UK Limited PUU4 11:15 12:15 UK/NHSS/18/0021b Date of Preparation: August 2018 The views expressed in this presentation are those of the speaker
More informationWomen s Issues in Epilepsy. Esther Bui, Epilepsy Fellow MD, FRCPC
Women s Issues in Epilepsy Esther Bui, Epilepsy Fellow MD, FRCPC How are women different? Different habitus Different metabolism Different co-morbidities Different psychosocial stigma Different hormonal
More informationTable I. Examples of Hormone and Tapering Regimens
Table I. Examples of Hormone and Tapering Regimens Severe AUB Heavy bleeding (soaking through 2 maxi pads an hour, 2 hours in a row) History of heavy menses Hemodynamically un (tachycardia, hypotensive,
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 informationHRT in Perimenopausal Women. Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College
HRT in Perimenopausal Women Dr. Rubina Yasmin Asst. Prof. Medicine Dhaka Dental College 1 This is the Change But the CHANGE is not a disease 2 Introduction With a marked increase in longevity, women now
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 informationHeadache Mary D. Hughes, MD Neuroscience Associates
Headache Mary D. Hughes, MD Neuroscience Associates Case 1 22 year old female presents with recurrent headaches. She has had headaches for the past 3 years. They start on the right side of her head and
More informationDifferentiating Migraine from Other Headache Types to Target Treatment Peter J. Goadsby, MD, PhD
Differentiating Migraine from Other Headache Types to Target Treatment Peter J. Goadsby, MD, PhD University of California, San Francisco San Francisco, CA King's College London London, England Learning
More informationHeadaches. Mini Medical School. November 10, A. Laine Green MSc, MD FRCP(C) Assistant Professor Department of Medicine (Neurology)
Headaches. Mini Medical School. November 10, 2016 A. Laine Green MSc, MD FRCP(C) Assistant Professor Department of Medicine (Neurology) Artist Agnes Cecile Disclosures I have received an honorarium from
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 informationPaediatric headaches. Dr Jaycen Cruickshank Director of Clinical Training Ballarat Health Services. Brevity, levity, repetition
Paediatric headaches Dr Jaycen Cruickshank Director of Clinical Training Ballarat Health Services Brevity, levity, repetition Paediatric)headache?)! Headache!in!children!is!not!that!common.!The!question!is!which!headaches!do!I!
More informationMigraine Management. Dr Helen Brown Director of Neurology and Stroke The Princess Alexandra Hospital
Migraine Management Dr Helen Brown Director of Neurology and Stroke The Princess Alexandra Hospital Referral Criteria for Migraine Migraine Management Migraine Diagnosis Spot on Health Migraine pathway
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 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 informationContraception. Yolanda Evans MD MPH Assistant Professor of Pediatrics Division of Adolescent Medicine
Contraception Yolanda Evans MD MPH Assistant Professor of Pediatrics Division of Adolescent Medicine Disclosures No financial relationships to disclose I have no commercial, financial, research ties to
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 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 informationPatient Guide Levonorgestrel and Ethinyl Estradiol Tablets USP (0.1 mg/0.02 mg) and Ethinyl Estradiol Tablets USP (0.
Patient Guide Levonorgestrel and Ethinyl Estradiol Tablets USP (0.1 mg/0.02 mg) and Ethinyl Estradiol Tablets USP (0.01 mg) Rx Only This product (like all oral contraceptives) is intended to prevent pregnancy.
More informationGoals. 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 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 informationWORTH A CLOSER LOOK.
A birth control pill... WORTH A CLOSER LOOK. Ask your healthcare provider about. Please see Important Safety Information including Boxed Warning throughout this brochure and on pages 4 and 5. offers a
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 informationHEADACHE: Types, Tips & Treatment Suggestions
Headaches are one of the most common complaints patients present with in primary care settings. They are often correlated with stress, tension and a litany of existing medical conditions. Often, patients
More informationMIGRAINE ASSOCIATION OF IRELAND. Migraine & Women. Her life can be hers AGAIN
MIGRAINE ASSOCIATION OF IRELAND Migraine & Women Her life can be hers AGAIN What is Migraine? Migraine and Women Migraine is 3 times more common in women than in men, this is largely due to hormonal changes
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 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 informationA Q&A with N1-Headache users
A Q&A with N1-Headache users Content Guide: 1. Daily Factor logging 2 2. Migraine & Other Headaches 3 3. Medication & Medication Overuse 3-4 4. MAPS 5 2019 Curelator, Inc. All rights reserved. No part
More informationIs Yoga an Effective Treatment for Reducing the Frequency of Episodic Migraine?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Is Yoga an Effective Treatment for Reducing
More informationHMFP Comprehensive Headache Center Department of Anesthesia, Critical Care and Pain Medicine Beth Israel Deaconess Medical Center Instructor in
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 Limited time
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 informationDisclosures. Objectives 6/2/2017
Classification: Migraine and Trigeminal Autonomic Cephalalgias Lauren Doyle Strauss, DO, FAHS Assistant Professor, Child Neurology Assistant Director, Child Neurology Residency @StraussHeadache No disclosures
More informationWhat is the Effectiveness of OnabotulinumtoxinA (Botox ) in Reducing the Number of Chronic Migraines (CM) in Patients Years Old?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 What is the Effectiveness of OnabotulinumtoxinA
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 informationprevalence was 13.8% among females
1 2 3 1. Woldeamanuel YW et al. Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of communitybased studies involving 6 million participants. J Neurol
More informationHEADACHE. Summary of British Association on the Study of Headaches {click to visit}
F:M=3:1 Affects 15% adults HEADACHE Summary of British Association on the Study of Headaches {click to visit} Primary: Migraine (with aura 1/3, without aura 2/3) Tension Cluster Other Secondary Neuralgia
More informationUCNS Course A Review of ICHD-3b
UCNS Course A Review of ICHD-3b Andrew D. Hershey, M.D., Ph.D., FAHS Endowed Chair and Director of Neurology Director, Cincinnati Children s Headache Center Professor of Neurology and Pediatrics University
More informationAdult with headache. Problem-specific video guides to diagnosing patients and helping them with management and prevention
Adult with headache Problem-specific video guides to diagnosing patients and helping them with management and prevention London Strategic Clinical Networks London Neuroscience Strategic Clinical Network
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 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 informationPreparing for your Appointment: HEADACHE. How bad is your typical headache pain on the 0-10 pain scale with 10 being the worst pain?
Preparing for your Appointment: HEADACHE Write down your symptoms: When did the headaches begin? Where are your headaches located? How bad is your typical headache pain on the 0-10 pain scale with 10 being
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 informationChronic Daily Headaches
Chronic Daily Headaches ANWARUL HAQ, MD, MRCP(UK), FAHS DIRECTOR BAYLOR HEADACHE CENTER, DALLAS, TEXAS DISCLOSURES: None OBJECTIVES AT THE CONCLUSION OF THIS ACTIVITY, PARTICIPANTS WILL BE ABLE TO: define
More informationRecognition and treatment of medication overuse headache
Recognition and treatment of medication overuse headache Marcus Lewis MA, MRCGP, DRCOG, DFSRH 20 Mean weekly headache index 15 10 5 Medication overuse headache is a common condition responsible for a high
More informationPuberty and Fertility. Normal Female Puberty PUBERTY! What about girls with Galactosemia? E Puberty and Fertility Badik Spencer 1
Puberty and Fertility Jennifer Badik*, MD Pediatric Endocrinology and Jessica Spencer*, MD, MSc Reproductive Endocrinology and Infertility Part One PUBERTY! *no conflicts of interest to report Every girl
More informationPremenstrual Syndrome
page 1 Premenstrual Syndrome Q: What is premenstrual syndrome (PMS)? A: Premenstrual syndrome (PMS) is a group of symptoms linked to the menstrual cycle. PMS symptoms occur in the week or two weeks before
More informationUNDERSTANDING CHRONIC MIGRAINE. Learn about diagnosis, management, and treatment options for this headache condition
UNDERSTANDING CHRONIC MIGRAINE Learn about diagnosis, management, and treatment options for this headache condition 1 What We re Going to Cover Today The symptoms and phases of migraine Differences between
More informationHeadaches are highly prevalent in
How to choose a contraceptive for a patient who has headaches Developing an accurate diagnosis of headache subtype will help avert unnecessary restriction of hormonal methods among your patients who do
More informationWhat s New in Adolescent Contraception?
What s New in Adolescent Contraception? Abby Furukawa, MD Legacy Medical Group Portland Obstetrics and Gynecology April 29, 2017 Objectives Provide an update on contraception options for the adolescent
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
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 informationMigraine: Past, Present and Future Edward O Sullivan September 12 th 2015 Dublin 12/09/2015
1 Migraine: Past, Present and Future Edward O Sullivan September 12 th 2015 Dublin Tour de France 2015: Mark Renshaw Yesterday at the end of the stage 17 I came down with a migraine before the final climb
More informationSex Differences in Migraine
Sex Differences in Migraine European Before puberty (10-14 girls), migraine affects both sexes equally Following puberty, migraine has strikingly higher prevalence in females than in men Female:male ratio
More informationHEADACHE: Benign or Severe Dr Gobinda Chandra Roy
HEADACHE: Benign or Severe Dr Gobinda Chandra Roy Associate Professor, Department of Medicine, Shaheed Suhrawardy Medical College and Hospital Outlines 1. Introduction 2. Classification of headache 3.
More informationHEADACHES AND MIGRAINES
HEADACHES AND MIGRAINES CONTENT CREATED BY Learn more at www.health.harvard.edu TALK WITH YOUR DOCTOR Table of Contents Whether this is your first visit or a follow-up, answer these questions for your
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 informationChapter 100 Gynecologic Disorders
Chapter 100 Gynecologic Disorders Episode Overview: 1. Describe the presentation and RF for Adnexal torsion 2. List the imaging findings of adnexal torsion (US vs CT) 3. What is the management of adnexal
More informationDaniel Kassicieh, DO, FAAN
Daniel Kassicieh, DO, FAAN Migraine a Disease Process Migraine is a chronic disease process similar to many other chronic medical conditions Migraine has a low mortality but high morbidity 38 million Americans
More informationContraception: Common Problems Faced in Office Practice. Jane S. Sillman, MD Brigham and Women s Hospital
Contraception: Common Problems Faced in Office Practice Jane S. Sillman, MD Brigham and Women s Hospital Disclosures I have no conflicts of interest Contraception: Common Problems How to discuss contraception
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 informationRisk Factors, Clinical Course, and Barriers to Care in Adults and Pediatrics. Rebecca R. Buttaccio, PA-C Dent Neurologic Institute
Risk Factors, Clinical Course, and Barriers to Care in Adults and Pediatrics Rebecca R. Buttaccio, PA-C Dent Neurologic Institute Speaker for Avanir Disclosures Learning Objectives 1. Review the risk factors
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 informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
CGRP Page 1 of 13 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 informationHEADACHES THE RED FLAGS
HEADACHES THE RED FLAGS FAYYAZ AHMED CONSULTANT NEUROLOGIST HON. SENIOR LECTURER HULL YORK MEDICAL SCHOOL SECONDARY VS PRIMARY HEADACHES COMMON SECONDARY HEADACHES UNCOMMON BUT SERIOUS SECONDARY HEADACHES
More informationAn Overview of MOH. ALAN M. Rapoport, M.D. Clinical Professor of Neurology The David Geffen School of Medicine at UCLA Los Angeles, California
An Overview of MOH IHS ASIAN HA MASTERS SCHOOL MARCH 24, 2013 ALAN M. Rapoport, M.D. Clinical Professor of Neurology The David Geffen School of Medicine at UCLA Los Angeles, California President-Elect
More information25/09/2018 HEADACHE. Dr Nick Pendleton
HEADACHE Dr Nick Pendleton September 2018 1 Small Group Work Tension Type Headache Cranial Nerve Examination Migraine Migraine Treatment Medication Overuse Headache Headache Red Flags Sinusitis Headache
More informationMigrainous headache, the menstrual cycle and pregnancy. Dr Manuela Fontebasso Headache Specialist, Author and Headache Education Facilitator
Migrainous headache, the menstrual cycle and pregnancy Dr Manuela Fontebasso Headache Specialist, Author and Headache Education Facilitator What sort of headaches? Migraine with and without aura Tension
More informationProgestin-only methods Type or dose of progestagen
Progestin-only contraception and beneficial effects on migraine Conflicts of interest A d v ise r a n d le ctu re r fo r E X E LT IS Le ctu re s a n d A d v iso ry b o a rd s B aye r Le ctu re s a n d
More informationWhen acute therapies of menstrually
PREVENTIVE TREATMENT OF MENSTRUALLY RELATED MIGRAINE * Stephen D. Silberstein, MD, FACP ABSTRACT Preventive treatment of menstrually related migraine (MRM) is initiated when acute therapies fail to provide
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 informationAdolescent Migraine Treatment O F A
Adolescent Migraine Treatment M A R C Y Y O N K E R, M D F A H S D I R E C T O R, P E D I A T R I C H E A D A C H E P R O G R A M A S S O C I A T E P R O F E S S O R, C H I L D H E A L T H, U O F A Goals
More informationHEADACHE. Dr Nick Pendleton. September Headache
HEADACHE Dr Nick Pendleton September 2017 Headache Tension Type Headache Cranial Nerve Examination Migraine Migraine Treatment Medication Overuse Headache Headache Red Flags Sinusitis Headache Raised ICP
More informationMigraine. What are the symptoms of a migraine attack?
Migraine Migraine causes attacks of headaches, often with feeling sick or vomiting. Treatment options include: avoiding possible 'triggers', painkillers, antiinflammatory painkillers, anti-sickness medicines,
More informationBackground. Background. Headache Examination. Headache History. Primary vs. Secondary Headaches. Headaches In Children: Why Worry?
Background Headaches In Children: Why Worry? Marcy Yonker MD FAHS Associate Professor of Pediatrics University of Arizona Director, Pediatric Headache Program Phoenix Children s Hospital Headaches are
More informationInformation for you. Managing premenstrual syndrome (PMS) What is PMS?
Managing premenstrual syndrome (PMS) Information for you Published in August 2009 What is PMS? Premenstrual syndrome or PMS is the name given to a collection of physical and emotional symptoms that can
More informationSubject: CGRP Inhibitors
ARCHIVED (NOT ACTIVE RETIRED) Archived: 08/01/18 09-J2000-98 Original Effective Date: 06/15/18 Reviewed: 05/09/18 Revised: 08/01/18 Next Review: ARCHIVED (NOT ACTIVE RETIRED) Subject: CGRP Inhibitors THIS
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 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 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 informationHEADACHE HISTORY & PROFILE QUESTIONNAIRE
1 HEADACHE HISTORY & PROFILE QUESTIONNAIRE Patient Name: On what part of the head do your headaches start? R Side L Side Either Side Both Sides Back On Top Temples Behind/AroundEyes Forehead Face Neck
More informationProgesterone. What is progesterone? Important information. Before taking this medicine
Progesterone Generic Name: progesterone (proe JESS te rone) Brand Names: First Progesterone MC10, Menopause Formula Progesterone, Prometrium What is progesterone? Progesterone is a female hormone important
More informationVI.2. ELEMENTS FOR A PUBLIC SUMMARY
VI.2. ELEMENTS FOR A PUBLIC SUMMARY VI.2.1 Overview of Disease Epidemiology COCs (Combined Oral Contraceptives) containing DRSP-EE (Drospirenone- Ethinylestradiol) are indicated for the prevention of pregnancy
More informationIs Topiramate Effective in Preventing Pediatric Migraines?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2013 Is Topiramate Effective in Preventing
More information1. During the follicular phase of the ovarian cycle, the hypothalamus releases GnRH.
1. During the follicular phase of the ovarian cycle, the hypothalamus releases GnRH. 2. This causes the anterior pituitary to secrete small quantities of FSH and LH. 3. At this time, the follicles in the
More informationARxCH. Annual Review of Changes in Healthcare. Calcitonin Gene-Related Peptide Receptors and the Prevention of Migraines. Abstract
Calcitonin Gene-Related Peptide Receptors and the Prevention of Migraines Brian Schuler, PharmD Candidate 2018 1 1 University of Findlay College of Pharmacy Abstract Migraines are the third most prevalent
More information