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Tuesday, September 20, 2011

NHF Regional Conference - Part III

Dr. Steven Linder

Dr. Linder has a private practice in Dallas, TX, where he treats children and adolescents with migraine. He discussed neurostimulators (occipital and supra-orbital nerves) in adolescents. He was very knowledgeable, and answered audience questions.


Dr. John Claude Krusz

Dr. Krusz has a private practice in North Texas (Anodyne Headache and PainCare), where he treats pain, headache disorders, sleep, mood and neuropsychiatry/neurobehavioral disorders. He spoke primarily about treatment options for migraine.

* The goal of medication is to improve function *


Acute Medication Treatment:
  • Not more than 2 days per week
  • Treat early (don't wait until severe)
  • Use adequate dose, combine meds
  • Keep headache diary
  • Goal is to get you back to 'normal' within 2-4 hours
  • Can repeat meds, if not getting relief
  • Go to sleep (sometimes, no matter what you do, some headaches get out of control)
  • Some examples:
    • NSAIDs - Aspirin, Ibuprofin, Naproxen, Diclofenac, Indocin
    • Anti-Nausea - Reglan, Compazine, Zofran, Phenergan
    • Others - Excedrin, Tramadol
    • Triptans - Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig
    • Ergots - DHE, Migranal, Ergotamine

Rescue Medication Treatment (when acute treatments don't work):
  • Sedatives - get to sleep
  • IV or IM injections (often requires office or ER visit)
  • Avoid narcotic pain meds
  • Examples: Corticosteroids, Depacon, Magnesium, Toradol

Medication Overuse Headache:
  • Rebound (use acute/rescue meds too often)
  • Acute meds become less effective
  • Headache frequency increases, eventually becoming daily
  • Narcotics (opioids)/barbituates - high rebound
  • No preventative works well

Preventive Therapy:
  • Control other medical problems
  • Diet
  • Exercise
  • Sleep
  • Medication
    • Anti-depressants (SNRIs)
    • Anti-hypertensives
    • Anti-epilepsy (neurostabilizers)
    • Anti-inflammatory
    • Muscle relaxants
    • Sleep aids

Supplements:
  • 5-HTP
  • Magnesium
  • Riboflavin (Vitamin B-2)
  • CoQ-10
  • Butterbur
  • Feverfew