Autonomic Nervous System Sensitivity

Mild dysfunction in the autonomic nervous system (ANS), also called mild dysautonomia is commonly comorbid with all primary headaches (migraine, TTH, NDPH). The ANS controls those body functions that we consciously have no control over, such as breathing, blood pressure regulation, heart rate regulation, digestion/GI motility, temperature regulation, sweating, or nervous system over-stimulation.  Common causes … Continue reading Autonomic Nervous System Sensitivity

Headaches and psychiatric co-morbidities, part 2

In part 1 of this post, pain and psychiatric issues often travel together. Chronic headache pain can lead to long-lasting psychological distress, and depression and anxiety increase the perception of both acute and chronic pain. They are intimately connected. This post will continue the discussion about psychiatric co-morbidities and headache, focusing on psychopharmacology. What is … Continue reading Headaches and psychiatric co-morbidities, part 2

Headaches and psychiatric co-morbidities, part 1

It is quite common for patients with migraine and headaches to have a coexisting psychiatric co-morbidity, such as anxiety or depression. In fact, headache and psychological distress share the same risk factors, such as environmental stressors and genetic predisposition. Headache history may predispose a patient to psychopathology and psychopathology may predispose a patient to headache. … Continue reading Headaches and psychiatric co-morbidities, part 1

My book is reviewed!

The most recent volume (June 2021) of Pediatric Pain Letter ( contains a review of my book, Getting Ahead of Pediatric Headaches. The review was done by Angelina Koehler, CPNP, a pediatric headache provider at Children’s Hospital of Colorado in Denver. Ms Koehler reviews the book thoroughly, covering the main areas of information presented. This … Continue reading My book is reviewed!

Back to school, bring on the stress; psychiatric comorbidities and headache

In my part of the country, there has been a gradual transition from remote learning to hybrid learning to full in-person learning, starting this spring. And as we all experience, there are significant stressors with all this change. Kids are happy to be back at school with their friends, teachers, feeling sort of ‘back to … Continue reading Back to school, bring on the stress; psychiatric comorbidities and headache

Migraine and headache and pain conditions

Ever notice that your patients with migraine and headache often have other medical issues? Well, there are a number of common coexisting medical conditions which are often associated with migraine and headache. Frequently these issues are associated with pain, and are referred to as overlapping pain conditions. Examples of these types of overlapping pain conditions … Continue reading Migraine and headache and pain conditions


Oh my goodness, along with the Covid 19 pandemic, there has been a significant uptick in anxiety, among my patients with headaches, especially the teens and young adults. This has been clear since about mid-October. Historically, there is the usual ramp up of anxiety, worry, lack of coping, that tends to happen around this time … Continue reading Anxiety!!!

Pandemic reflections

Children and teens with headache and migraine have been affected in a variety of ways by these pandemic times. Thinking back, there has been a difference between last spring and this fall and the effect on my patients, particularly in the school environment.  I will refer back to specific chapters in my book ‘Getting ahead … Continue reading Pandemic reflections