Your patient has passed the next step, by graduating from high school. They have chosen their next path- going to college. They are so pleased to tell you all about it, and you are so proud of them. This is also a time of both positive and negative stress. Perhaps high school was really hard … Continue reading Thriving with college accommodations
There are times when all your patient’s rescue strategies just are not working. The migraine episode is going on and on for several days, or it is worse than usual, or they are vomiting and getting dehydrated. Your patient has taken their usual rescue medications, perhaps done their usual thing when the rescue does not … Continue reading Visiting the ED or Urgent care
My most viewed blog post was the one about the headache-focused neurologic examination. I posted it 4 years ago, February 2019. Because of its popularity, I thought it would be a good idea to take a look and update it where needed. The most important part of any office visit is the conversation between provider, … Continue reading Revisiting the headache-focused neuro exam
Greetings! I have been absent for a bit, dealing with a health issue, but now I am back and feeling great. I wanted to report back some findings, which we are submitting for publication, about using Onabotulinumtoxin A (BTX-A or Botox) for chronic migraine in teens under age 18. We have been able to get … Continue reading Botox for teens under age 18, results
I did my first post about Botox for teens under 18 in July 2019, 3 years ago! My intention was to review our data and prepare for publication a paper supporting the use of Botox for those under age 18. The more academic publications there are available, the better to make the case with insurance … Continue reading Update on Botox for teens under 18
Since I am revisiting the topic of caring for kids with migraine, I thought I would jump right into medications next, treatment and then preventive. I am a firm believer in headache healthy lifestyle factors and their important for preventing migraines. I have discussed these quite a bit in the blog. So let’s talk about … Continue reading Revisiting Migraine part 2: abortive medications
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
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
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
It’s August, and lots of my patients getting ready to go off to college, either as freshmen or as sophomores, whose freshman year was spent at home doing college over zoom. It is an exciting and scary time for them (and their parents), especially with the continuing uncertainly of the Covid pandemic. I have had … Continue reading Off to college during the pandemic
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