“An approach to the diagnosis and treatment of chronic migraines” From Episode #4 Of The Curbsiders

In addition to this post, please see my migraine therapy post: coming soon.

And please see also my post on migraine headache diagnosis and classification: coming soon.

Note to myself: This podcast is 50 minutes long and is an outstanding review of migraine headaches and is full of great pearls on  diagnosis and treatment.

In this post I link to and reproduce the show notes from the Curbsiders’ March 30,2016 #4: Are You Afraid of Patients with Migraines? An approach to diagnosis and management of chronic migraine headache. [Link is to to the podcast and show notes]

What follows are from the show notes:


  1. Take a simple approach to the diagnosis of chronic headache syndromes.
    1. If patient is “sick” with their headache, then call it a migraine.
    2. If patient is not nauseous or debilitated with their headache, then call it chronic tension type headache.
    3. One in 1,000 will have cluster headaches. Other causes are even more rare than that
  2. Rationale for preventive therapy: there are a number of drug classes to choose from and they more or less all cause 50% reduction in headache frequency for about two-thirds of patients. Therefore, tailor your therapy based on side effects and comorbid conditions.
  3. Pitfalls:
    1. Stop thinking you need a Specialist. Primary Care Physicians can and should handle most headache cases.
    2. Don’t talk too much. Let the patient talk and DON’T interrupt them.
    3. Failure to start prophylaxis. Don’t be afraid. Know the side effects for each drug class and give patients at least a one month trial at therapeutic doses before calling treatment a failure.


This entry was posted in Curbsiders, Headache, Neurology, The Curbsiders. Bookmark the permalink.