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]
MARCH 30, 2016 By TONY SIDARI, MD
What follows are from the show notes:
TAKE HOME POINTS:
- Take a simple approach to the diagnosis of chronic headache syndromes.
- If patient is “sick” with their headache, then call it a migraine.
- If patient is not nauseous or debilitated with their headache, then call it chronic tension type headache.
- One in 1,000 will have cluster headaches. Other causes are even more rare than that
- 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.
- Stop thinking you need a Specialist. Primary Care Physicians can and should handle most headache cases.
- Don’t talk too much. Let the patient talk and DON’T interrupt them.
- 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.