#122 Headaches Advanced Class

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Paul Williams MD

Edited by: Matthew Watto MD

Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Rebecca Burch MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders
• 10:38 Clinical case of migraines; diagnosis and classification
• 14:12 Does medication overuse headache exist?
• 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa
• 21:43 Approaches to medication overuse headache
• 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.)
• 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management?
• 38:44 Migraine cocktails
• 41:15 Comorbid mood disorders; Use of psych meds and triptans
• 45:08 Migraines and oral contraceptives
• 48:42 Botulinum toxin and new CGRP therapies
• 53:36 What does success look like in migraine therapy?
• 55:32 Nonpharmacologic management
• 60:45 Case 3: headaches of short duration
• 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches
• 72:00 Idiopathic intracranial hypertension
• 75:25 Take home points
• 77:00 Outro