Articles related to MIGRAINES/HEADACHES

FDA’s New Approval of Atogepant for Chronic Migraine Prevention is a Breakthrough in Migraine Management A promising breakthrough in migraine management, the FDA’s new approval of atogepant tablets, brings renewed hope for chronic migraine sufferers. According to AbbVie, this endorsement allows the use of atogepant (Qulipta) in the prevention of chronic migraines in adults. Atogepant stands out as the first oral calcitonin gene-related peptide (CGRP) receptor antagonist to receive dual approval for episodic and chronic migraines. It works by blocking CGRP, a molecule involved in transmitting pain signals. Chronic migraines, to clarify, involve enduring headaches for at least 15 days a month, with eight of those days associated with migraines. Before this, in September 2021, the FDA approved atogepant for treating episodic migraines. Patients can take the drug in 10 mg, 30 mg, and 60 mg dosages. The FDA recommends the 60 mg dose for chronic migraine patients. Peter McAllister, MD, from the New England Center for Neurology and Headache, noted that the FDA’s endorsement offers a new, convenient daily treatment for chronic migraine patients. The demonstrated efficacy and functional improvement of atogepant make it an appealing option for neurologists and headache specialists when devising treatment plans for patients. The […]

A 29-member specialist interest group (SIG) was formed, comprising representation from neurology, neuroradiology, anesthesia, neurosurgery, and patient advocacy. The SIG unanimously agreed on the scope and purpose of the guideline. Using a modified Delphi method, the SIG then created guideline statements for a number of question themes. A rigorous literature study, surveys of patients and healthcare professionals, and a review by numerous international experts on SIH all contributed to this process. Any patient presenting with orthostatic headache should be evaluated for spontaneous intracranial hypotension (SIH) and its possible diagnosis. MRI of the brain with contrast and the whole spine should be used as first-line imaging. The non-targeted epidural blood patch (EBP) is the first-line treatment and should be performed as soon as possible. The authors discuss treatment ideas and present criteria for doing myelography based on the spine MRI result and response to EBP. There are also recommendations for conservative care, symptomatic headache treatment, and management of SIH consequences.

This course is intended to provide information from an unbiased viewpoint on managing headaches while treating Chiari malformation with either medication or surgical therapy. This course will combine lectures, patient insights, and expert panels. It will be offered in person, digitally through Microsoft Teams, and on-demand for all paid attendees for one month following the conference. After completing this course, participants will be able to identify more precise headache care techniques and understand when surgery is necessary, use logic and reason when treating patients with Chiari malformation and headaches, and determine the prevalence of headaches and Chiari malformation in the general population.

Headaches have increased in frequency from about once weekly to more than four-times-a-week in this patient with a 25-year headache history. He is on amitriptyline and has increased his sumatriptan dose to five times weekly. PE and contrast MRI are normal. What’s next?

Other than anterior cervical and occipital lymphadenopathy, the physical examination and vitals are unremarkable. The patient is also requesting HIV pre-exposure prophylaxis initiation. HIV testing negative. What’s the best management?

The Nerivio device is worn on the arm and uses painless electrical stimulation to activate peripheral nerves, thereby inducing a conditioned pain modulation response. It is controlled by a smartphone app and is recommended to be used every other day for migraine prevention.