Articles related to MIGRAINES/HEADACHES

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.

This woman’s headache started suddenly three months ago. It begins as a dull, localized pain at the top of the head, starting within 30 minutes of rising, and increases in intensity, becoming a global headache as the day progresses. Bedrest alleviates the symptoms. Review the MRI and choose an appropriate therapy.

Neurology referrals for headache are often unnecessary and delay appropriate headache care. A Geisinger Medical Center neurologist developed a tool that pops up on the EMR when the diagnosis of headache is entered. It guides with questions and suggested medications. The tool was developed in response to a chart review showing that referrals for headache from PCPs did not regularly document enough data in their notes on headache to reach a viable diagnosis nor were they regularly trying medications before referring.

A total of 35 status migrainosus patients were enrolled; 30 of them were female, and the average age was 39. Before the drugs were given, everyone’s serum magnesium levels were normal. There were no ECG alterations found, and none of the patients experienced any severe side effects either during or right away following the infusion. In 15 patients, there was a positive effect; in 10, there was no effect; and in 10, there were no data.