#122 Headaches Advanced Class

The Curbsiders Internal Medicine Podcast

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 [e-mail].

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