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Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers.  In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes  not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Drs. VanderPluym and Starling review the updated position statement from the American Headache Society indicating that CGRP-targeting migraine therapies should be considered as a first-line option.

Join us for the 5th Annual JOWMA Conference: Transforming Healthcare Through Innovation & Research on January 5, 2025, from 8am to 5pm in NYC! Spend the day immersed in expert-led scientific sessions, hands-on surgical simulations, specialty roundtables, and a networking lunch tailored for healthcare professionals and students. PLUS, we're offering a full premed program with panels, roundtables, and networking dedicated to aspiring medical students.

Join us for the 5th Annual JOWMA Conference: Transforming Healthcare Through Innovation & Research on January 5, 2025, from 8am to 5pm in NYC! Spend the day immersed in expert-led scientific sessions, hands-on surgical simulations, specialty roundtables, and a networking lunch tailored for healthcare professionals and students. PLUS, we're offering a full premed program with panels, roundtables, and networking dedicated to aspiring medical students.

In the patient populations treated by neurologists, central neuropathic pain develops most frequently following spinal cord injury, multiple sclerosis, or stroke. To optimize pain relief, neurologists should have a multimodal and individualized approach to manage central neuropathic pain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Charles E. Argoff, MD, author of the article “Central Neuropathic Pain,” in the Continuum October 2024 Pain Management in Neurology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Argoff is a professor of neurology and vice chair of the department of neurology, director of the Comprehensive Pain Management Center, and director of the Pain Management Fellowship at Albany Medical College in Albany, New York. Additional Resources Read the article: Central Neuropathic Pain Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Doctor Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Charles Argoff, who recently authored an article on central neuropathic pain in the latest issue of Continuum covering pain management. Dr Argoff is a neurologist at Albany Medical College where he's a professor of Neurology, and he serves as vice chair of the Department of Neurology and program director of the Pain Medicine Fellowship Program there. Dr Argoff, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Argoff: I'm Charles Argoff. It's a pleasure to be here and thank you so much for that kind introduction. Dr Jones: I've read your article. Many of our listeners are going to read your article. Wonderful article, extremely helpful. Closes a lot of gaps, I think, that exist in our field about understanding central neuropathic pain, treating central neuropathic pain. You now, Doctor Argoff, you have the attention of a huge audience of mostly neurologists. What's the biggest point you would like to make to them, or the most important practice-changing advice that you would give to them? Dr Argoff: I think it's at least twofold. One is that central neuropathic pain is not as uncommon as you think it might be, and it occurs in a variety of settings that are near and dear to a neurologist's heart, so to speak. And secondly, although we live in an evidence-based world and we want to practice evidence-based medicine - and I'm proud to have formerly been a member of the Quality Standard subcommittee, which I think has changed its name over time. And so, I understand the importance of, you know, treatment based upon evidence - the true definition of evidence-based medicine is using the best available evidence in making decisions about individual patients. And so, I would urge those who are listening that, although there might not be as robust evidence currently as you'd like, please don't not take the time to try to treat the patient in front of you o r at least acknowledge the need for treatment and work with your colleagues to address the significant neuropathic pain associated with that central neurological disorder. Because it can be life-changing in a positive way to make even a dent and to really work with somebody, even though not clear-cut always what's going to work for an individual patient. Dr Jones: Well said. I'm glad you brought that up. So, to put it a different way, absence of evidence is not an excuse for absence of treatment. Right? Dr Argoff: Exactly. And I think that, I hope that we would agree that especially in neurology, what we do is about as far from, ‘Yep, you've got strep throat, here's that antibiotic that's going to work for you and all you have to do is take the medicine.' I mean, most of what we do is nowhere near that.  Dr Jones: It's complicated stuff. And this is a complicated topic. And I'll tell you, I learned a lot reading your article. I think most of us in neurology and medicine, when we hear the term neuropathic pain, it feels roughly synonymous with peripheral generators of that pain, such as diabetic neuropathy or posttraumatic neuralgia. But as you mentioned, there's central mechanisms for pain generation. How is it defined? What is central neuropathic pain? Dr Argoff: It's defined as pain caused by a lesion or disease of the central somatosensory system . Though neuropathic pain in general is pain associated with the lesion of the somatosensory system; and to your point, that can be peripheral, which of course is outside the spinal cord, or brain or central, which is within the spinal cord or brain. And central neuropathic pain is defined specifically as pain caused by a lesion or disease of the central somatosensory system. That's either brain or spinal cord. But there's an interesting follow-up, and I'm going to ask if you could remind me because I know we're talking about definitions now, but I'll just bring something up and we can come back to it. What's interesting about that is that my - whoever 's listening, that's not to say that they're not connected. And in fact, they are very much connected. And there's very new work, which I included in the article, down at Washington University in Saint Louis, that suggests you can actually affect central neuropathic pain by addressing peripheral input to the central nervous system. If you remember Ken Casey at the University of Michigan at the World Pain Congress in Vancouver, British Columbia many years ago, he ended his talk on pain with a limerick, of which the last line was, Remember, there ain't no such thing as pain without a brain. And so that kind of summarizes that. Dr Jones: Well, and it goes both ways too, right? We know that there's some central sensitization that can happen with peripheral generators, right? So we really have to think about the whole circuit. Dr Argoff: Yes. And that's been sometimes the bane of my existence as a colleague of others and a sometimes debater. Is the pain central? Is it peripheral? Well, it's everything. And it's important to know as many of the mechanisms and many of the targets that you could use for treatment so that you can affect the best outcome for your patients. Dr Jones: Yeah, so - and you mentioned in your article what some of the common causes of central neuropathic pain are. What are the big ones in your experience?  Dr Argoff: So, the biggest ones are spinal cord injury-related pain, MS-related pain - and I'd like to come back to a point and just if I do the third one - and central poststroke pain. And what struck me, I think Tim Vollmer published a survey about the incidence, the prevalence of ongoing pain in patients with multiple sclerosis. And it blew my mind several years ago because it was incredibly high. Like in this survey of MS patients who, you never hear about pain, you hear about these modifying treatments, all the wonderful expanses that have been made. I mean, like seventy something percent of people say they have moderate to severe pain. And when you think about how sensory processing occurs, it makes perfect sense that a demyelinating disorder is going to interrupt the flow of information for a person to feel normal.  Dr Jones: Yeah, I think it's a good example of, there are things that we tend to focus on as clinicians where we worry about deficit and function and capacity. But if we're patient-centered and we ask patients what they care about, pain usually moves up higher on the list. And so, I think that's why we, it's maybe underrecognized with some of those central disorders, right? Dr Argoff: I think so, and I and I think you hit the nail on the head that - and we're also trained that way. I tell this to my patients very often so that they are reassured when I examine them and I say, and I tell them that everything looked pretty OK. It's not a medical term, I understand that. Because what we do in a typical neurological exam, even if it's detailed, doesn't really address all the intricacies of the nervous system. So it's really a big picture and sensory processing and especially picking up sensory deficits; you know, we use quantitative sensory testing and research studies and things like that, but bedside testing may not reveal the subtle changes. And when we don't see overt changes, we often think - that can lead someone to think that everything is OK and it's not. Dr Jones: So, when you when you see a patient who you've diagnosed with a central mechanism, so central neuropathic pain, how do you approach the management of those patients, Dr Argoff? Dr Argoff: I always review what treatments and what approaches have been addressed already. And I see if - a handful of time, we actually just submitted a paper for publication regarding this in a group of patients with pelvic pain who had untreated, difficult-to-treat chronic pelvic pain, seen all the urological kinds, gynecological things. Look, we picked up two patients who had unknown MS. So, it's just interesting when it comes down to that level. And we also picked up some patients who had subacute combined degeneration. So that's another central kind of disorder as well. Again, the neurologist in us says to make sure that we have specific diagnosis that underlies the central neuropathic pain. And so interestingly, of course, for somebody with MS - or even though it's uncommon, it could be more than one. Somebody with MS might have a stroke, somebody with MS might have a cord injury due to cervical, you know, joint disc disease. Not to overcomplicate things. Know the lay of the land, know the conditions, know what you're battling and lay out so that you can treat the treatable; you want to treat whatever you can correct? So, for MS you simply want to have the best disease-modifying treatment on board, tolerable and appropriate for that person, and so on. And then you really want to take a history of past treatments - and your treatments can be everything and anything, including behavioral modification, physical rehabilitative approaches, as well as pharmacologic management. That's - as I think I put in my article, we concentrated in the article on pharmacologic management because honestly, that's what most patients are looking for, is ‘what can we, what can you do to help me now, in addition to what I can do myself.' And that's what we typically think of. There are also some more interventional approaches, invasive options, that have developed over time. And of course, those are the ones, some of them, especially in neuromodulation, that we have the least information about, but it appears somewhat promising.  Dr Jones: No, that's exactly what we need to hear. And you also mentioned something that I think is important. This is a common theme throughout the issue because I think it's true for the management of many different types of pain and interdisciplinary approach. In other words, not just honing in on pharmacotherapy or neuromodulation as a one-size-fits-all magic pill, right? So, that - tell us a little bit more about that interdisciplinary approach and how that's important for these patients. Dr Argoff: So, let me back up and give an example. Let's look at Botox for chronic migraine. So, the pre-M studies that led to the approval of Botox for chronic migraine: two treatment sessions versus two random, two placebo session in different patients. The mean headache frequency was, let's say, fifteen to twenty in each group. It was like seventeen, eighteen, something like that. But the mean pain headache day reduction was somewhere between four and five after two treatments compared to a lesser, a lower number in the placebo group. So, if you think about that, that means that you went from nineteen, let's say, to fourteen, thirteen, or twelve. Want to be generous, eleven or ten. But that means that person, everyone 's happy. We use treatment. We have better data than that because the longer you use it, the better it gets in general, but it means that people are still going to be symptomatic. So that drives home in a different painful disorder the importance of yes, treatment can be effective, but it's not the only treatment that a person is going to likely need. And so, I think that's what's so important about multidisciplinary approach. I- we may affect positive changes, reduction in pain intensity with a particular pharmacologic agent, but we don't anticipate it's like taking an antibiotic or a strep throat, not curative. And so, we want to, early on, to explain that logically, methodically, step by step. There are many options for you and we're going to, you know, systematically go through them. And I may need to call in some colleagues to help because I don't do everything. No one does everything, right? But don't feel as if there isn't any hope because there is. If we were to use intraspinal Baclofen for someone who has painful spasticity following a stroke or a spinal cord injury, combining that with physical therapy might give more effect, maybe synergistic. Some targeted muscles, some local muscles may not respond as well to the intraspinal Baclofen, so is that - what can we do? Well, we could use oral agents or we might be able to target that with botulinum toxin, and so on and so forth. So it's limitless, virtually, in what you can do. Dr Jones: There's kind of setting expectations and letting people know that you, you're going to need a lot of different approaches, right? To sort of get them the best possible outcome. Dr Argoff: Yeah, I think that's so important. And of course, no matter what we try to set out, there are going to be individuals - for those of you who are listening, we all know - who expect to be cured yesterday. That might be challenging for us not only to actually complete, but also, it's challenging for some individuals to appreciate that we're with them, we're going to work with them. It'll be a process, but we've got your back. Dr Jones: Great. And you know, this is a question that I get all the time from patients and from other clinicians is, you know, what about cannabinoids? What's the role of cannabinoids for the management of central neuropathic pain? Dr Argoff: First, I'll say that the short answer to that is we don't know. The second part of my response would be, there is new evidence that it might be helpful in the acute treatment of migraine. And I'm happy to say that the editor of this edition of Continuum is the person who developed that evidence, and it's been recently presented at the American Headache Society. But the challenge and the conundrum that we all face is, everywhere within our nervous system where there's pain being processed, there are endocannabinoid receptors. There also happen to be opioid receptors, but that's a separate issue. And the endocannabinoid system, the peripheral or central, you know, CB1, CB2, is very, very important, but we haven't figured out a way of harnessing that knowledge in developing an analgesic, an effective analgesic. And part of that is that there are so many chemical agents that have cannabinoid properties and there are different… the right balance has not yet been found. But even the legalization, the available of medical cannabis, hasn't led to a standardized approach to evaluating if a preparation does help. And that's part of the conundrum. It's like saying, ‘does medicine work?'Well, yeah, sometimes. But which medicine? Which receptor? How do you harness the right ratio between TBD, THC, other active agents, et cetera? And I think maybe as we go forward in the future, we'll be able to do that with - more precise. I mentioned Dr Schuster's study in which he had defined ratios of THC effect and CBD and was able to clearly show effect based upon that. But the average person going into a dispensary doesn't really get that. We don't get to study that. Each person's an NF1  and it's not very helpful to understand how to do that. I would say, as I'm sure you remember, there was a practice parameter that was published probably over a decade ago about using cannabis symptomatically in different neurological disorders. And I believe that it was what they studied or what they reviewed was helpful in MS-related urinary discomfort and spasticity, but not necessarily pain.  Dr Jones: And we're still in the early days of studying it, right? Dr Argoff: Yes.  Dr Jones: That's part of the point, as we got started late and we're still waiting for high-quality evidence. And I guess, if you look at the horizon, Dr Argoff, or the future of management of central neuropathic pain, what's going to be the next big thing?  Dr Argoff: One of the joys of being asked to get involved in a project like this is that inevitably we learn so many new things because, you know, that's when anyone says, oh, you must be an expert, I say, I don't know anything because I'm always learning something new. One of the reasons why I moved to Albany Medical College about seventeen years ago was to be able to further my interest in studying why people benefit from topical analgesics by working with a scientist at Albany Med who studied keratinocyte neurochemistry and its impact on pain transmission. And that's a separate issue, but it indicates my love for the peripheral nervous system. And one of my thoughts historically, that is, what the central nervous system processes is what it processes and it might get input, as you mentioned earlier, from the peripheral nervous system, so that topical agents could be dampening central mechanisms. And lo and behold, as I was doing research for this article, I learned that people doing peripheral nerve blocks - so blocking peripheral input at the into the spinal cord - at Washington University, Simon Guterian and colleagues, demonstrate that they could give prolonged benefit from central pain by blocking peripheral input. And that's wild because certainly the nervous system is a two-way street. It's an understatement. What I really found amazing was that, again, blocking input helped the injured central nervous system to behave better.  Dr Jones: That is kind of cool to think about. And I'll tell you, as editor of the journal, one of the funnest things is getting to learn all about neurology, including pain and including central neuropathic pain, when in the end you're doing all the work, I just get to sit here and enjoy it. And you're a program director of a pain fellowship. What's the pipeline look like? Are neurologists more interested in pain than they used to be?  Dr Argoff: I'm happy for this. We are seeing more and more applicants from neurology into our pain management programs. I would say… I was going to say tragically. If I say tragically, it's because what specialty better understands how to diagnose, figure out, assess, come to a conclusion? You can't have pain without your brain. It's always amazed me that more neurologists weren't interested, and I understand the background and such. Just like in migraine, it's only advances in understanding mechanisms of migraine that allow neuroscientific advances that are leading to great therapeutics - that's happening and increasing in ‘pain.' Today, as program director, we had our fellowship interviews earlier today and three of the nine applicants that we interviewed were neurologists. Last week, I think we interviewed two or three also. That would not have happened five years ago or six years ago. And if you think about it, we can not only diagnose, quote-unquote figure out what's happening, but we now, with pain management training, we can offer people a variety of both invasive and noninvasive options, all while understanding what we're doing with respect to the nervous system in a way that's different than the other specialties that typically go into pain med. And that's such - for me, it's a beautiful experience and something I really enjoy doing. There isn't a neurological condition in the most part that either doesn't have pain associated with it or doesn't have mechanisms that overlap. If you think about epilepsy, and please don't think I'm crazy, but epilepsy is associated with disinhibited hyper-excitatory behavior, just to put it loosely, among certain neurons. That's what pain and neuropathic pain is about too. And you, in fact, we know that several mechanisms since now what medicines are used for both. But what was interesting since, if I may just go back to another point, one of the advances since I brought up the migraine that's very exciting is the whole story about sodium channels. Dr Harouthounian at WashU and his group used lidocaine injection. Lidocaine's a more generalized sodium channel blocker, but some of the newest treatments for treating neuropathic pain. Our NAV specific sodium channel blocker's trying to match up mechanism to treatment. Not exactly the way that we do with migraine, but still a step forward to not just generally treat but really target different neuronal mechanisms. It's an exciting time.  Dr Jones: So, the pipeline is doing better because we're getting better understanding of disease, and hopefully that pulls in more interest because obviously there are big gaps in caring for patients with pain. And again, thank you, Dr Argoff, for an amazing article. Thank you for joining us and thank you for such a fascinating discussion. I enjoyed the article. I read the article, I learned from our conversation today. So, thank you for joining us to talk about central neuropathic pain. Dr Argoff: Thank you for having me. Dr Jones: Again, we've been speaking with Dr Charles Argoff, author of an article on central neuropathic pain in Continuum 's most recent issue on pain management. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Doctor Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Dr. Tesha Monteith provides an overview of the updated position statement on migraine prevention by the American Headache Society.  

In this special episode of Talking Head Pain, Joe is joined by renowned headache specialists Dr. Tepper and Dr. Ailani to discuss a groundbreaking shift in migraine treatment accessibility. They delve into the recent endorsement by the American Headache Society of calcitonin gene-related peptide (CGRP) blockers as the primary preventive treatment for migraines, a move that promises to simplify the patient's journey toward relief. This discussion explores the implications for insurance and pharmacy benefit managers practices and patient care, providing hope and actionable advice for those living with migraine. Contact Our Hosts: Joe Coe, Chief Value, Growth, and Therapeutic Solutions Officer, Country Manager, Canada at GHLF: jcoe@ghlf.org Sarah Shaw, Associate Director, Diversity, Equity and Inclusion at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.  See omnystudio.com/listener for privacy information.

We partnered with @HealthyWomen with support from Pfizer to answer some of the most popular questions about the difference between headaches and migraines.Our expert guest, Dr. Rashmi Halker Singh, shares real-time solutions to know the following:The difference between a headache and migraineHow to understand symptoms and why they are not the same for every womanWhy women of color are often misdiagnosed due to pain biasWhy clinical trials play a role in validating pain managementWhat you need to know when speaking with your doctorWhy you need a great girlfriend at your next appointment!Listen now and share your iTunes review with us!Follow now

In this special episode of Talking Head Pain, Joe speaks with Dr. Christopher Gottschalk, Director of Headache Medicine and the Headache Medicine Training Program at Yale University, Connecticut, live from the American Headache Society's scientific meeting. Dr. Gottschalk shares insights from a new study revealing how prolonged use of anti-CGRP drugs can reduce prodromal symptoms and the occurrence of headaches. He discusses the evolving understanding of migraine phases and the broader impacts of treatment on quality of life and cognitive function. Join Joe and Dr. Gottschalk as they discuss these significant advancements in migraine treatment and education. Contact Our Hosts: Joe Coe, Director, Chief Value, Growth, and Therapeutic Solutions Officer, Country Manager, Canada at GHLF: jcoe@ghlf.org Sarah Shaw, Associate Director, Diversity, Equity and Inclusion at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe is live from the American Headache Society's scientific meeting with Dr. Mario Peres, President-Elect of the International Headache Society. Dr. Peres, hailing from São Paulo, Brazil, discusses the application of artificial intelligence (AI) in migraine diagnosis and management. They discuss how AI tools are being developed to improve diagnostic accuracy, which is crucial for effective treatment. Dr. Peres emphasizes the importance of validating these AI models to ensure they provide reliable and useful outcomes.  Join Joe and Dr. Peres as they delve into the future of migraine care, emphasizing technology's role in enhancing patient self-management and care strategies. Contact Our Hosts: Joe Coe, Director, Chief Value, Growth, and Therapeutic Solutions Officer, Country Manager, Canada at GHLF: jcoe@ghlf.org Sarah Shaw, Associate Director, Diversity, Equity and Inclusion at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe is live from the American Headache Society's scientific meeting with Alicia Duyvejonck, a nurse practitioner at Genesis Headache Clinic in Davenport, Iowa. Together they discuss a research poster to which they both contributed titled "Person-Centric Communications in Migraine: Delphi-Like Consensus on Best Practice." This study, conducted using the Delphi consensus model, involved headache neurologists, nurse practitioners, psychologists, and advocacy community representatives, focusing on enhancing communication between patients and health care professionals in migraine care. They emphasize the importance of person-centric communication and individualizing treatment, highlighting key recommendations for both providers and patients to improve understanding and reduce migraine stigma.Join Joe and Alicia as they explore how effective communication is essential in managing this heterogeneous condition and fostering shared decision-making. Contact Our Hosts: Joe Coe, Director, Chief Value, Growth, and Therapeutic Solutions Officer, Country Manager, Canada at GHLF: jcoe@ghlf.org Sarah Shaw, Associate Director, Diversity, Equity and Inclusion at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe speaks with Dr. Nada Hindiyeh, Director of Headache Medicine at Metrodora Institute and CMO at Haven Headache & Migraine Center, and Dr. Lauren Natbony, Founder and CEO of Integrative Headache Medicine of New York. Recorded live at the American Headache Society's (AHS) Annual Scientific Meeting in San Diego, CA, they discuss the complex interrelations between migraine, autonomic disorders such as POTS, Ehlers-Danlos Syndrome, and Mast Cell Activation Syndrome (MCAS). They highlight the importance of a holistic approach to treatment and the innovative work being done to create special interest groups within the AHS to address these issues. Join them as they share insights and advances in treating these interconnected conditions. Contact Our Hosts: Joe Coe, Director, Chief Value, Growth, and Therapeutic Solutions Officer, Country Manager, Canada at GHLF: jcoe@ghlf.org Sarah Shaw, Associate Director, Diversity, Equity and Inclusion at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

Moderator: Anna Gryglas-Dworak (Wroclaw, Poland)Guest: Dimos-Dimitrios Mitsikostas (Athens, Greece)This podcast episode presents the current guidelines of the European Headache Federation (published in 2021, updated in 2022) and the American Headache Society (2024) on migraine treatment. Acute and preventive as well as new and old options are discussed.

Headache medicine relies heavily on the patient's history, perhaps more than any other field in neurology. A systematic approach to history taking is critical in evaluating patients with headache. In this episode, Katie Grouse, MD, FAAN, speaks with Deborah Friedman, MD, MPH, FAAN author of the article “Approach to the Patient With Headache,” in the Continuum April 2024 Headache issue. Dr. Grouse is Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Friedman is a neuro-Ophthalmologist and headache specialist in Dallas, Texas. Additional Resources Read the article: Approach to the Patient with Headache Subscribe to Continuum: continpub.com/Spring2024 Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Transcript Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: Stay tuned after the episode to hear how you can get CME for listening. Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr Deborah Friedman on approach to the clinic patient with headache, which is part of an issue on headache. Dr. Friedman is a neuro-ophthalmologist and headache specialist in Dallas, Texas. Deborah, I'd love if we could just start by you telling us more about you. How did you become interested in the diagnosis and treatment of headache? Dr Friedman: I guess one of the lessons in life that I have learned regarding this question is, “never say never.” I started as a neuro-ophthalmologist - that's what I did my fellowship in. My very first job was in Syracuse, New York, at Upstate Medical University, and there was no headache specialist in Syracuse at the time. And I started seeing neuro-ophthalmology patients and specifically told the person who did my scheduling for me, “Do not schedule headache patients. I am not a headache doctor; I'm a neuro-ophthalmologist.” Well, these people just snuck in the door. They got referred in for their visual disturbances, right - we know what that was - or for their, you know, transient loss of vision or some type of visual manifestation of migraine or eye pain, right? So, I started seeing the patients and I figure, “Well, I did a neurology residency; I can treat headache as well as anybody else.” And so I started treating their headaches. and they would come back to see me in follow-up and say, “You gave me my life back,” and I was pretty blown away by that. This was a few decades ago, and we didn't give very many people “their lives back” at the time in neurology, so I decided I should go learn more about headache medicine. And I started attending national meetings of what is now the American Headache Society. I found that I really, really loved treating headache, and it has a natural marriage with neuro-ophthalmology. As my career progressed, I ended up doing more headache medicine and less neuro-ophthalmology, but I still love both. Dr Grouse: Yeah, absolutely. I think the treatment of headache can be so satisfying and I'm so happy to hear that you were able to discover that love of treating headache in your own career. Why do you think it's important for neurology clinicians to read your article? Dr Friedman: Well, headache is the most common disorder seen in general neurology. It is actually the most common neurological disorder overall, by a factor of ten. And it is one of the most common causes of neurologic disability worldwide - like it's in (routinely in) the top five. So, it's an important problem, and patients are going to come see us, and we need to know how to effectively interview them so we can effectively manage them. I think, in a nutshell, that's why. Dr Grouse: You mentioned in your article the importance of making time to discuss the headache - so much so that, actually, you said that if they mentioned it offhand at the end of the visit that they have a headache, you really should be scheduling time for them to come back, to prepare and organize the information, and to have the time to really talk with them. I find this is such an important point and, in my mind, really gets to the heart of what you're trying to tell us in your article - that the way you take the history can make or break your ability to diagnose and treat the problem. Can you talk more about that? Dr Friedman: Sure. The history is absolutely the most important part of the office visit with headache medicine. I mean, they always say, “In medicine and in neurology, ninety percent of the diagnosis is made by history.” And that is more than true in headache medicine. So, you have to really get a good history. And it's a skill, but there's also kind of an art to it. So, there are certain questions you want to have answers to, but there's also this art of how to relate to the patient and how to really get them to tell you what you need to know, right? When I wrote the article, I really tried to convey that, because I think a lot of it can be learned. But there are a lot of nuances to taking a headache history, and I think that, for many people, it's helpful to have a guide to do that. Dr Grouse: Following up on what you just said - you mentioned, of course, the art of taking the good history for headache, which I completely agree is absolutely true. However, in your article, you also mentioned that things like various questionnaire tools, AI, can also be really helpful for diagnosis, which seems to be the opposite of the art of medicine. Tell me more about how you can incorporate that into taking your history. Dr Friedman: I find that questionnaires are incredibly helpful. I devised my own - it is one of the questionnaires that's available in the article (there's a link for it). It's not that I just read the questionnaire and I walk in the room knowing exactly what's going on - sometimes that's true - but at least I have a good idea of what I'm going to be facing when I walk into the room and start talking to the patient. The other reason (perhaps more importantly) that I think it's so helpful is because it gets the patient thinking about the details of their headaches and the details of their life and, you know, like, what medications they've taken in the past. And it really prepares the patient for the interview. In a lot of ways, I think that's more important than the information it gives me. But I do look at all the questionnaires, and I'll say, “Well, you know, you checked off this, and what did you mean by that? And you said this or that on your questionnaire.” And I kind of refer to it so they at least know that I looked at it - there's nothing more irritating than filling out a long questionnaire and then nobody ever looks at it - so, I do look at it and I do acknowledge in front of them that I have looked at it and am looking at it. But I think that they help in many ways. There are programs in AI that the patient will just enter information into online and the program will just spit out a narrative, as well as a diagnosis or a differential diagnosis. For clinicians that are really under a lot of time constraints, I think these can help considerably as well. Dr Grouse: That's really interesting, and that actually brings me to the next question I wanted to ask, which was - do you have any tips for the many busy neurologists out there (many listening to this podcast right now) who really want to do a good job gathering information and taking a careful history but are really limited on time to be able to do this? What other tools out there would you recommend for them, or tips? Dr Friedman: Yeah, I think that probably the questionnaires and the AI-based programs are very helpful. There is - I have no financial relationship with this company; I just happen to know about it and I know the people that developed it - but it's called BonTriage (as opposed to bon voyage), and it was developed by headache specialists. And I've seen the product and I've seen the output that can be used, and I think that one is incredibly helpful. It was really made for primary care, so that people could do this thing online and then just walk in with a piece of paper, hand it to their primary care doctor, and they'd have the whole history and the differential diagnosis. But it's equally as useful for neurologists. Dr Grouse: How about in history taking - any tricks to get the history you need and let the patient feel heard without necessarily taking lots of time going down the wrong pathway? Dr Friedman: Yeah, that can be really hard, and sometimes patients just want to bring you down what you would consider the wrong pathway (obviously, they consider it the right pathway). People have different styles of interviewing and people have different styles of answering the question. I find that it's often very obvious early on whether the patient is going to do better by asking closed-ended questions or asking open-ended questions. I always start with open-ended questions because the research says that that's more helpful, and that getting the patient to describe their headache disability is one of the most important things that you can do, so you should ask it right up front. But some people - when you ask them the questions (as you probably know), they just go on and on and on, and it's really not the way that you might process information. So sometimes I just have to take it back and ask them very specific questions – “Do you have this symptom? Do you have that symptom? How long does this last? What triggers your headache?” - that kind of stuff. It's very, I think, specific to an individual patient. Dr Grouse: Yeah, that absolutely makes sense. Your article highlights some important and frequently missed causes of headache, including hemicrania continua and intracranial hypotension, and specifically, you have some example cases that you talk about. I have to say, reading those certainly triggers my own latent fear of misdiagnosis of these important causes of secondary headache. Can you highlight some of the important questions to ask or situations to keep in mind in order not to miss these? Dr Friedman: Sure. You know, those examples in the article came from my practice. I had to alter them a little bit because they're not supposed to sound like real people, but the patient with hemicrania continua was a real - I wouldn't say necessarily “eye opener” - but it really hit home with me. I spent all this time taking the history from the patient. She'd seen numerous doctors beforehand; they all thought she had chronic migraine. I take her history and I think she's got chronic migraine too, but she's trialed several medications; they haven't really worked, so, you know, we kind of ended it. I said, “Well, I think you have chronic migraine.” She came back for her follow-up visit and looked at me and said, “Could I have hemicrania continua?” At which point, I panicked. It's like, “Oh my god - I think I take a pretty good history, but what did I miss?” I'm like, looking through the note from the last visit and trying to figure out where I went wrong. And where I went wrong was, I never asked her, “Are you ever completely headache free?” And that is such an important question to ask because most often, when people come in and they start talking about their headaches, they talk about their worst headaches, right? Those are the ones that are really interfering with their lives. They often will just totally neglect to tell you that they have a headache almost every single day, but it's just mild and they don't pay attention to it. That was like a big lesson for me, and I try - it's even on my questionnaire – “Are you ever headache free?,” because it's just so important to know that. Intracranial hypotension is also one that you really have to be a detective for. A lot of times, the imaging will help us, but about ten, fifteen, twenty percent of people with intracranial hypotension have normal imaging. Then it becomes like this whole quest of making a diagnosis based on your clinical impression, right? So, there are just a lot of different things that you can ask and there are a lot of different symptoms people can have. One of the important lessons I learned in there was asking about orthostatic headache; the common way to ask that is, “Does it get better when you lie down?” Well, with few exceptions, most people with headache prefer to lie down, right? People with migraine prefer to lie down. But their headache doesn't get better just because they were lying down. It gets better because they took medicine and maybe they went to sleep. So, it's not just, “Is it better when you're lying down?” Is not going to sleep is part of it? And conversely, we want to know like what they feel like when they first wake up in the morning before they get out of bed, right? So just asking about, “Well, what's your headache like in the morning?” - that's not going to necessarily get the answer you want. So there are, again, kind of fine points about asking some of these questions to really find out what you need to know. Dr Grouse: Absolutely - that makes sense, that the intracranial hypotension case was another one that really, you know, makes me go back and think, “Gosh, how many of these might I have missed in my own career?” You know, such an easy-to-miss case based on what was described. Dr Friedman: I go through the same thing. I think that, early in my career, I could think back to patients that I probably missed that diagnosis. One of them I even sent to (may he rest in peace) Dr Mokri, who described it, and I sent him the imaging. He said, “No, this patient doesn't have it.” But knowing what we know now, I think she probably did. Dr Grouse: Wow. Transition to some other types of questions - what's the most common misconception you've encountered in treating patients with migraine? Dr Friedman: I would say that a lot of people think that migraine has to be (as the name implies) hemicranial. A substantial proportion of adults and even a higher proportion of children have migraine headaches that affect both sides of the head. I think that's really the most common misconception. Dr Grouse: What's the easiest mistake to make (and potentially avoid) when treating patients with migraine, or headache in general? Dr Friedman: Studies have been done looking at this question in migraine. The first mistake is not giving the patient a correct diagnosis. And it is surprising in real life how many people walk out of the doctor's office and nobody's ever told them, “You have migraine with aura,” or “You have chronic migraine,” right, and giving them a very specific diagnosis. Second most common mistake in treatment is not offering them an acute treatment. So, many people are using over-the-counter medications that are not very effective, or even prescription medications that are not very effective. We have a lot of good treatments out now, and basically every patient with migraine should be offered an acute treatment. We also know that preventive treatment is massively underutilized. Again, studies (mostly by Richard Lipton and his group) have interviewed patients and done population studies, and people who clearly meet contemporary guidelines for offering preventive treatment are never offered it. So, I guess those would be my top three. Dr Grouse: Going on the theme of patients maybe not being offered the optimal treatments, what's the greatest inequity or disparity you see in treating patients with headache disorders? Dr Friedman: The first thing that contributes to that is - there is a shortage of headache specialists. There's also a shortage of neurologists, so that's a problem. There are certain groups that are less likely to seek care for headache. If people don't seek care, it makes it harder for us to treat them. African American males, in particular; Hispanics. I think that some of this might be stigma; some of this just might be cultural - I'm not sure. Women are more likely to seek care for migraine than men are. But there are what they refer to as, like, “islands of health-care disparity” throughout our country, where there are just not enough physicians, or even advanced practice providers working with physicians, to be able to take care of all these people. So, it's estimated that there are well over forty million people with migraine alone in the United States (not to mention all the other kinds of headaches), and there are really not enough of us to go around, and there are very long waiting times to get in to see us. So, some people will end up using the emergency room to treat their headaches, which is totally suboptimal and not a good experience for the patient, either. So, I think there are a lot of aspects to disparities in migraine care, and there is a group in the American Headache Society that actively focuses on this issue and has written papers about it. But I think it's multifaceted and it's going to take a lot of effort on both the part of us, as clinicians, as well as patients, recognizing that there is good treatment out there and people shouldn't have to live with these kinds of disorders. Dr. Grouse: Absolutely. This has been such an interesting article. I just wanted to end with one last question, which is, what do you think is the most important clinical message of your article that you hope our listeners take away from this podcast? Dr Friedman: I was really happy to be asked to write this article for Continuum. And I'm glad it is the lead article in Continuum because I think that taking the headache history is by far and away the most important part of the headache medicine evaluation. When I was asked to write it, I was specifically requested to write it from the perspective of a clinician seeing adult patients. And I just want to let the audience know that I did not neglect the pediatric patients - that there is a different chapter in Continuum that addresses the specifics of taking a history and what's important to ask from pediatric patients. It was really a joy to write the article. I hope that people read it and learn from it and enjoy it. Dr Grouse: I really thoroughly enjoyed this article - it was so interesting. Even as someone who does a lot of headache diagnosis and treatment myself, I learned a lot. I think it's such a rich source of information and I hope everyone takes advantage of the opportunity to read it and learn a little bit more about headache treatment and diagnosis. Thanks so much for coming to talk with us today. Dr Friedman: Thank you so much for inviting me. It was a pleasure. Dr Grouse: Again, today I've been interviewing Dr. Deborah Friedman whose article on Approach to the Patient with Headache appears in the most recent issue of Continuum on Headache. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

Headache is among the most common neurologic disorders worldwide. The differential diagnosis for primary and secondary headache disorders is broad and making an accurate diagnosis is essential for effective management. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Amy Gelfand, MD, who served as the guest editor of the Continuum® April 2024 Headache issue. They provide a preview of the issue, which publishes on April 3, 2024. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Gelfand is an associate professor at Benioff Children's Hospitals, University of California San Francisco in San Francisco, California. Additional Resources Continuum website: ContinuumJournal.com Subscribe to Continuum and save 15%: continpub.com/Spring2024 More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @aagelfand Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by clicking on the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes.   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum Lifelong Learning in Neurology. Today, I'm interviewing Dr Amy Gelfand, who recently served as Continuum's guest editor for our latest issue on headache disorders. Dr. Gelfand is a child neurologist at the University of California, San Francisco, where she is an associate professor of neurology, and she also happens to be Editor-in-Chief of the journal Headache. Dr Gelfand, welcome, and thank you for joining us today. Dr Gelfand: Thank you so much for having me. Dr Jones: Dr Gelfand, this issue is full of extremely helpful clinical descriptions and treatment strategies for headache disorders. With your perspective as the editor for this issue - and you've just read all these wonderful articles and edited these articles - what were you most surprised to learn? Dr Gelfand: I would say that the medication overuse headache article I think is where you'll find the most surprising content. This is an area in headache medicine that has been controversial. I think what we've got is new data - relatively new data, published in Neurology (in the Green Journal) in 2022 - the MOTS trial, showing that what we all thought was not necessarily true. In headache medicine, there was this mantra that, if somebody is overusing (too frequently using) a certain kind of headache acute medication, you've got to stop them; you've got to have them stop it completely before you can get them on a preventive treatment if you expect it to work. Turns out, in this trial, that's not the case. People were randomized to either stopping the overused acute medicine and starting a preventive versus continuing it and starting a new preventive, and they did equally well. I think that's really taught us that that dogma was not based in evidence (was not true), and what really matters is getting a patient started on an effective migraine preventive treatment. Dr Jones: Wow, that is really – that is kind of ground shaking, isn't it? That's going to change a lot of practices for a lot of neurologists out there. Do you think that's going to be well received, or has it been well received so far? Dr Gelfand: I think it has. I want it to get out there further, so I hope everybody will read in that chapter and really pick up on that piece. I think it's helpful for patients, too - that we don't necessarily need to disrupt what makes them feel like they're getting some acute, in-the-moment relief. We just need to make sure we're getting a good-quality migraine preventive therapy started. That's the most important thing. We don't necessarily need to ask them to change something about their acute treatment. Dr Jones: That's fantastic, and it certainly could make things a little more straightforward, I think for people who are helping patients manage this. To be honest with you, the term, “medication overuse” almost sounds like it's putting the onus on the patient a little bit. Dr Gelfand: It very much does sound that way. It is a very challenging term for a lot of reasons. And I agree with you that that's a problematic part of this whole terminology. Dr Jones: Well, just three minutes into the interview here and, Dr Gelfand, you've already changed people's practice. I think that's wonderful, and we'll look forward to reading that specific article in the issue. Again, from your view as a headache specialist and a leader in the field, what do you think the biggest debate or controversy is in headache medicine right now? Dr Gelfand: I think where we're really a little bit stuck in trying to figure out how to move forward is how to take care of patients who have continuous headache. It's not even really a fully defined term, but if you imagine a person who - they wake up, headache is present; it continues to be present throughout the entire day; they go to bed- it's still present; if they happen to wake up in the middle of the night to go to the bathroom, it's there then - it's just there all the time. It can be hard to imagine that situation is real - that somebody could have a headache that is continuously present for weeks, months - but this is true of some of our patients who have chronic migraine, our patients who have new, daily, persistent headache, certain other headache disorders. This entire group of patients who have continuous headache have historically been excluded from treatment trials, so our existing data don't necessarily generalize to how to treat their condition. And we need to change that, because this is a group that is arguably most in need of research, most in need of effective therapies. The question is how? Who exactly should be included in the inclusion criteria? And then, what are your outcome measures? Historically, in migraine treatment trials, we use headache days per month or migraine days per month. Days of headache per month may or may not be the right primary outcome measure for somebody who's starting from a point of continuous headache. Maybe more appropriate is, how many severe headache days you're having in a month, or how much disability you have from your headache disease. It's an area that's evolving and really does need to evolve, because this is a patient population that has been underserved in research thus far. Dr Jones: I learned that, I think, in reading one of the articles talking about continuous headache at onset – so, the headaches that are continuous from day one, which is, as I understand it, pretty uncommon. But really very little of the clinical trial data speak to how to care for those patients - is that right? Dr Gelfand: That is exactly right. And, epidemiologically, maybe not as common. But in a headache clinic, we certainly see patients who have had these headache disorders where it starts on one particular day, it becomes continuous within twenty-four hours of onset and has now been going for at least three months, and we would call that new, daily, persistent headache. Or equally commonly, people with chronic migraine where it ramped up over maybe a short to medium-long period to daily and continuous. And now they have been experiencing continuous headache for some number of months, if not longer. Dr Jones: This question may be a little bit of an unfair question. One of the challenges with headache is that, unlike some other areas of a diverse specialty of neurology, there aren't as many biomarkers as you might have for dealing with patients who have cerebral ischemia or neuromuscular disease. Do you find that that leads to more differences of opinion or more variability in diagnosis and management than you might see in other areas? Dr Gelfand: I'm so glad you asked that question. What I find that leads to is more stigma. Many of our patients are not believed, including by medical professionals who they've met before. People might think they are faking their symptoms, or that there's some sort of secondary gain, or this is something related to - they just don't know how to manage stress. This is a real problem for patients with migraine to be encountering so much stigma. As a headache medicine clinician, when I'm meeting a patient, oftentimes I need to make sure to acknowledge that, almost certainly, they've encountered that before. I need to reassure them that they're not going to be experiencing that in our headache clinic, and really try to undo some of that harm to be able to build trust that we're going to have a collaborative relationship moving forward - we're going to be a team; we're going to be determining the next steps in treatment together - and that I 100% believe them that the symptoms they are experiencing are real, are very challenging. Because migraine and other primary headache disorders are real neurologic diseases that can be quite severe. But because we have a paucity of biomarkers, it's hard for some people outside the field to recognize that. And that, I think, has been really difficult for patients historically. Dr Jones: So, a challenge for clinicians has become really more of a burden for patients. Dr Gelfand: Yes - well said. Dr Jones: Yeah. That's too bad, and maybe someday that will change, and probably can be approached from a couple of different directions, right? - from educating clinicians' perspective and also pursuing the science. This might be a related question, Dr Gelfand - what do you think the biggest misconception you've encountered in - I'm thinking mostly from the provider of the clinician community - what do you think the biggest misperception or misconception there is about patients who have headache and the management of those patients? Dr Gelfand: Well, I think it is tied in, in some way, to this notion that the patients are somehow causing their problem; that it's something about - well, I'm a child neurologist; I see adolescents and children – so, their parent is causing their problem because they're a helicopter mom or whatever it is, or they're just not managing stress in an appropriate way. I think that that is really an issue that patients are sort of handed from the medical community. Whereas if I step back and think about it, before 2018, no migraine-specific preventive therapies existed. We were borrowing from all other corners of medicine. We were borrowing from antihypertensives, antiseizure medicines, antidepressant medicines, but there was no actual migraine-specific therapy. Then came the monoclonal antibodies targeting CGRP (calcitonin gene-related peptide) - they're targeting either the ligand or the receptor. We now also have the oral forms that target the receptor, the gepants. So, we do have this one or two classes, depending on how you break that out, that are migraine-specific preventive therapies. But that's not enough for a complex disease like migraine - we need twenty of them. Look at epilepsy; there are probably twenty-plus antiseizure medicines, and yet, some patients still seize. Is that because they're anxious or stressed, or their mothers are too stressed? No - it's because some people have terrible epilepsy. And yet that same explanation has not been afforded to people with difficult migraine disease, that with just one class of migraine-specific preventive (or two, if you break out the monoclonals and the gepants) - that, somehow, they're supposed to have magically stopped with this treatment. That really doesn't make any sense. It's because we don't have enough effective therapies that they're still having difficult migraine - it's not because they're causing their disease. Dr Jones: Thank you - that's a great example. That is important to understand - that misconception about causation. And we may come back to causation here in a moment. It really doesn't make any sense that there are few specific, disease-modifying therapies for migraine, which affects tens of millions of people in the United States alone, right? Why is that? Why are there so few? Dr Gelfand: First of all, Dr Jones, I love it that you called it disease-modifying therapy, because that's how I think about it, too. The term, “preventive migraine therapy,” which is the more commonly used therapy, is not always really useful because - some people who have continuous headache will say, “Well, what are you trying to prevent? I've got headache all the time.” But this is really just treatments that are designed to dampen down disease activity in any form - how frequent, how long of duration, how intense - and I think it is really better conceptualized as disease-modifying therapy, so I love that you use that term. Why have there been so few? I think that it comes down to a paucity of research. Historically, NIH has underfunded migraine and other primary headache disorder research quite a bit, compared to how much disability those diseases cause in Americans each year. Hopefully, that will be getting better soon; I think there are some positive signs that that could be moving in a more positive direction. But I think, because migraine and other primary headache disorders are “invisible” illnesses - can't show you an x-ray with a broken bone; can't show you a lab readout with what your disease activity is; like you said, there's not a lot of biomarkers. Because of that, it's been hard for funders to really get behind it, and I think that's put us a little bit behind where we need to be. More research will lead to more therapies. Dr Jones: Let's hope so. It certainly is very common and affects, again, millions upon millions of people and leads to impaired quality of life and disability, as you point out. You are also the editor-in-chief of a leading journal in your field, Headache. I know many of our listeners who are neurologists and perhaps interested in editorial work as a career path might be curious - what led you to that, and how has it helped you as a clinician (being in that role)? Dr Gelfand: Yeah - I love being the editor of Headache. It's the journal of the American Headache Society. I think it's where the most interesting new science and work in headache medicine is coming out of. I have always found that reading helps me learn. If I want to learn about a topic, I need to read about it and I need to synthesize everything I read about. Being an editor makes that so accessible and fun. I really enjoy reading all of the articles that are coming in. It really helps me to think about everything I know, and thought I knew, in the field. And keeps my mind really questioning – do I really know that that's true or did I just think that's true? - and now this new data shows me that, actually, it's something else. And I really enjoy being challenged that way, on a daily basis, by new science that's coming in. So for anybody out there who has an interest in editing and playing an editorial role, I definitely encourage you to pursue that. There are programs - I know that the Green Journal has a resident and fellow section; that's where I started out, and I really had a wonderful experience in that. And then in our journal, in Headache, we have an assistant editor program for junior people - residents, fellows, postdocs - people who want to learn more about how to be an editor. I think that you learn so much about how to be a better writer, how to be a better scientist, how to communicate your findings in the most effective way. It's just invaluable and it's very fun. Dr Jones: It is kind of selfishly fun, isn't it? Dr Gelfand: Right, right. Dr Jones: Yeah, and it's important work, obviously - to put good information out into the world. At Continuum, we also have - on our editorial board, we have two residents and fellow positions, again, for that career development. I have to ask you a really hard question here, Dr Gelfand. You mentioned you read to learn; if you had to make a choice - electronic or print - what would it be? Dr Gelfand: Electronic. I know that many journals, including ours, are having to make some of these decisions right now. But I read my PDFs and I store them so that I can come back to them and search for them, and make sure, when I'm citing them, that they actually say what I thought they said because sometimes I need to look back at that. So, I am an electronic person. How about you? Dr Jones: I think I'm print. Dr Gelfand: Uh huh. Dr Jones: And I'm just sitting here thinking, there are so many people listening to this interview, and they're screaming at their device, saying, “Electronic is the answer,” or “Print is the answer.” Like you, we want to meet our subscribers where they are, and I think neurologists are very clear in their preferences. Let's just say we'll agree to disagree, and no one is right and no one is wrong – how about that? Dr Gelfand: Fair enough - I can respect that. Dr Jones: All right. I have one more question for you. This might sound like a strange question in an interview between two neurologists talking about headache - what can you tell us about chicken farming? Dr Gelfand: Well, I'd be delighted to tell you about chicken farming. As you know, because they were squawking earlier in our chat, I've got a little flock of chickens in our backyard and they are an absolute joy in my life. One thing I can tell you is that chickens respond to the photo period (how long the daylight is in a year). Now that it's November, it's the time of year when they don't get a lot of light, so they stop laying very much. I find that between Thanksgiving and about Valentine's Day, we actually start to need to buy eggs, which makes me very sad because I love having our egg supply come completely from our chickens. But we want them to rest and so that's what they're doing. Chickens will not lay very much at this time of year. During the summer and the spring and the fall (in the earlier part of the fall), they will lay almost daily, depending on which breed and how old they are. But at this time of year, it's really quiet - really, just one or two a week, I would say, right now. Dr Jones: It sounds like a fun hobby. Hopefully the chickens don't mind that you're buying chickens in the winter, and they don't feel offended by that or jealous. Dr. Gelfand: I worry that they do. I try not to show them the grocery bags. Dr Jones: Well, Dr Gelfand, thank you so much for joining us today, and thank you for such a thorough and fascinating discussion on headache disorders from your unique position as a guest editor for Continuum, I do encourage all of our listeners to check out that issue. It's really full of phenomenal pointers on practice-changing tips and tricks for managing patients who have headache disorders. I'm really grateful for your time today. And thank you for telling me a little bit about chicken farming. Dr Gelfand: Thank you so much for having me. It was really fun. And thank you for your interest. Dr Jones: Again, we've been speaking with Dr Amy Gelfand, guest editor for Continuum's most recent issue, on headache. Please check it out and thank you to our listeners for joining today. Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. Right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024.

In this episode of Talking Head Pain, Joe is joined by Dr. Andrew Charles, Professor of Neurology and Director of the UCLA Migraine and Pain Program, as well as the current President of the American Headache Society (AHS). Together, they explore the groundbreaking updates in migraine prevention therapy, highlighting the AHS's recent position on CGRP inhibitors as a first-line treatment. Dr. Charles shares insights into the development of these migraine-specific therapies, their efficacy, and the significant impact they have on patients' lives, offering a glimpse into the future of migraine management.  Join Joe and Dr. Charles for a compelling conversation that shines a light on the latest advancements in migraine treatment and the positive changes they bring to the migraine community. For more information, visit: https://ghlf.org/migraine/ahs-recommends-cgrp-therapies/  Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org A podcast episode produced by Ben Blanc, Manager of Programs & Special Projects at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe speaks with Dr. Eyal Maoz Halevy, a Frontiers Award recipient at the American Headache Society's Scottsdale Headache Symposium. Dr. Eyal Maoz Halevy shares what he has found most impactful at the Symposium, and discusses his research on the role of physical activity as a vital sign (PAVS), revealing surprising insights about physical activity levels in migraine patients. Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org A podcast series produced by Ben Blanc, Manager of Programs & Special Projects at GHLF. We want to hear what you think. Send your comments, or a video or audio clip of yourself, to podcasts@ghlf.org   Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this week's episode of Talking Head Pain, Joe is joined by Dr. Nina Riggins, a board-certified neurologist who specializes in headache medicine and traumatic brain injury. The episode sheds lights on the intersection of migraine, weight management, and the impact of a new class of weight-loss drugs, GLP-1 agonists. Joe provides his own patient insight by sharing his personal experience with weight loss and migraine. Together, they also discuss the importance of a patient-specific plan and open communication between doctors and patients. Among the highlights in this episode: 01:47: Dr. Riggins discusses her excitement about the conversation around lifestyle, new medications, and new ways to treat migraine and headaches, along with the approach to weight loss 02:08: Joe talks about his own struggle with weight issues and the need for a more nuanced approach when addressing weight loss or gain in patients 03:47: Dr. Riggins explains the research she presented at the American Headache Society's meeting, focusing on GLP-1 agonists and their potential effects on people with migraine 05:10: Dr. Riggins delves into the multiple ways GLP-1 agonists work, including blood pressure control and blood sugar regulation 08:21: Joe shares the unexpected effects his weight-loss journey had on his migraine and overall health 11:45: Dr. Riggins elaborates on the changes that can occur when starting GLP-1 agonists 14:14: Joe emphasizes the importance of creating shared decisions between patients and providers for a successful treatment plan 16:20: Dr. Riggins discusses how medication may affect hunger and cravings and also elaborates on the role of energy in the migraine theory 18:56: Joe brings up how calorie deficits might initially make one feel tired 21:52: Joe and Dr. Nina discuss the Spoon Theory Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

Dr. Andrew Charles discusses new updates in the field of migraine following the American Headache Society conference.  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, we spoke with a variety of specialists in neurology who presented research and gave talks at 4 recent major medical meetings—the Consortium of MS Centers Annual Meeting, the Annual Joint SLEEP Meeting, the Advanced Therapeutics in Movement and Related Disorders Congress, and the American Headache Society's Annual Scientific Meeting. Those included in this week's episode, in order of appearance, are: Amit Bar-Or, MD, FRCPC, FAAN, FANA, the Melissa and Paul Anderson President's Distinguished Professor at the Perelman School of Medicine of the University of Pennsylvania. Gavin Giovannoni, MBBCh, PhD, FCP, FRCP, FRCPath, a professor of neurology at Barts and The London School of Medicine and Dentistry. Dayna Johnson, PhD, MPH, MSW, MS, a sleep epidemiologist and assistant professor at the Rollins School of Public Health at Emory University. John Winkelman, MD, PhD, the chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital. Laxman Bahroo, DO, a professor of neurology and the residency program director at MedStar Georgetown University Hospital. Ling Wan-Albert, OTD, OTR/L, an assistant professor of occupational therapy at the New York Institute of Technology. Sara Pavitt, MD, the chief of headache at UT Austin Dell Children's Hospital. Ali Ezzati, MD, the director of the Neuroinformatics Program at the University of California, Irvine. Want more from all of NeurologyLive's coverage of these medical meetings—including dozens more interviews with expert clinicians—click the links below: Consortium of Multiple Sclerosis Centers Annual Meeting SLEEP, the Joint American Academy of Sleep Medicine and the Sleep Research Society Meeting Advanced Therapeutics in Movement and Related Disorders Congress American Headache Society Annual Scientific Meeting Episode Breakdown: 1:15 – Bar-Or on the potential of BTK inhibition in multiple sclerosis at CMSC 2023 4:40 – Giovannoni on the understanding of MS as a smoldering disease at CMSC 2023 10:30 – Johnson on multilevel efforts to address modifiable factors of sleep health at SLEEP 2023 13:05 – Winkelman on moving away from dopamine agonists as first-line treatments for restless legs syndrome at SLEEP 2023 15:30 – Bahroo on the role of botulinumtoxins in Parkinson disease care at ATMRD 2023 19:00 – Wan-Albert on the impact of social isolation on cognition at ATMRD 2023 22:10 – Pavitt on the universal knowledge about pediatric headache for neurologists and nonspecialists at AHS 2023 24:05 – Ezzati on the use of machine learning models to improve treatment optimization in heterogenous migraine at AHS 2023 This episode is brought to you by Medical World News, a streaming channel from MJH Life Sciences®. Check out new content and shows every day, only at medicalworldnews.com. Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Dr. Tesha Monteith talks with Dr. Andrew Charles about new updates in the field of migraine following the American Headache Society conference in honor of National Migraine and Headache Awareness Month.  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

In this special episode of Talking Head Pain, Joe speaks with Dr. Barbara Nye, a Neurologist, Headache Specialist, and the Program Director for the Headache Fellowship at Atrium Health Wake Forest Baptist. Recorded live at the American Headache Society's (AHS) Annual Scientific Meeting in Austin, they discuss the latest trends and developments in headache research, including a focus on diversifying patient representation and understanding the unique experiences of different ethnicities and genders. Dr. Nye also sheds light on the AHS's ambitious plan for the next five to 10 years, with an aim to enhance headache diagnosis and management, possibly incorporating AI and genetic-based strategies. Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe speaks with Dr. Kristyn Pocock, a headache fellow, who shares her insightful research on the impact of breast size on headache. The discussion also delves into how personal experiences can inspire significant research, such as her own experience with migraine and breastfeeding, sparking her study into this correlation. Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe speaks with Dr. Hida Nierenburg at the American Headache Society's meeting in Austin. Dr. Nierenburg sheds light on the transformative potential of recent therapies in managing head pain and migraine, along with her anticipation for future breakthroughs in treatment. She also provides insight into her role as a mentor for her first fellow. Contact Our Hosts: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org Sarah Shaw, Senior Manager of BIPOC Community Outreach at GHLF: sshaw@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

In this episode of Talking Head Pain, Joe is joined by Dr. Nina Riggins, Director of the Headache and Traumatic Brain Injury Center at UC San Diego Health, a Neurologist, and Headache Specialist. By applying her passions for education and advocacy, Dr. Riggins is very active in the headache community and has participated in Neurology on the Hill as well as Headache on the Hill. Join Joe and Dr. Riggins as they discuss her work providing migraine education to primary care doctors as well as her education and advocacy efforts aimed at bolstering awareness so patients can reach earlier diagnosis and achieve better management of their symptoms. Dr. Riggins also shares the latest on migraine treatment options and research advancements. Among the highlights in this episode: 01:25: Dr. Riggins kicks off the episode by sharing her excitement with her work in the field of headache medicine 02:17: Dr. Riggins describes her work for the American Headache Society in providing education directly from headache specialists to primary care doctors 04:43: “It was amazing to me to see that Headache on the Hill this year did address pediatrics [on] kids issues with migraine… proposing [a] letter to the Department of Education to support our kids when they need extra resources in school to be successful in the long run, because migraine is not just a headache, it's a whole disorder of brain networks,” says Dr. Riggins 07:06: The challenges migraine patients face in terms of advocacy and access 09:42: Joe and Dr. Riggins discuss unmet needs for researchers, including biomarkers and precision medicine 12:08: The importance of pursuing research for long COVID, especially in the area of headache medicine 13:07: The link between autonomic dysfunction and migraine 13:42: “Some people can have these multiple headache disorders, migraine and cluster, even hoarse voice during attacks and it's because [of] this autonomic neurosystem,” says Dr. Riggins Contact Our Host: Joe Coe, Director, Therapeutic Area Growth and Integration at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel.See omnystudio.com/listener for privacy information.

Dr. Dorlyne Brchan, MD is a board-certified pediatric neurologist and board-certified headache physician with extensive background in treating headaches and migraines of all ages!   Dr. Brchan is a member of the American Headache Society and the Child Neurology Society. She was also awarded a delegate of the International Headache Academy in 2021. Furthermore, she has had the privilege of providing education and promoting advocacy to families and parents through Miles for Migraine. She has a special interest in adolescent care, complimentary and integrative management, as well as procedures in headache medicine. Dr. Brchan also serves her family as a devoted Army wife and mother of two young daughters. She has had the unique privilege of traveling the United States and, therefore, gaining diverse experiences in medical organizations and communities. She is a Christian which forms the foundation and backbone to all her values, goals, and pursuits. She deeply loves and cares for all those she has the privilege to know and serve.  Dr. Brchan jam packs this episode with all her expertise in headaches and migraines. 1. What causes migraines and headaches? 2. Top methods of treatment (preventive, abortive, therapies, supplements, procedures) 3. Nutrition and the gut-brain-microbiome axis 4. Biblical and faith-based perspective of pain 5. Mind-body therapies 6. Our faith-based headache coaching program launching late January/early February! Details below: Headache coaching program: 8 weeks long 8 weekly calls with group + 1-2 fifteen minute touch-base sessions; then 1:1 session Teach neuroscience of pain Pain re-processing therapy (Cognitive reframing from Biblical worldview); negative thoughts to become aware and focus on positive; mindset; growth from stagnant using neurolinguistic programming Gut health and nutrition; immune health, and more. Because this is a Biblical approach method, it is quite contrary to current secular treatment approaches, we're trying to provide this treatment approach ourselves without the ability to have financial backing of a specific medical organization. Our goal is to make it as affordable as possible and are praying about what God may do in the future to make this treatment approach even more accessible over time. We are trusting Him to provide the means for this to not only provide physical healing options but; most importantly bring our patients to the ultimate healer of all, Jesus Christ and tend to the proper nourishment of our relationship with Him and who we are in Him. Sign Up for a FREE 15-min discussion of the program to learn more (judgement and commitment-free!): https://www.healthispowher.com/ OR Email us at Hello@HealthIsPowHer.Com  ---------------------------------------------------------------- Sleep for Teens Coaching Program!!! Email us at hello@healthispowher.com If you think your teen needs help with their sleep, as we're launching our sleep coaching program just for adolescents this coming January/February 2023!  We can only take so many due to the nature of the group coaching program, but your teens will be coached by two top pediatric integrative medicine physicians in the country, as well as one who got the NIH federally-funded grant on sleep interventions for teens!!  These are evidence-based tools to help your teen thrive at school, perform well on exams, and go throughout the day without any daytime drowsiness, concentration, or focus issues!!  These are tried and true sleep methods for teens, so get your child's SPOT today!   --------------------------------------------------------------- And as our team is growing, we are launching our first faith-based headache and migraine coaching program for women (and a separate one just for teens!!) this coming February 2023. If you want to learn more, contact us through the form on the website, or email us at hello@healthispowher.com, or set up a time to schedule a call with us below!  Plus, your coach team consists of two physicians, one board-certified neurologist and headache physician, and one triple-board certified physician/headache doc with a multitude of clinical and personal experience with pain and headaches! https://www.healthispowher.com/ ------------------------------------------------------------- I'm now offering a FREE Call with ME for women who are finally ready to heal themselves from chronic pain and autoimmune symptoms that's holding them back from moving their bodies freely and having enough energy to do all the things they love again! Go to our website and sign up here!  Judgement and commitment FREE! https://healthispowher.com/ ------------------------------------------------------------ Ideal Life Without Pain Quiz: If you are a woman who has struggled with chronic pain, headaches, pelvic pain, or fibromyalgia.  If you have dreams of living a normal life again, free of pain and illness. If you want to have energy and feel refreshed when you wake up each morning. If you want to spend time with your loved ones. If you're into spiritual growth and personal development and may have dabbled in meditation. If you have sought support groups and answers to your healing.  If this sounds like you, I would be so GRATEFUL if you could take my survey so I can better serve you! and if you leave your e-mail, you'll get a free discovery call with me, Dr. Anna, MD https://forms.gle/ZCRSogcVARUk6PNJ8   ------------------------------------------------------------ Hope you enjoy! Don't forget to rate and review us on this podcast platform so we can continue reaching like-minded women! Drop us a comment or like on instagram @HealthIsPowHer and facebook @HealthIsPowHer ---------------------------------------------------------------- DISCLAIMER Anna Esparham, M.D.is a medical doctor, but she is not your doctor, and she is not offering medical advice on this podcast. If you are in need of professional advice or medical care, you must seek out the services of your own doctor or health care professional. This podcast provides information only, and does not provide any financial, legal, medical or psychological services or advice. None of the content on this podcast prevents, cures or treats any mental or medical condition. You are responsible for your own physical, mental and emotional well-being, decisions, choices, actions and results. Health Is PowHer, LLC disclaims any liability for your reliance on any opinions or advice contained in this podcast.  

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Annika Ehrlich, a nurse practitioner at the University of California, San Francisco Headache Center. Join Joe and Annika as they discuss her history in migraine care and the exciting topics they're hearing about at the symposium. Among the highlights in this episode: 00:24- Joe introduces his guest, nurse practitioner Annika Ehrlich 03:43- Annika shares her biggest takeaway from the conference that migraine patients should know 05:00- Joe and Annika discuss precision medicine for migraine patients Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Dr. Sarah Bobker, a headache medicine specialist who works at the University of California, San Francisco and is the Associate Editor for the American Headache Society's journal, Headache. Join Joe and Dr. Bobker as they discuss the growth of headache medicine fellowships and why this matters for patients. Among the highlights in this episode: 00:24- Joe introduces his guest, headache medicine specialist Dr. Sarah Bobker 01:12- Dr. Bobker tells Joe fascinating topics of discussion she is hearing while at the Symposium 02:12- Joe and Dr. Bobker discuss the growth of headache fellowships and what that means for patients   Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Dr. Liza Smirnoff, a headache specialist at the University of Miami. Join Joe and Dr. Smirnoff as they discuss the importance of care of migraine in pregnant women and those going through gender affirming care, as well as the work she and her peers are doing in reducing the amount of monthly migraine days in adults. Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Dr. Matthew Robbins, a neurologist and headache specialist. He is presenting on the relationship between migraine and COVID. Among the highlights in this episode: 00:24- Joe introduces Dr. Matthew Robbins, a neurologist presenting at the American Headache Society 01:14- Dr. Robbins shares his findings about the relationship between COVID and migraine 04:36- Joe and Dr. Robbins discuss whether other providers are also seeing an increase in migraine patients because of COVID Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Dr. Lauren Natbony, a headache specialist who tells Joe about the connection between autonomic disorders, like postural orthostatic tachycardia syndrome (POTS), and Ehlers-Danlos syndrome, and migraine. Among the highlights in this episode: 00:37- Joe introduces his guest, headache specialist Dr. Lauren Natbony 01:46- Joe asks Dr. Natbony about how finding the connection between autonomic disorders and migraine helps patients 02:41- Dr. Natbony shares the integrative approaches she uses with patients once she understands the root cause of migraine 04:27- Joe and Dr. Natbony discuss the non-pharmacologic ways of treating migraine Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

On this episode of Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium with Dr. Adelene Jann, a headache specialist and licensed acupuncturist. They discuss how acupuncture can be used for migraine patients. Among the highlights in this episode: 00:34- Joe introduces his guest, headache specialist and licensed acupuncturist Dr. Adelene Jann 00:55- Joe asks Dr. Jann about what she's learning about acupuncture/complimentary procedures and migraine while at the American Headache Society 01:37- Dr. Jann shares some of the research being done surrounding migraine and acupuncture 02:13- Joe asks Dr. Jann about other non-medication alternatives that migraine patients should have on their radar 02:47- Dr. Jann speaks on the benefits of strength training  for migraine patients 03:09- Dr. Jann offers the key discussion topics  that have been of interest to her while attending the symposium   Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

Today on Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium. He is talking to Dr. Vincent Martin, who is presenting on Ehlers-Danlos syndrome and  its effect on people living with migraine.    Among the highlights in this episode: 00:30- Joe introduces Dr. Vincent Martin, a speaker at the American Headache Society conference in Scottsdale, Arizona 00:47- Dr. Martin tells Joe about his talk on Ehlers-Danlos syndrome and its relation to migraine 01:52- Joe asks Dr. Martin how the research is helping advance care for patients Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

Today on Talking Head Pain, Joe is on location at the American Headache Society's Scottsdale Headache Symposium talking to Dr. Jennifer Robblee, a neurologist focusing on migraine and headache disorders. Dr. Robblee, a member of the Refractory, Inpatient, and Emergency Care (RIEC) specialty interest group, is researching effective ways to treat status migrainosus (or a headache that doesn't respond to treatment or lasts longer than 72 hours). Among the highlights in this episode: 00:37- Joe kicks off the episode by introducing Dr. Jennifer Robblee 01:21- Dr. Robblee tells Joe about the RIEC special interest group she works closely with and the emerging research from that group 03:24- Joe asks Dr. Robblee how her research on status migrainosus will help the patient communitySee omnystudio.com/listener for privacy information.

This week on Talking Head Pain, Joe is joined by licensed psychologist Dawn Buse, PhD. She's the Clinical Professor of Neurology at Albert Einstein College of Medicine in New York City, an Assistant Professor in Clinical Health Psychology, the doctoral program at Ferkauf Graduate School of Psychology, and a current fellow of the American Headache Society. Dr. Buse specializes in helping people along the emotional side of their migraine journey, providing a support system to those who need it. Join Joe and Dr. Buse as they discuss tips to help integrate healthy habits into daily life, and the concept that wellness is not linear. Among the highlights in this episode: 01:20- Joe starts the episode by asking Dr. Buse what drew her into becoming a clinician in the field of migraine and stress 03:02- Joe asks Dr. Buse how practitioners and researchers talk about Cognitive Behavioral Therapy and similar interventions in a way that affirms and uplifts people with migraine 06:45- Dr. Buse talks about the emotional impact patients have when she recommends cognitive behavioral therapy and other similar modalities 10:00- Dr. Buse shares tips that can make big life changes a bit easier 15:38- Joe and Dr. Buse discuss the importance of recognizing privilege in one's journey 19:15- Dr. Buse discusses the importance of viewing wellness and health as a dynamic journey and not a linear one 24:22- Dr. Buse shares other wellness-based practices she thinks Talking Head Pain listeners should know about 28:51- Joe and Dr. Buse discuss habit bundling as a way to integrate lifestyle changes into daily life 31:11- To close out the episode, Joe asks Dr. Buse about what excites her about the future of migraine research Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

Podcast: Teens and Headaches    Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat43   Target Audience             This activity is targeted toward all physician specialties.   Statement of Need  When pediatric patients present with headaches, a comprehensive evaluation should be conducted to determine if it is a primary or secondary headache. Providers should consistently utilize the latest diagnostic and management guidelines to effectively diagnose and manage their pediatric patients with headaches.   Objectives  At the conclusion of this offering, the participant will be able to:  Discuss the prevalence of headaches in the pediatric population. Discuss the symptoms and clinical characteristics of headaches including the distinction of symptoms between adults and teens.  Describe the diagnostic process for headaches in teens including red flags.  Identify effective management strategies for primary headaches including migraines in the teen patient.   Moderator Joe Flynn, D.O. Chief Administrative Officer Norton Medical Group Physician-in-Chief  Norton Cancer Institute   Speaker Brian Plato, D.O., FAHS Medical Director Headache Medicine, Neurology Norton Neuroscience Institute Norton Healthcare   Moderator, Speaker and Planner Disclosures   The planners and moderator of this activity do not have any relevant relationships to disclose.  The speaker, Brian Plato, D.O., FAHS has relevant relationships with: Allergan and Amgen - Advisory Board and Speaker Bureau; Biohaven – Speaker Bureau; and Teva - Advisory Board. These relationships have been successfully mitigated.   Commercial Support   There was no commercial support for this activity.    Physician Credits   Accreditation  Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation  Norton Healthcare designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Nursing Credits Norton Healthcare Institute for Education and Development is approved with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation (ANCC). This continuing professional development activity has been approved for .5 contact hours. In order for nursing participants to obtain credits, they must claim attendance by attesting to the number of hours in attendance. For more information related to nursing credits, contact Sally Sturgeon, DNP, RN, SANE-A, AFN-BC at (502) 446-5889 or sally.sturgeon@nortonhealthcare.org.   Resources for Additional Study:   Headache Diagnosis in Children and Adolescents https://pubmed.ncbi.nlm.nih.gov/29476266/   Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American https://pubmed.ncbi.nlm.nih.gov/31413171/   American Headache Society https://americanheadachesociety.org/     Norton Healthcare, a not for profit health care system, is a leader in serving adult and pediatric patients throughout Greater Louisville, Southern Indiana, the commonwealth of Kentucky and beyond. Five Louisville hospitals provide inpatient and outpatient general care as well as specialty care including heart, neuroscience, cancer, orthopedic, women's and pediatric services. A strong research program provides access to clinical trials in a multitude of areas. More information about Norton Healthcare is available at NortonHealthcare.com.     Date of Original Release |September 2022; Information is current as of the time of recording.  Course Termination Date | September 2024 Contact Information | Center for Continuing Medical, Provider and Nursing Education; (502) 446-5955 or cme@nortonhealthcare.org  

Listen to highlights of the 64th Annual Scientific Meeting of the American Headache Society.

Listen to highlights of the 64th Annual Scientific Meeting of the American Headache Society.

Listen to highlights of the 64th Annual Scientific Meeting of the American Headache Society.

Listen to highlights of the 64th Annual Scientific Meeting of the American Headache Society.

In this episode we discuss headaches, a problem that most if not all of us have had at some point in our lives.  For most people, a headache is a minor inconvenience relieved with an over the counter medication.  But what happens when the headache does not go away or keeps recurring? What do we do then?  What can we do to avoid headaches?  What home remedies and alternative therapies may be worth trying?  And when is it time to see a doctor and what are the long term treatment options.  To answer these questions and many more, we turned to a true expert.  Dr Teshamae Monteith is an Associate Professor of Clinical Neurology at the University of Miami, Miller School of Medicine. She is the Chief of the Headache Division and the program director for the United Council of Neurologic Subspecialties (UCNS) Headache Medicine fellowship program. Dr. Monteith received her medical degree at the University of Miami, Miller School of Medicine. She completed her Neurology residency training at New York University, and then pursued two fellowships in headache medicine at Thomas Jefferson University and University of California, San Francisco.  Dr Monteith currently serves on the editorial board for the American Migraine Foundation and the American Academy of Neurology's Brain and Life Magazine. She is the Headache Topic Chair for the 2022 AAN Annual Meeting Scientific Program abstract review process. She is also a co-recipient of the American Academy of Neurology's (AAN) Palatucci Advocacy Leadership Award and the American Headache Society's Wolff award. She has lectured both nationally and internationally, authored numerous publications and has provided peer review for both national and international journals. Dr. Monteith has served on several advisory boards for migraine and cluster headache. She has hosted over 80 podcasts for the AAN Neurology Journal/Neurology, Neurology Minute and Continuum Audio for topics important for neurologists including brain health, migraine, cluster headache and secondary headache disorders. And now, without further ado, I bring your our conversation with Dr Teshamae Monteith about the management of headaches.#headache #migraine #clusterheadache

Please visit answersincme.com/AFP860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in neurology discusses the most up-to-date recommendations and clinical evidence on oral calcitonin gene-related peptide (CGRP)–targeted therapies for the acute and preventive management of migraine disease. Upon completion of this activity, participants should be better able to: Review the latest American Headache Society consensus statement recommendations for the treatment of migraine disease; Describe the latest clinical evidence on approved oral CGRP-targeted therapies in the management of migraine disease; and Outline practical, patient-centered strategies to optimize the use of oral CGRP-targeted therapies in the management of migraine disease.

In this podcast episode, 2 migraine experts discuss clinical pearls for individualizing migraine care from diagnosis to ongoing management. They cover patient factors to consider in the differential diagnosis, when choosing an acute treatment, and in making the decision to initiate preventive treatment. This activity is available for CE/CME credit. Claim your credit at pce.is/migraine.ContributorsMaureen Moriarty, DNP, ANP-BCAssociate Professor DirectorMalek School of Nursing ProfessionsMarymount UniversityArlington, VirginiaOwnerMoriarty AssociatesWestminster, MarylandDr Moriarty:consultant/advisor/speaker: AbbVie/Allergan, Amgen, Biohaven, Lilly;researcher: Teva.Karen A. Williams, DNP, FNP-BC, AQHPresidentKDW Health ManagementPensacola, FloridaDr Williams: consultant/advisor/speaker: Biohaven.

In this special episode of Talking Head Pain, Joe speaks with Dr. Eric Kaiser, a professor and neurologist at the University of Pennsylvania. Learn about sleep and cannabis research presented at the American Headache Society, and the inspiring work being done to better serve LGBTQ headache and migraine patients. Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

In this special episode of Talking Head Pain, Joe speaks with Howard Rosen, the CEO of the American Headache Society. Learn about the history behind the American Headache Society — and how the research presented at their meeting helps patients and providers alike. Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

Joe talks with Dr. Robert Cowan, a professor and neurologist from Stanford University, about research on chronic/episodic migraine and how access barriers harm patients. Contact Our Host: Joe Coe, Director, Education and Digital Strategy at GHLF: jcoe@ghlf.org We want to hear what you think. Send your comments, or a video or audio clip of yourself, to TalkingHeadPain@GHLF.org. Catch up on all our episodes on our website or on your favorite podcast channel. To receive headache/migraine related resources, giveaways, and latest episode releases, text the word "Headache" to 1-845-285-1563 to sign up.See omnystudio.com/listener for privacy information.

Dr. Dawn Buse is a licensed psychologist who specializes in helping people live well with chronic diseases, including chronic pain. She is a member of the Board of Directors of the American Headache Society. She is currently a Clinical Professor of Neurology at Albert Einstein College of Medicine, and an Assistant Professor in the Clinical Health Psychology Doctor Program of the Ferkauf Graduate School of Psychology of Yeshiva University. Dr. Buse has been a co-investigator in multiple studies of migraine and a recipient of multiple research and professional awards for her work on headache conditions. In this podcast Dr. Buse will be discussing the behavioral approach to the management of headache migraine.

The American Migraine Foundation is a non-profit organization dedicated to the advancement of research and awareness surrounding migraine, a disabling condition that impacts more than 39 million men, women and children in the United States. In this episode, Dr. Christine Lay and Nim Lalvani cover:Challenges with getting diagnosed with migraine given the dynamics of our healthcare systemHow to get properly diagnosed and tools to help you do just thatImpact of migraines on individuals and loved onesHow to manage migraines including available treatmentsYou will definitely walk away empowered with a toolbox of resources to support you!Related EpisodesHow to Talk to Your DoctorResourcesDownload the American Migraine Foundation's patient toolsSign up for the World Migraine SummitAbout the American Headache SocietyIf you liked this episode and you're feeling generous, please leave a review on iTunes!And be sure to:Sign up for the Fempower Health Monthly NewsletterFollow  on Instagram for updates and tips.Shop the Fempower Health store for products discussed on the podcast.SponsorsReceptivaDx the sponsor of all of Season 2.  Provide code FEMPOWER-HEALTH for $75 off.About my GuestsDr. Christine Lay is a professor of neurology at the University of Toronto where she holds the Deborah Ivey Christiani Brill Chair in Neurology and she is the founding director of the Centre for Headache at Women's College Hospital. As someone who has had migraine most of her life, Dr. Lay understands firsthand the disability of this common brain disorder. She advocate for her patients and educates trainees and colleagues to better understand and treat migraine. In her position as a board member of the American Headache Society and the Canadian Headache Society, she works tirelessly on a clinical and research level to improve patient care and lessen migraine stigma. She is excited to be part of the American Migraine Foundation and work with AMF leaders to move against migraine.Nim Lalvani has worked in patient engagement, patient programming and patient advocacy for over 12 years. She has held leadership positions at organizations including the National Kidney Foundation, Younger Survival Coalition and New York State Health Foundation. As director of the American Migraine Foundation, she plans to fully commit to the needs of patients affected by migraine and ensure that they have access to support, resources and research that will empower them throughout their patient journey.**The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. Contains affiliate links.Support the show (https://www.patreon.com/fempowerhealth)

Join Dr Tepper and Dr Goadsby as they present cutting-edge data on the management of headache. Credit available for this activity expires: 8/4/2022 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/955861?src=mkm_podcast_addon_955861

David W. Dodick, MD, FRCP (C), FACP is a Professor of Neurology at the Mayo Clinic College of Medicine, and a consultant in neurology at the Mayo Clinic in Scottsdale, Arizona. At Mayo Clinic in Arizona, Dodick serves as the Director of the Headache Program and the Sports Neurology & Concussion Program.   Dr. Dodick is board certified by the Royal College of Physicians and Surgeons of Canada, and the American Board of Psychiatry and Neurology (ABPN). He also holds United Council for Neurologic Subspecialties certification in headache medicine and ABPN certification in vascular neurology. Dr. Dodick has authored more than 350 peer-reviewed publications and authored/edited 10 books. He is the Chair of the Sports Concussion Conference Workgroup and the AAN Annual Sports Concussion Conference of the American Academy of Neurology; and a member of the AAN's Annual Meeting Committee. He is a member of the scientific committee of the International Migraine Trust. He is Chair of the International Headache Academy. He is on the editorial board of several journals including Lancet Neurology, Journal of Neurology, Neurosurgery and Psychiatry, Postgraduate Medicine, Headache, and Cephalalgia.   Dr. Dodcik is the former President of the International Headache Society, former President of the American Headache Society, Chair of the American Migraine Foundation, Director of the US Academic Headache Consortium, and former Editor-in-Chief of Cephalalgia.   —   In today's podcast with Dr. Dodick we'll cover: 1. Dr. Dodick's professional journey 2. What is a concussion? 3. What is the future of concussion testing? 4. What is Synaquell? 5. The future of contact athletics. Have questions about this episode? Fill out the form below and we will connect with you directly! https://www.hawkindynamics.com/hawkinpodcast   Hawkin Dynamics is an industry leader in force plates, education, and support. Check out www.HawkinDynamics.com to learn more, or request a hassle-free quote to see what the HD System costs, here.

Clinical Significance of Micronutrient Supplementation in Critically Ill COVID-19 Patients with Severe ARDS  University Hospital Wuerzburg (Germany), June 12, 2021 Abstract The interplay between inflammation and oxidative stress is a vicious circle, potentially resulting in organ damage. Essential micronutrients such as selenium (Se) and zinc (Zn) support anti-oxidative defense systems and are commonly depleted in severe disease. This single-center retrospective study investigated micronutrient levels under Se and Zn supplementation in critically ill patients with COVID-19 induced acute respiratory distress syndrome (ARDS) and explored potential relationships with immunological and clinical parameters. According to intensive care unit (ICU) standard operating procedures, patients received 1.0 mg of intravenous Se daily on top of artificial nutrition, which contained various amounts of Se and Zn. Micronutrients, inflammatory cytokines, lymphocyte subsets and clinical data were extracted from the patient data management system on admission and after 10 to 14 days of treatment. Forty-six patients were screened for eligibility and 22 patients were included in the study. Twenty-one patients (95%) suffered from severe ARDS and 14 patients (64%) survived to ICU discharge. On admission, the majority of patients had low Se status biomarkers and Zn levels, along with elevated inflammatory parameters. Se supplementation significantly elevated Se (p = 0.027) and selenoprotein P levels (SELENOP; p = 0.016) to normal range. Accordingly, glutathione peroxidase 3 (GPx3) activity increased over time (p = 0.021). Se biomarkers, most notably SELENOP, were inversely correlated with CRP (rs = −0.495), PCT (rs = −0.413), IL-6 (rs = −0.429), IL-1β (rs = −0.440) and IL-10 (rs = −0.461). Positive associations were found for CD8+ T cells (rs = 0.636), NK cells (rs = 0.772), total IgG (rs = 0.493) and PaO2/FiO2ratios (rs = 0.504). In addition, survivors tended to have higher Se levels after 10 to 14 days compared to non-survivors (p = 0.075). Sufficient Se and Zn levels may potentially be of clinical significance for an adequate immune response in critically ill patients with severe COVID-19 ARDS.       Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms Louisiana State University, June 20, 2021 Insomnia is common in the elderly and is associated with chronic disease, but use of hypnotics increases the incidence of falls. Montmorency tart cherry juice has improved insomnia by self-report questionnaire. Study Question:  Is insomnia confirmed by polysomnography and is tryptophan availability a potential mechanism for treating insomnia? Study Design:  A placebo-controlled balanced crossover study with subjects older than 50 years and insomnia were randomized to placebo (2 weeks) or cherry juice (2 weeks) (240 mL 2 times/d) separated by a 2-week washout. Measures and Outcomes:  Sleep was evaluated by polysomnography and 5 validated questionnaires. Serum indoleamine 2,3-dioxygenase (IDO), the kynurenine-to-tryptophan ratio, and prostaglandin E2 were measured. In vitro, Caco-2 cells were stimulated with interferon-gamma, and the ability of cherry juice procyanidin to inhibit IDO which degrades tryptophan and stimulates inflammation was measured. The content of procyanidin B-2 and other major anthocyanins in cherry juice were determined. Results:  Eleven subjects were randomized; 3 with sleep apnea were excluded and referred. The 8 completers with insomnia increased sleep time by 84 minutes on polysomnography (P = 0.0182) and sleep efficiency increased on the Pittsburgh Sleep Quality Index (P = 0.03). Other questionnaires showed no significant differences. The serum kynurenine-to-tryptophan ratio decreased, as did the level of prostaglandin E2 (both P < 0.05). In vitro, cherry juice procyanidin B-2 dose-dependently inhibited IDO. Conclusions:  Cherry juice increased sleep time and sleep efficiency. Cherry juice procyanidin B-2 inhibited IDO, increased tryptophan availability, reduced inflammation, and may be partially responsible for improvement in insomnia.         Many with migraines have vitamin deficiencies, says study   Cincinnati Children's Hospital, June 10, 2021    A high percentage of children, teens and young adults with migraines appear to have mild deficiencies in vitamin D, riboflavin and coenzyme Q10—a vitamin-like substance found in every cell of the body that is used to produce energy for cell growth and maintenance.   These deficiencies may be involved in patients who experience migraines, but that is unclear based on existing studies.   "Further studies are needed to elucidate whether vitamin supplementation is effective in migraine patients in general, and whether patients with mild deficiency are more likely to benefit from supplementation," says Suzanne Hagler, MD, a Headache Medicine fellow in the division of Neurology at Cincinnati Children's Hospital Medical Center and lead author of the study.   Dr. Hagler and colleagues at Cincinnati Children's conducted the study among patients at the Cincinnati Children's Headache Center. She will present her findings at 9:55 am Pacific time Friday, June 10, 2016 at the 58th Annual Scientific Meeting of the American Headache Society in San Diego.   Dr. Hagler's study drew from a database that included patients with migraines who, according to Headache Center practice, had baseline blood levels checked for vitamin D, riboflavin, coenzyme Q10 and folate, all of which were implicated in migraines, to some degree, by previous and sometimes conflicting studies. Many were put on preventive migraine medications and received vitamin supplementation, if levels were low. Because few received vitamins alone, the researchers were unable to determine vitamin effectiveness in preventing migraines.   She found that girls and young woman were more likely than boys and young men to have coenzyme Q10 deficiencies at baseline. Boys and young men were more likely to have vitamin D deficiency. It was unclear whether there were folate deficiencies. Patients with chronic migraines were more likely to have coenzyme Q10 and riboflavin deficiencies than those with episodic migraines.   Previous studies have indicated that certain vitamins and vitamin deficiencies may be important in the migraine process. Studies using vitamins to prevent migraines, however, have had conflicting success.     Research suggests mask-wearing can increase struggles with social anxiety University of Waterloo (Canada), June 21, 2021 People who struggle with social anxiety might experience increased distress related to mask-wearing during and even after the COVID-19 pandemic. A paper authored by researchers from the University of Waterloo's Department of Psychology and Centre for Mental Health Research and Treatment also has implications for those who haven't necessarily suffered from social anxiety in the past. "The adverse effects of the COVID-19 pandemic on mental health outcomes, including anxiety and depression, have been well-documented," said David Moscovitch, professor of clinical psychology and co-author of the paper. "However, little is known about effects of increased mask-wearing on social interactions, social anxiety, or overall mental health. "It is also possible that many people who didn't struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future -- especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written." Social anxiety is characterized by negative self-perception and fear that one's appearance or behaviour will fail to conform with social expectations and norms. Social anxiety disorder is an extreme manifestation that affects up to 13 per cent of the population.  The researchers reviewed existing literature addressing three factors that they hypothesized might contribute to social anxiety associated with mask-wearing: hypersensitivity to social norms, bias in the detection of social and emotional facial cues, and propensity for self-concealment as a form of safety behaviour. "We found that mask-wearing by people with social anxiety is likely to be influenced by their perception of social norms and expectations, which may or may not be consistent with public-health guidelines and can vary widely by region and context," said Sidney Saint, an undergraduate psychology student at Waterloo and lead author of the paper. The paper also highlights that people with social anxiety have difficulty detecting ambiguous social cues and are likely to interpret them negatively. These individuals also tend to worry about sounding incomprehensible or awkward. "We believe that both issues are likely to be magnified during interactions with masks," Saint said. Another highlighted impact is that masks can function as a type of self-concealment strategy that enables people with social anxiety to hide their self-perceived flaws. Therefore, the desire for self-concealment may motivate their use of masks over and above their desire to protect themselves from contagion. "Due to their self-concealing function, masks may be difficult for some people to discard even when mask-wearing is no longer required by public health mandates," Saint said.  In addition to contributing insights to guide clinicians toward effective assessment and treatment, the paper shows that people with social anxiety may be particularly vulnerable to periods of norm transitions where expectations for mask-wearing are in flux or become a matter of personal choice.       Going with your gut can result in better decision-making than using detailed data methods, study shows City University London, June 21, 2021 Managers who use their gut instinct together with simple decision-making strategies may make equally good, but faster, decisions as those who use data to reach an outcome, a new study has found. The report, co-authored by academics at the Business School (formerly Cass), King's Business School, and the University of Malta, finds that the reliance on data analysis in decision-making might be counterproductive as this reduces decision-making speed without ensuring more accuracy. The research, based on information from 122 advertising, digital, publishing, and software companies, finds that using data to inform decision making under high uncertainty is often not optimal. This may explain why 12 different publishers initially rejected the opportunity to publish "Harry Potter and the Philosopher's Stone' – because it had no data to inform its potential. A recent survey revealed that 92 percent of Fortune 1000 companies were reporting increased investment in data initiatives, although it appears this may not always be necessary. The authors asked managers how they made decisions on their most recent innovation project, including the extent to which they used data, instinct, and other simple heuristics (mental strategies). The findings outlined that among those decision-making methods were: Majority—choosing what the most people wanted Tallying—picking the choice with the greatest quantity of positive points Experience—selecting the option that the most experienced individual on the team wanted. Managers were asked whether they think they made the right decision and how fast they were in reaching that decision. Results showed that managers relied on their own instinct as much as data, using 'tallying' more than any other metric. Dr. Oguz A. Acar, Reader in Marketing at the Business School and co-author of the report, said: "This research shows that data-driven decision-making is not the panacea in all situations and may not result in increased accuracy when facing uncertainty. "Under extreme uncertainty, managers, particularly those with more experience, should trust the expertise and instincts that have propelled them to such a position. The nous developed over years as a leader can be a more effective than an analytical tool which, in situations of extreme uncertainty, could act as a hindrance rather than a driver of success." "Choosing among alternative new product development projects: The role of heuristics" is published in Psychology and Marketing.   Pretreatment by rosemary extract or cell transplantation improves memory deficits of Parkinson disease Damghan University (Iran) June 21 2021 According to news originating from Damghan, Iran, research stated, “The therapeutic effect of adipose tissue-derived stem cells (ADSCs) or RE on hippocampal neurogenesis and memory in Parkinsonian rats were investigated. Male rats were lesioned by bilateral intra-nigral injections of 6-OHDA and divided into six groups: 1. Lesion 2 and 3: RE and water groups were lesioned rats pretreated with RE or water, from 2weeks before neurotoxin injection and treated once a day for 8weeks post lesion. 4&5: Cell and alpha-MEM (alpha-minimal essential medium) received intravenous injection of BrdU-labeled ADSCs or medium, respectively from 10days post lesion until 8weeks later. 6: Sham was injected by saline instead of neurotoxin.” Our news journalists obtained a quote from the research from Damghan University, “Memory was assessed using Morris water Maze (MWM), one week before and at 1, 4 and 8weeks post 6-OHDA lesion. After the last probe, the animals were sacrificed and brain tissue obtained. Paraffin sections were stained using cresyl violet, anti-BrdU (Bromodeoxyuridine / 5-bromo-2'-deoxyuridine), anti-GFAP (Glial fibrillary acidic protein) and anti-TH antibodies. There was a significant difference of time spent in the target quadrant between groups during probe trial at 4 and 8 weeks' post-lesion. Cell and RE groups spent a significantly longer period in the target quadrant and had lower latency as compared with lesion. Treated groups have a significantly higher neuronal density in hippocampus compared to water, alpha-MEM and lesion groups. BrdU positive cells were presented in lesioned sites. The GFAP (Glial fibrillary acidic protein) positive cells were reduced in treated and sham groups compared to the water, alpha-MEM and lesion groups.” According to the news editors, the research concluded: “Oral administration of RE (Rosemary extract) or ADSCs injection could improve memory deficit in the Parkinsonian rat by neuroprotection.”     Inadequate vitamin D levels associated with interstitial lung disease Johns Hopkins University, June 20 2021.    An article appearing in the Journal of Nutrition documents a link between decreased vitamin D levels and a greater risk of early signs of interstitial lung disease (ILD), a group of disorders characterized by inflammation and scarring that can lead to lung damage. Although ILD can be caused by environmental and other factors, some cases have unknown causes. The investigation included 6,302 participants in the Multi-Ethnic Study of Atherosclerosis who had information available concerning their initial serum 25-hydroxyvitamin D concentrations and computed tomography (CT) imaging that included partial views of the lungs. Ten years after enrollment, 2,668 participants had full lung CT scans that were evaluated for presence of scar tissue and other abnormalities. Subjects who had deficient vitamin D levels of less than 20 ng/mL had more spots on their lungs that were suggestive of damage in comparison with subjects whose vitamin D was adequate. Among those who had full lung CT scans, deficient or intermediate (between 20-30 ng/mL) vitamin D levels were associated with a 50-60% greater risk of abnormalities suggestive of ILD. "We knew that the activated vitamin D hormone has anti-inflammatory properties and helps regulate the immune system, which goes awry in ILD," commented senior author Erin Michos, MD, MHS. “There was also evidence in the literature that vitamin D plays a role in obstructive lung diseases such as asthma and COPD, and we now found that the association exists with this scarring form of lung disease too." "Our study suggests that adequate levels of vitamin D may be important for lung health,” she concluded. “We might now consider adding vitamin D deficiency to the list of factors involved in disease processes, along with the known ILD risk factors such as environmental toxins and smoking.”

Dr. Sara Crystal MD is a board certified neurologist and (UCNS certified) headache specialist. She completed her neurology residency at NYU, where she served as a chief resident, followed by a fellowship in Headache and Facial Pain at the Montefiore Headache Center of Albert Einstein. Dr. Crystal is a neurologist at the New York Headache Center and a member of the American Headache Society and International Headache Society. Join us Thursday nights at 8 PM EST on Instagram live @jowma_org for our latest podcast discussions!!

Dr. Sara Crystal MD is a board certified neurologist and (UCNS certified) headache specialist. She completed her neurology residency at NYU, where she served as a chief resident, followed by a fellowship in Headache and Facial Pain at the Montefiore Headache Center of Albert Einstein. Dr. Crystal is a neurologist at the New York Headache Center and a member of the American Headache Society and International Headache Society. Join us Thursday nights at 8 PM EST on Instagram live @jowma_org for our latest podcast discussions!! This podcast is powered by JewishPodcasts.org. Start your own podcast today and share your content with the world. Click jewishpodcasts.fm/signup to get started.

  I’m really lucky to know a lot of amazing people.   And there are a few that aren’t technically entrepreneurs!   Dr. Cynthia Armand is my dear friend from college. We met our freshman year at the auditions for the prestigious dance troupe Precision and we were the only two freshmen to get in.   We became fast friends and eventually co-directed the dance group as seniors–something that I am extremely proud of.   These days Cynthia is an Assistant Professor of Neurology at Montefiore-Einstein and the Fellowship Director at the prestigious Montefiore Headache Center here in NYC. She is on the founding board of the Society of Haitian Neuroscientists, where she also serves as Vice President.   She is the current web editor at JAMA Neurology and the host of the JAMA Neurology author interviews podcast. She is also heavily involved in Diversity, Equity, and Inclusion work and headache education with the American Headache Society.   Cynthia is an avid lover of neurology and health news with a strong interest in patient education as well as social media as a valuable means of patient empowerment and knowledge.   In college, it was clear that Cynthia was always going to be a doctor. She loved acting and performing but becoming a doctor always came first. It was exciting to talk with her about how these two loves came together.   Tune into this episode to hear: How Cynthia made room for dance even while attending med school How, despite all of her successes, she still struggles with imposter syndrome, and what she has done to address this What she is doing to address the stigma and misconceptions around migraine disease How can we improve healthcare around headache medicine when it comes to diversity, equity, and inclusion   Learn more about Dr. Cynthia Armand: Instagram: @cynplifiedmd Twitter: @cynarmandmd   Learn more about Pia: Make Six Figures Your Biatch Application LEAP To Badass Authority The Show Your Business Who's Boss Crash Course Start reading the first chapter of my book Piasilva.com  

Suffering from the pain of headaches and migraines? This podcast offers vital information for those who experience migraine symptoms. Dr. Lucas helps listeners both understand what we know about these conditions and explains different therapeutics and what they do. Listen and learn What causes migraines, including genetic factors and environmental stimuli, Why research on chronic headaches treatment has lagged and how it is accelerating, and How therapeutics differ, what exactly they do, and what are the latest advances in treatment. Dr. Sylvia Lucas is a Clinical Professor Emeritus of Neurology at the University of Washington Medical Center. She brings an approachable, clear delivery of information for all-things-migraine in this episode. Her overview includes an explanation of why research has been less than optimal until recently. Research wasn't there in the early part of modern medicine in part because it was considered a "women's condition." Because stress is one of the most common triggers, sufferers were told to "buck up." But now scientists have a biological model and resources such as imaging to invest in careful study. For the most part, migraines are thought to be a genetic process. There are about 40 major and hundreds of minor genes linked to migraines. A major class of drugs to treat migraines called triptans were developed in the '80s and then advancement in therapeutics stalled. Recently, however, CGRP drugs were introduced, which are small molecule drugs. They block receptors very specific to migraine pain. In spring of 2020, one such drug called Nurtec was released, which can be taken without water and brings relief within an hour. She explains in detail how and also discusses daily habits that might help. She emphasizes the help a regular routine can offer migraine sufferers as well as other stress-relieving habits. She also talks about her current research into concussions and headache-related symptoms from this injury. Listen in for more about strategies for relief.  For more information, see the National Headache Foundation and the American Headache Society. Available on Apple Podcasts: apple.co/2Os0myK

Medication Overuse Headache is a monster medical problem.  It affects 3-4 % of the world population.  Listen to Dr. Daniel's discussion. Please stay on Podbean and listen to my other podcasts to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best.Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD  

Allodynia means that touch is perceived as painful.  Listen to Dr. Daniel's discussion of Allodynia with Migraine. Please stay on Podbean and listen to my other podcasts to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

The FDA written product information notes for all triptans says they are not allowed during breastfeeding.  Is this right?  Listen to Dr. Daniel's talk. Please stay on Podbean and listen to my other podcasts to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD  

Is Exercise good for Migraine?  Does it really help?  Listen to Dr. Daniel's talk. Please stay on Podbean and listen to my other podcasts to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

What is a Migraine Trigger?  Listen to Dr. Daniel's talk.Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best.Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

Pseudoephedrine is thought to work for headache.  Listen to Dr. Daniel's discussion to find out.  Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

Use of opioid narcotics in the ER is problematic.  This discussion relates options for treatment of Migraine in the ER.Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best. Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD 

What are the scientifically validated issues that trigger or aggravate Migraine?Listen and learn.Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best.Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

Many people have headaches and they live with them and treat with over the counter drugs like Advil and do okay.  But then some of these people may have a severe bout of headache lasting days and requiring a visit to the ER for a CT Head scan to be sure everything is okay.  Wouldn't it be nice to educate these people that they really have had Migraine all along and help them treat it and live with it better?  Listen to Dr. Daniel's explanation.Please stay on Podbean and listen to my other videos to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology, the American Headache Society, migraine textbook author, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best.Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podbean, and YouTube.Britt Talley Daniel MD

  L. Charleston IV, MD, MSc., FAHS: Headache Medicine. Clinical Associate Professor, Department of Neurology University of Michigan. He received is M.D. from Wayne State University. Dr. Charleston's research focuses on better understanding disparities and challenges in headache management among minority, vulnerable, and underserved populations, with the aim of developing strategies to reduce those disparities and inform health policy. He has also chaired the American Headache Society's (AHS) Underserved Population in Headache Medicine Special Interest Section. Jaime Sanders'journey with migraine has been a life-long one. From a toddler with abdominal migraine to a wife and mother with chronic intractable migraine, Jaime has learned to turn her pain into empowerment. She strives to do her best to find her optimal health. Advocating for headache disorders and mental health are her passions. She is the author of the award-wining blog The Migraine Diva, and was the Migraine Patient Advocacy Coordinator for Global Healthy Living Foundation. She also partners with the American Migraine Foundation and Shades for Migraine. You may reach her on Facebook, Twitter, Instagram, and YouTube.  

Episode 16: Snoop That HeadacheThe sun rises over the San Joaquin Valley, California, today is June 12, 2020. The results of the DAPA-HF (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial) were presented in November 2019. If you haven’t heard about it, here you have it: In patients with Heart Failure with reduced Ejection Fraction, both WITH and WITHOUT Type 2 Diabetes, dapagliflozin plus standard therapy reduced the risk of worsening Heart Failure events and Cardiovascular death and improved symptoms. Did you hear that? It improved heart failure outcomes in patients WITH and WITHOUT diabetes. This certainly opens a new window for potential use of SGLT-2 inhibitors in patients WITHOUT diabetes.On May 8, the CDC reported a significant decline in childhood immunizations since March. Let’s remember to prioritize well-child visits for patients who need vaccinations. As family physicians, we play an essential role in prevention, and we need to avoid the resurgence of preventable communicable diseases.  Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere.The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “The roots of education are bitter, but the fruit is sweet” –Aristotle.Going to school and learning requires effort, patience, and perseverance, but the consequences of your determination will be well worth it. Dear residents, you will learn something new every day of your lives, even if you don’t realize it. Today we will learn even more from one of our sweetest and smartest residents. Welcome Monica Kumar, thanks for being here with us. I understand you were working nights, but now you are rested and refreshed. Who are you?Question number 1: Who are you?My name is Monica and I am a second-year family medicine resident at the Rio Bravo Family Medicine Residency Program. So, a little bit about me, I was born in Malaysia, a small country located in Southeast Asia. In 2004, my parents and I moved to Bakersfield, California, a place I now call home. I went to Bakersfield High for high school and then graduated from UC Berkeley with a major in Integrative Biology. After undergrad, while trying to plan out the rest of my life career wise, I worked as an air testing chemist for a year, which made me want to run as far away as I can from being stuck in a lab, so I ran all the way to the beautiful island of Saint Marten to pursue a career in Medicine. After finishing medical school, I was very fortunate I was able to return home to learn and serve the community that has given me so many opportunities. For fun, I love playing badminton and ping pong, flying kites, walking my dog, gardening, going on adventures, and binge watching romantic comedies and horror movies on Netflix. Question number 2: What did you learn this week?So, after working multiple shifts in the ED while wearing the N95 for about 7-9 hours consistently and walking around with a daily headache, I thought it was only appropriate for me to talk a little bit about headaches, particularly the indications for imaging, assessment and management of headaches in the outpatient setting. I have had numerous patients who have come to clinic repeatedly complaining of headaches and, though we all have gotten headaches in our lifetimes, we often forget how debilitating it can be for patients who cannot find an appropriate treatment regimen to control their symptoms. There is a fine balance about when to treat headaches. We should not overuse medications because overuse can worsen migraine and tension headaches, but at the same time not controlling repeated headaches can result in central sensitization and transformation to chronic headaches that are intractable and difficult to treat. When to treat headaches First, we should perform a thorough interview of the patient presenting with frequent headaches. We have to ask about •   Associated symptoms: nausea, vomiting, photophobia, neck tenderness•   Duration of episodes and frequency•   Aggravating and alleviating factors (if the headache is worse with activity or light, or if there is any improvement with noise avoidance)•   Inquire about the intensity, location and quality of the pain •   Medications utilized and its effectivenessNext, we have to perform a thorough, focused physical exam carefully examining head, neck, eyes including fundoscopy, evaluating extraocular movements, visual fields, assessing sinus tenderness and gait Some labs to consider: CBC, CMP, ESR to evaluate for temporal arteritisThe next big question is when is imaging indicated. Being family physicians we do not want to expose our patients to excessive procedures and radiation but we have to find a fine balance by considering the pros and cons. The American Headache Society and American Academy of Neurology recommend the use of the mnemonic SNOOP to guide in the decision of obtaining further imaging The mnemonic SNOOP can be used to think about secondary causes of headaches and the need for imaging. S in snoop stands for Systemic symptoms and Secondary risk factors. You want to inquire if the patient has been experiencing fevers, chills, weight loss OR if they have a history of HIV or cancer.N in snoop is for Neurologic symptoms. Ask the patient if they have experienced any confusion, impaired alertness or alteration in consciousness of mentation. The presence of neurologic symptoms should prompt immediate evaluation for focal nervous system lesion.O stands for Onset: is the headache sudden, abrupt.O in snoop is for Older. A new onset or progressive headache in an older patient >50 years of age requires further investigation.P in the mnemonic stands for Papilledema.Per the American Headache Society and the American Academy of Neurology, if imaging is indicated at the outpatient setting always order an MRI without contrast instead of a CT. A CT should mainly be used in an emergent situation to r/o hemorrhage. Non-pharmacologic TreatmentReduce stressors, exercise, meditate, keep a headache journal.Address lifestyle issues such as poor sleep, lack of exercise, smoking, obesity, caffeine use in triggering headachesThe US Headache Consortium strongly recommends relaxation training with or without thermal biofeedback and cognitive behavior therapy for the treatment of migrainesOf note, patients with frequent headaches require both prophylactic and acute pharmacologic treatments. Question Number 3: Why is this knowledge important?Since headaches are one of the most common complaints we as family medicine physicians encounter, it is very important that we do not miss secondary causes of headaches which can be life threatening. Question number 4: How did you get that knowledge?After SNOOPing around AAFP articles pertaining to the treatment and management of headaches in the outpatient setting, I stumbled across the SNOOP mnemonic and thought it would help me and my fellow colleagues remember the indications for imaging and the danger signs that can prevent us from missing a life-threatening diagnosis Question number 5: Where did you get that knowledge?The information discussed was condensed from various AAFP articles titled “Frequent headaches: evaluation and management” “Migraine Headache Prophylaxis” as well as UpToDate’s headache article. That’s all for this week, stay tuned for the treatment and management which will be covered during our next episode with Dr Brito, hope you have a nice rest of your week.  Speaking Medical: Formication or delusional infestationby Dr Gina ChaForMication, with an M, (not to be confused with forNication with an N, which is consensual sexual intercourse between two unmarried people). ForMication is one of the terms used to describe the sensation of small insects crawling on (or under) the skin. Formication comes from the Latin word formica, which means ant. A patient with formication perceives the sensation as “real”, they have a fixed, delusion that they are infested by bugs, that’s why we also call it delusional infestation. Primary delusional infestation is a psychiatric disorder which cannot be treated only by reasoning with the patient that he or she is not infested by bugs. Delusional infestation is the most common form of monosymptomatic hypochondriac psychosis. Formication can also be secondary to substance abuse (methamphetamine, cocaine), or substance withdrawal (alcohol and benzodiazepines). Do not confuse formication with pruritus or paresthesias, which can be explained by an organic cause, but formication has a heavy psychiatric component. Espanish Por Favor: Chorro by Dr Claudia CarranzaHi this is Dr Carranza on our section Espanish por favor. This week’s word is cabeza. Cabeza means head, this word comes from Latin root “caput” which literally means head. Patients can come to you with the complaint: “Doctor, me duele la cabeza” or “Doctor, tengo pesadez de cabeza”, which means “Doctor, my head hurts” or “Doctor, my head feels heavy”. You can then continue the interview and ask about timing, duration, exact location, prior trauma, and associated symptoms, just like Dr Kumar eloquently explained before.  Now you know the Espanish word of the week, “CABEZA”. For your Sanityby Drs Lisa Manzanares, Gina Cha and Alyssa Der Mugrdechian—What is the medical term for owning too many dogs? A RoverdosePatient: Doctor, someone decided to graffiti my house last night!Doctor: So, why are you telling me?Patient: I can’t understand the writing, was it you?_______________Now we conclude our episode number 16 “Snoop That Headache”, Dr Kumar talked about how to determine if a headache needs imaging evaluation. Remember, SNOOP stands for Systemic and Secondary risk factors, Neurologic symptoms, Onset, Older, and Papilledema. ForMication (with an M) is used to describe the sensation of bugs crawling on or under the skin. It is an unusual symptom for a psychiatric or neurologic illness. This week we taught you the spanish word cabeza, which means head, so now you know what your patient is talking about when they said they have pain in their cabeza.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Alyssa Der Mugrdechian, Gina Cha, Lisa Manzanares, and Monica Kumar. Audio edition: Suraj Amrutia. See you soon! ___________________________References:Zoler, Mitchel L., “Heart Failure, Dapaglifozin Equally Effective for Those with and without Diabetes”, Family Practice News, Vol. 49, No. 12, December 2019.Santoli JM, Lindley MC, DeSilva MB, et al. Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:591–593. DOI: http://dx.doi.org/10.15585/mmwr.mm6919e2external iconWalling, Anne, MB, ChB, “Frequent Headaches: Evaluation and Management”, Am Fam Physician. 2020 Apr 1;101(7):419-428. https://www.aafp.org/afp/2020/0401/p419.htmlHa, Hien, PharmD, and Gonzalez, Annika, “Migraine Headache Prophylaxis”, Am Fam Physician. 2019 Jan 1;99(1):17-24. https://www.aafp.org/afp/2019/0101/p17.htmlWootton, Joshua, MDiv and col., “Evaluation of headache in adults”, UpToDate, https://www.uptodate.com/contents/evaluation-of-headache-in-adults?search=headache&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1, accessed on 6/11/2020.     

What can patients do to advocate for themselves and the migraine community? What does advocacy look like for physicians? In this episode, Dr. Larry Newman and Dr. Starling discuss how patients can participate in self-advocacy and community advocacy as a part of their migraine journey. They also chat about physician advocacy and why it is important for patients and physicians to #MoveAgainstMigraine. Move Against Migraine host Dr. Larry Newman is Vice Chair of the American Migraine Foundation and a neurologist at NYU Langone. Dr. Amaal Starling is a neurologist and headache specialist at the Mayo Clinic Arizona and the chair of the American Headache Society’s Advocacy Committee. Additional Resources: Guide to Migraine Self-Advocacy Seeking Medical Help for Your Migraine Talking to your Doctor about Migraine

Dr. Diana Driscoll is an internationally recognized researcher, inventor, speaker, author, and patient advocate. An optometrist by education, she was disabled for over a decade with “invisible illnesses”. Now fully recovered, she is the recipient of two patents to date and continues her research as President of Genetic Disease Investigators. She is the founder and Clinical Director of POTS Care -- the only clinic dedicated to treating the underlying medical causes of POTS -- not just the symptoms. She is also a partner at TJ Nutrition. Dr. Driscoll graduated summa cum laude from both The University of Houston College of Optometry and The University of Texas at Austin. She is a geek, through and through. She is a member of the International Society of Neurovascular Disease, the American Headache Society, the Medical Advisory Board for EDS Network C.A.R.E.S, the American Optometric Association, the Tear Film and Ocular Surface Society, and served as a medical advisor for the Ehlers-Danlos National Foundation. Her peer-reviewed medical abstracts include those involving vascular abnormalities in the fundus of POTS patients, the etiology of left ventricular diastolic dysfunction, and the use of acetazolamide in multiple sclerosis. She is the author of “The Driscoll Theory” -- the publication revealing the propensity for high intracranial pressure in POTS patients that dramatically altered how this condition was evaluated and treated. She has also authored “Your Eyes and EDS”, and was the chief author of the “Ophthalmology Medical Resource Guide” for Ehlers-Danlos National Foundation. Dr. Driscoll is the recipient of numerous awards for patient advocacy and continues to donate her time to help others across the globe through her online forum and videos on YouTube. Her work in chronic inflammation, the autonomic nervous system, collagen disorders, and organ dysfunction can help others live their best life, as well as have their best body and mind. --Topics listed below. The NEW CorSense HRV sensor: https://elitehrv.com/corsense Leave a quick review for the podcast: https://elitehrv.com/review-ep-42 (Thanks in advance!) Learn about Heart Rate Variability at The Elite Academy: https://elitehrv.com/ep-42 TOPICS: 1:00 - Intro to Dr. Driscoll 4:35 - What led Dr. Driscoll to look into POTS 11:00 - Where does the Vagus nerve come in? 16:35 - Her surprising discovery involving nicotine 20:00 - The importance of communication between the brain and the state of your organs 22:45 - Narrowing down the cause of her POTS 24:15 - Why using nicotine is not a good solution 26:20 - Neurotransmitters and why acetylcholine is important 29:00 - The health of your autonomic nervous system and longevity 35:00 - How she went from the nicotine patch to her oral supplement 41:35 - Invisible illness: what is POTS, really? 47:00 - POTS and measuring HRV 50:00 - Top practical tips to start making progress towards improving Vagus nerve function 53:00 - Takeaways 55:15 - Where to find Dr. Driscoll Guest: Dr. Diana Driscoll https://prettyill.com/the_driscoll_theory/ http://bit.ly/36mU0ro Host: Jason Moore https://elitehrv.com Show notes: https://elitehrv.com/podcast Leave a quick review for the podcast: https://elitehrv.com/review-ep-42 (Thanks in advance!) Learn about Heart Rate Variability at The Elite Academy: https://elitehrv.com/ep-42 The NEW CorSense HRV sensor: https://elitehrv.com/corsense --

Britt Talley Daniel MD is a neurologist and a headache doctor.  He is member of the American Academy of Neurology and the American Headache Society.  He has published 2 books on migraine available on Amazon as eBooks and in print.  The books are Migraine and The Mini Neurology Series Volume 1 Migraine.He has a webpage at www.doctormigraine.com and also publishes YouTube videos on migraine under his name, Britt Talley Daniel MDThis first podcast is a general description of Migraine without aura.  Stay tuned for more about migraine.Best wishes to all.Britt Talley Daniel MD

Introduction: Dr. Diana Driscoll is an internationally recognized researcher, inventor, speaker, author, and patient advocate. An optometrist by education, she was disabled for over a decade with “invisible illnesses”. Now fully recovered, she is the recipient of two patents to date and continues her research as President of Genetic Disease Investigators. She is the founder and Clinical Director of POTS Care — the only clinic dedicated to treating the underlying medical causes of POTS — not just the symptoms. Dr. Driscoll graduated summa cum laude from both The University of Houston College of Optometry and The University of Texas at Austin. She is a member of the International Society of Neurovascular Disease, the American Headache Society, the Medical Advisory Board for EDS Network C.A.R.E.S, the American Optometric Association, the Tear Film and Ocular Surface Society, and served as a medical advisor for the Ehlers-Danlos National Foundation. Her peer-reviewed medical abstracts include those involving vascular abnormalities in the fundus of POTS patients, the etiology of left ventricular diastolic dysfunction, and the use of acetazolamide in multiple sclerosis. She is the author of “The Driscoll Theory” — the publication revealing the propensity for high intracranial pressure in POTS patients that dramatically altered how this condition was evaluated and treated. She has also authored “Your Eyes and EDS”, and was the chief author of the “Ophthalmology Medical Resource Guide” for Ehlers-Danlos National Foundation. Dr. Driscoll is the recipient of numerous awards for patient advocacy and continues to donate her time to help others across the globe through her online forum and videos on YouTube. Her work in chronic inflammation, the autonomic nervous system, collagen disorders, and organ dysfunction can help others live their best life, as well as have their best body and mind. Diana Driscoll, OD POTS Care, PLLC 6114 Colleyville Blvd Colleyville, TX 76034 O: 1-866-349-9905 E: Info@POTSCare.com Orders@TJNutrition.com Websites: To order Parasym PlusTM: Parasym Plus Vagus Nerve Support Parasympathetic Nervous System Support To order products all discussed on this podcast: www.VagusNerveSupport.com Clinic: www.POTSCare.com The only clinic dedicated to treating the underlying medical causes of POTS — not just the symptoms. Social Media: https://www.facebook.com/potscare https://www.facebook.com/ParasymPlus

Migraine:  Diagnosis and Treatment  Evaluation and Credit: https://www.surveymonkey.com/r/MedChat9 Target Audience             This activity is targeted toward internal medicine, family medicine, pediatrics, and neurology.    Statement of Need  A recent study concluded that 12 percent of Americans suffer from migraine headaches and migraines/headaches is a top diagnosis for physician visits.  Providers should be current on recognizing the symptoms of migraines as well as how to treat migraines or when to refer to a neurologist. Objectives At the conclusion of this offering, the participant will be able to: Diagnose headache disorders and migraines. Describe treatment and preventative therapies for migraines, including both prescribed and over-the-counter. Discuss emerging trends in the treatment of migraines. Moderator Joe Flynn, D.O., MPH, FACP Chief Administrative Officer Norton Medical Group Physician-in-Chief Norton Cancer Institute   Speaker Brian Plato, D.O. Neurologist Norton Neuroscience Institute   Speaker Disclosure The speaker has the following conflicts of interest to disclose:  Honoraria and Speakers Bureau - Eli Lilly and Company and Amgen.   Moderator and Planner Disclosures  The moderator and planners for this activity have no potential or actual conflicts of interest to disclose.   Commercial Support  This activity has not received commercial support.   Physician Credits   American Medical Association   Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation Norton Healthcare designates this enduring material for a maximum of .50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Date of Original Release | December 2019 Course Termination Date | December 2020 Contact Information | Center for Continuing Medical Education; (502) 446-5955 or cme@nortonhealthcare.org     Resources for Additional Study     American Academy of Neurology - https://www.aan.com/ American Headache Society – https://americanheadachesociety.org/   Francesca Puledda, M.D., and Peter J. Goadsby, PhD, An Update on Non-Pharmacological Neuromodulation for the Acute and Preventive Treatment of Migraine, Headache, 2017 American Headache Society, April 2017, pp. 685-691   Richard B. Lipton, M.D., et. al., Barriers to the Diagnosis and Treatment of Migraine: Effects of Sex, Income, and Headache Features, Headache, 2012 American Headache Society, January 2013, pp. 81-92   Elio Clemente Agostoni, et. al., Current and Emerging Evidence-based Treatment Options in Chronic Migraine: A Narrative Review, The Journal of Headache and Pain, 2019, 20:92, pp. 1-9   Todd Schwedt, et. al., Early Onset of Efficacy with Erenumab in Patients with Episodic and Chronic Migraine, The Journal of Headache and Pain, 2018, 19:92, pp. 1-8  

During this podcast, Dr. Bender will provide information that addresses the following Learning Objectives: 1. Define sleep related breathing disorders 2. Describe the risk factors associated with obstructive sleep apnea 3. Discuss the role of dentist in the management of sleep disorders Dr. Steven D. Bender earned his Doctorate of Dental Surgery degree from Baylor College of Dentistry in 1986 and practiced general restorative dentistry for 14 years. He then studied orofacial pain and temporomandibular disorders at the Parker E Mahan Facial Pain Center at the University Of Florida College Of Dentistry. From 2000-2015, Dr. Bender maintained a private practice devoted to pain management of the head and face, as well as sleep medicine. Beginning in 2016, he transitioned to a full time faculty member of Texas A&M University College of Dentistry and assumed the role of director of facial pain and sleep medicine. He has earned Fellowship in the American Academy of Orofacial Pain, the American Headache Society, the International Academy of Oral Oncology and the American College of Dentists and he is a diplomate of the American Board of Orofacial Pain. He is a past president of the The American Academy of Orofacial Pain, The Fourth District Dental Society of Texas and the Dallas Academy of General Dentistry. In addition, he serves as a consultant for the United States Army. The AAOP will be conducting a Scientific Literature review of Sleep Medicine on November 2, 2019 at the Hilton O'Hare in Chicago, IL. For more information please visit: https://aaop.clubexpress.com/content.aspx?page_id=22&club_id=508439&module_id=361389

A few months ago, I briefly mentioned on a podcast that I discovered that by taking a specific blend of nutrients to support my vagus nerve, I was able to completely get rid of morning constipation. Today, my podcast guest, Dr. Diana Driscoll, is the individual who actually designed that blend, and who knows a heckuva lot about the vagus nerve and its interplay with our bodies. Dr. Diana Driscoll is an optometrist who had always been healthy - she was also a bit of an exercise fanatic who also geeked out with nutrition. But despite this history, she was struck down by an illness that few understood and was disabled for over a decade. Ultimately, she was diagnosed with something called POTS (Postural Orthostatic Tachycardia Syndrome) - a disorder of the autonomic nervous system and was told there was no cure for this mysterious condition. When her children also became ill and doctors had no answers, she formed Genetic Disease Investigators to formally study these conditions. Dr. Driscoll is considered to be “the patients researcher”, bypassing notoriously slow academic research institutions to get answers quickly. Twelve years later, she is now the director of POTS Care – the only POTS Clinic focused on searching for the underlying cause of POTS, and treating it at its source. She has received two patents to date, and is now not only helping patients who are ill -- she is reaching out to healthy folks who want to improve their quality of life and maximize their health, even into old age. Dr. Driscoll graduated summa cum laude from both The University of Houston College of Optometry and The University of Texas at Austin. She is a geek, through and through. She is a member of the International Society of Neurovascular Disease, the American Headache Society, the Medical Advisory Board for EDS Network C.A.R.E.S, the American Optometric Association, the Tear Film and Ocular Surface Society, and served as a medical advisor for the Ehlers-Danlos National Foundation.   Her peer-reviewed medical abstracts include those involving vascular abnormalities in the fundus of POTS patients, the etiology of left ventricular diastolic dysfunction, and the use of acetazolamide in multiple sclerosis. She is the author of “” and “”, and was the chief author of the “” for .  Dr. Driscoll is the recipient of numerous awards for patient advocacy and continues to donate her time to help others across the globe through her online forum and videos on YouTube. Her work in chronic inflammation, the autonomic nervous system, collagen disorders, and organ dysfunction can help others live their best life, as well as have their best body and mind. During our discussion, you'll discover: -Diana's story and how she first became interested in her field of work...8:15 Contracted a virus during a missions trip to Costa Rica, but she was unable to kick it Difficulty breathing Poor sleep Racing heart Poor digestion Developed a tremor Memory loss Difficulty handling any type of stress Her kids began to develop similar symptoms Treatment included more exercise; but nothing worked Was disabled due to fatigue for over a decade -The results of Diana's studies and research...14:15 "Layers of discovery" over the course of several years Abnormal inter cranial pressure Inflammation was a factor The exaggerated symptoms actually made it easier to discover the causes Genetics play a large role (her children experienced the same symptoms) Started by looking at the eyes (great window into systemic illness) -A working definition of POTS...21:20 POTS is not a disease, it's a symptom There was no specific diagnosis for her condition Dysfunction of the autonomic nervous system ALS/Parkinson's begin with POTS symptoms Astronauts get POTS while in space, due to the lack of gravity -How dysfunction of the vagus nerve is correlated with POTS...24:30 The abnormal inter cranial pressure is indicative of a poorly functioning vagus nerve When symptoms occur simultaneously (difficulty breathing, racing heart, gut dysfunction, etc.) it could be the vagus nerve Ileocecal valve is linked to POTS and nerve function Vagus nerve controls the function of the valve Gastro motility linked to migrating motor complex (cleaning up digestive system) Triggered by signals from the vagus nerve -The nicotine-induced method Diana devised to repair the ileocecal valve...30:10 A kidney stone turned up 3 days after being cleared for kidney stones The doctor confirmed the ileocecal valve was problematic A surgeon refused to open the valve Two parts of vagus nerve: preganglionic (extremely long) and postganglionic (extremely short) Diana tried to stimulate the postganglionic nerve The vagus nerve is a nicotinic acido cholinergic nerve (nicotine is the imitator of the vagal neurotransmitter) She put a nicotine patch over the side of the ileocecal valve Within hours, the symptoms began to subside This changed the way Diana viewed the cause of the problem: It wasn't an autoimmune condition affecting the receptors It was either a preganglionic vagus nerve or a neurotransmitter problem Ultimately nicotine was not a viable long-term solution -The long-term solution Diana used to address her problem...40:10 (use code GREENFIELD for 10% off on all products) Established goals: Use supplements already deemed safe by the FDA Wanted it to work in spite of genetic issues Stimulate postganglionic nerve just as nicotine did Cross the blood-brain barrier to help cognition Vagus nerve problems can be mistaken for acetylcholine production issues and vice versa provides instructions for making a protein called choline acetyltransferase It needed to account for nutrient malabsorption Finding the right balance between stimulation and overstimulation of the vagus nerve was a challenge Parasym is not a stool softener or a laxative; it allows a normal bowel movement by making the vagus nerve work properly Primary ingredients: Huperzine, Acetyl-L-carnitine, Alpha glycerylphosphorylcholine (use BEN for a 10% discount) Diana was able to acquire a patent because of the unique blend (and balance) of ingredients; it's not just another nootropic -The importance of the eyes in discovering vagal nerve issues...51:50 Pupil size is an indicator of the condition of the autonomic nervous system The sympathetic and parasympathetic nervous systems are out of balance, resulting in large pupil sizes High sensitivity to light Pupils responded more consistently than HRV -How to test for acetylcholine problems...55:00 Need to look for symptoms; there's no codified way of testing for problems Genetic tests can identify issues to a limited degree -The amount of time one can expect to use Parasym...58:00 Some will always need help Feeling "good enough" can be deceptive Vagus nerve is the anti-inflammatory pathway of the body Reasons typical stimulants of the vagus nerve won't work: Damage to the nerve Genetic issues Some inflammatory psydochines block the release of acetylcholine -The current direction of Diana's work and research in light of her discoveries thus far...1:03:00 -And much more... Resources from this episode: - (use code GREENFIELD for 10% off on all products!) - - -Diana's blog at -The website -Book:   by Dr. Diana Driscoll -My podcast with Dr. Sarah Myhill "" - - (use BEN for a 10% discount) - - - -My podcast on "" Episode sponsors: -: Carefully selected and roasted for taste, purity, high antioxidants and health. Ben Greenfield Fitness listeners, receive a 10% discount off your entire order when you use discount code: BGF10. -: After using the Joovv for close to 2 years, it's the only light therapy device I'd ever recommend. Give it a try: you won't be disappointed. Order using and receive a nice bonus gift with your order! -: Organic brands you love, for less. Your favorite organic food and products. Fast and free shipping to your doorstep. Receive 25% off your order when you use ! -: With NetSuite, you save TIME, MONEY, and UNNEEDED HEADACHES by managing sales, finance and accounting, orders, and HR instantly- right from your desktop or phone. Click and download the free guide: “Seven Key Strategies to Grow your Profits”. Do you have questions, thoughts or feedback for Diana or me? Leave your comments below and one of us will reply!  

In this podcast, Elizabeth Loder, MD, MPH, discusses the landscape of medicine, specifically headache medicine, in the context of the #MeToo and Time's Up era—a topic she also spoke about at the American Headache Society's 61st Annual Scientific Meeting. More at: www.consultant360.com/neurology.

Developed by the American Headache Society®, the Chronic Migraine Education Program (CMEP) includes new advances and addresses acute and preventive treatment options. In addition, the CMEP highlights epidemiologic data on the scope and distribution of migraine with an emphasis on diagnosing chronic migraine. Recent insights into the mechanisms of the complaint will set the stage for improving treatment outcomes for this most disabling of headache disorders. Part 2 will cover Pathophysiology of Chronic Migraine and Episodic Migraine; Acute Treatment Strategies; and Preventative Treatment Strategies. (Recorded at PAINWeek 2018)

Developed by the American Headache Society®, the Chronic Migraine Education Program (CMEP) includes new advances and addresses acute and preventive treatment options. In addition, the CMEP highlights epidemiologic data on the scope and distribution of migraine with an emphasis on diagnosing chronic migraine. Recent insights into the mechanisms of the complaint will set the stage for improving treatment outcomes for this most disabling of headache disorders. Part 1 will cover Diagnosis of Chronic Migraine and Episodic Migraine; Transitions, Risk Factors, and Barriers to Care; and case studies and Q&A.

The use of anterior mid-point stop appliances (AMPSAs) in Dentistry is surrounded with controversies and misconceptions, so I am joined by Dr Barry Glassman in this episode to answer this much debated question. Attending Dr Glassman’s lecture last year was eye opening and career-transforming for me. It changed the way I thought about Occlusion! Attending Dr Glassman’s lecture last year was eye opening and career-transforming for me. It changed the way I thought about Occlusion! In this Episode with Dr Barry Glassman we discuss: To what extent are occlusions designed for Function? How much does Occlusion matter? Why canine guidance? Do Anterior midpoint stop appliances cause posterior teeth to over-erupt? When to avoid using AMPSAs? What mechanism is behind patients developing AOB after splint therapy?   This is an example of a lower NTI or SCI (Sleep Clench Inhibitor). This falls in to the category of an anterior mid-point stop appliance (AMPSA) TLDL (Too Long Didn’t Listen): Jump to 22 mins and 30 seconds if you want the main question answered. Protrusive Dental Pearl: The BRB technique for incisor Class IV build ups to create an ‘instant wax-up’ within the putty. You can read more about this technique at Style Italiano. Do not miss out on the next Dentinal Tubules Congress in October! Dr Glassman will be lecturing again in the UK on ‘Myth-busting Occlusion for the General Dentist‘. He will be lecturing in Sheffield and London and this can be booked on the S4S website. If you use the discount code BG-PODCAST, this will give 30% off (RRP £179.99).   Barry Glassman, DMD, maintained a private practice in Allentown, PA, which was limited to chronic pain management, head and facial pain, temporomandibular joint dysfunction and dental sleep medicine.   He is a Diplomate of the Board of the American Academy of Craniofacial Pain, a Fellow of the International College of Craniomandibular Orthopedics and a Diplomate of the American Academy of Pain Management.  He is a member of the American Academy of Orofacial Pain and the American Headache Society.  He is on staff at the Lehigh Valley Hospital where he serves as a resident instructor of Craniomandibular Dysfunctions and Sleep Disorders.  He is a Diplomate of the Board of the Academy of Dental Sleep Medicine.  He has published articles that have appeared in both peer and non-peer reviewed journals in the fields of dental sleep medicine and orofacial pain. 

1) Featured Article: Collateral response modulates the time–penumbra relationship in proximal arterial occlusions2) Lesson of the Week: Migraine and neuromodulationThis podcast begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the January 23, 2018, issue of Neurology. In the first segment, Dr. Kevin Barrett talks with Dr. Smriti Agarwal about her paper on collateral circulation in proximal arterial occlusions and extending the scope of thrombolytic therapy. In the second part of the podcast, Dr. Teshamae Monteith focuses her Lesson of the Week interview with Dr. Stewart Tepper on acute and preventative neuromodulation treatment for migraine. DISCLOSURES: Dr. Barrett serves on the editorial board of Neurology and Neurohospitalist; has received research/grant support from the National Institute of Neurological Disorders and Stroke for serving on the executive committees of the CREST-2 and SHINE clinical trials; and receives publishing royalties from Wiley Blackwell.Dr. Agarwal reports no disclosures.Dr. Monteith serves as an editorial advisory board member for Neurology Now and receives research support from the NIH.Dr. Tepper is a member of the board for the American Headache Society and has been a consultant for or participated on a paid advisory board for Acorda Therapeutics, Inc; Alder BioPharmaceuticals, Inc; Allergan plc; Amgen, Inc; Avanir Pharmaceuticals, Inc; BioVision, Inc; Charleston Laboratories, Inc; Dr. Reddy’s Laboratories, Ltd; electroCore, LLC; eNeura, Inc; Eli Lilly and Company; GLG Pharma, LLC; Guidepoint Inc, LLC, Ltd; Kimberly-Clark Corporation; Pernix Therapeutics Holdings, Inc; Pfizer, Inc; Scion NeuroStim, LLC; Teva Pharmaceutical Industries, Ltd; and Zosano Pharma, Corp.

1. Featured Article: Practice guideline update summary: Mild cognitive impairment2. Lesson of the Week: Migraine and hormonesThis Neurology® Podcast begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the January 16, 2018, print issue of Neurology. In the first segment, Dr. Jeff Burns talks with Dr. Ronald Petersen about the updated 2001 AAN guideline on prevalence, prognosis, and treatment of MCI. For the Lesson of the Week, Dr. Teshamae Monteith speaks with Dr. Jelena Pavlovic about the association between hormones and migraine. DISCLOSURES: Dr. Burns has served on the DSMB for NIH-funded trials (non-profit entities); serves on the editorial board for Journal of Alzheimer's Disease; has consulted for Grifols, USA; has served on Eli Lilly Amyvid Speaker's Bureau; and has received research support from Eli Lilly, Avid Radiopharmaceuticals, Toyama Chemical Company, Merck, Biogen, AbbVie, Novartis, vTv Therapeutics, Janssen, and NIH (R01AG058557, R01AG053312, R01AG034614, R01AG03367, R01AG043962, P30AG035982, U10NS077356, UL1TR000001).Dr. Petersen receives publishing royalties from Mild Cognitive Impairment (Oxford University Press, 2003); has consulted for Roche Incorporated, Merck, Genentech, and Biogen; and receives research support from National Institute on Aging (U01-AG006786, P50-AG016574, U01-AG024904, and U01-AG016976). Dr. Monteith serves as an editorial advisory board member for Neurology Now and receives research support from the NIH.Dr. Pavlovic has received consulting honoraria and travel support from Allergan, Inc. and travel/conference registration support from The American Headache Society.

Show description/summary:1) Medication-overuse headache: An entrenched idea in need of scrutiny 2) What’s Trending: DAWN TrialThis podcast begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the September 19th, 2017 issue of Neurology. In the first segment, Dr. Alex Menze talks with Dr. Elizabeth Loder about her paper on medication overuse headache. In the second part of the podcast, Dr. Kevin Barrett focuses his interview with Dr. Tudor Jovin on the DAWN trial on Trevo thrombectomy for acute ischemic stroke. Disclosures can be found at Neurology.org.DISCLOSURES: Dr. Menze reports no disclosures.Dr. Loder has received travel funding from the American Headache Society and American Migraine Foundation and The British Medical Journal; has served on the editorial boards of The British Medical Journal, Cephalalgia, and Headache; receives publishing royalties from Cambridge University Press; and has received research support from Harvard Medical School.Dr. Barrett serves on the editorial boards of Neurology and Neurohospitalist; receives publishing royalties from Wiley-Blackwell; and has received research support from NINDS.Dr. Jovin has served on the Codman Neurovascular Data Safety Monitoring Board; has received travel funding from Stryker Neurovascular and Fundacio Ictus; and holds stock/stock options in Silk Road Medical, Anaconda, and Blockade Medical.

1) International consensus guidance for management of myasthenia gravis2) e-Pearl topic: Progressive multifocal leukoencephalopathy3) Topic of the month: Neurology Year in Review Plenary Session at the AAN meeting on the topic of headacheThis podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Ted Burns interviews Dr. Donald Sanders about the executive summary on the international consensus guidance for management of myasthenia gravis. Dr. Ilena George is reading our e-Pearl of the week about progressive multifocal leukoencephalopathy. Dr. Tesha Monteith interviews Dr. Richard Lipton about his Neurology Year in Review Plenary Session at the AAN meeting on the topic of headache.DISCLOSURES: Dr. Ted Burns serves as Podcast Editor for Neurology®; and has received research support for consulting activities with UCB, CSL Behring, Walgreens and Alexion Pharmaceuticals, Inc.Dr. Sanders receives royalties from the publication of the book: Single Fiber EMG; serves on the medical advisory board for Accordant Health Services; is a consultant for ArGen-X, Jacobus Pharmaceutical Co., Inc, Modus Outcomes, Momenta Pharmaceuticals, Inc. and UCB Celltech.Dr. George serves on the editorial team for the Neurology® Resident and Fellow Section.Dr. Monteith serves as an editorial advisory board member for Neurology Now and receives research support from the NIH.Dr. Lipton receives royalties for books published from Oxford University Press and Baxter Publishing; Receives honoraria for serving on the scientific advisory board for Alder, Allergan, Inc., American Headache Society, Autonomic Technologies, Avanir Pharmaceuticals, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, CoLucid, Dr. Reddys, Electrocore, Eli Lilly and Company, eNeura Therapeutics, Informa, Merck Serono, Novartis, Pfizer Inc, Teva Pharmaceutical Industries Ltd., Vedanta; is a consultant for Alder, Allergan, Inc., American Headache Society, Autonomic Technologies, Avanir Pharmaceuticals, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, CoLucid, Dr. Reddys, Electrocore, Eli Lilly and Company, eNeura Therapeutics, Informa, Merck Serono, Novartis, Pfizer Inc, Teva Pharmaceutical Industries Ltd., Vedanta; holds stock options in eNeura Pharma; receives research support from Bristol-Myers Squibb, Vedanta Research Migraine epidemiology and Progression. Boston Scientific Occipital Nerve Stimulation in Migraine, ElectroCore Vagal Nerve Stimulation for Migraine and Cluster, Novartis Sleep and Migraine, Allergan Botox in Migraine, Allergan Chronic Migraine Epidemiology and Outcome Study, S & L Marx Foundation Alzheimer's Research and the NIH.

1) The association between hospitalization and care after transient ischemic attack or minor stroke2) e-Pearl topic: Neuroretinitis3) Topic of the month: Migraine awareness seriesThis podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Andy Southerland interviews Dr. Moira Kapral about her paper on the association between hospitalization and care after transient ischemic attack or minor stroke. Dr. Sarah Wesley is reading our e-Pearl of the week about neuroretinitis. Dr. Tesha Monteith interviews Dr. Stephen Silberstein about the topic of migraine clinical trials: A drug therapy and neuromodulation update. DISCLOSURES: Dr. Southerland serves as Podcast Deputy Editor for Neurology; receives research support from the American Heart Association-American Stroke Association National Clinical Research Program, American Academy of Neurology, American Board of Psychiatry and Neurology, Health Resources Services Administration and the NIH; has a provisional patent application titled: “Method, system and computer readable medium for improving treatment times for rapid evaluation of acute stroke viamobile telemedicine;” and gave legal expert review.Dr. Kapral serves as Guest Editor for Cardiovascular Quality and Outcomes; serves as an editorial board member of Circulation; receives research support from the Heart and Stroke Foundation of Canada.Dr. Wesley serves on the editorial team for the Neurology® Resident and Fellow Section.Dr. Monteith serves as an editorial advisory board member for Neurology Now and receives research support from the NIH.Dr. Silberstein serves as an editorial board member of Cephalalgia, Current Pain and Headache Reports, CNS Drugs, Topics in Pain Management and Neurology®; serves on the scientific advisory board for Alder, Allergan, Inc., Amgen, Avanir, eNeura, ElectroCore Medical, Medscape, Medtronic, Inc., Mitsubishi Tanabe Pharma Corporation, Neuralieve, NINDS, Pfizer Inc, Supernus and Teva Pharmaceutical Industries Ltd.; is a consultant for Allergan, Inc., Amgen, eNeura, ElectroCore Medical, Mitsubishi Tanabe, Medtronic, Inc., Neuralieve, Pfizer, Inc, Supernus and Teva Pharmaceutical Industries Ltd.; receives research support from American Headache Society®, International Headache Society and the NIH.

Dr. Ken Nedd grew up on an island where no doctors existed, but he knew as a child that he wanted to be one and worked hard to get there. Connect with Dr. Ken Nedd drnedd.com I love Dr. Ken Nedd's story about growing up and wanting to be something that no one around him was aspiring to be. To top it off there were no doctors that lived around him. His passion and dedication to helping people has led him down a path of helping change people's lives. Not just on a local scale, but Dr. Ken Nedd has found ways to help on a global scale! More About Dr. Ken Nedd Dr. Ken Nedd is a practicing medical doctor, international keynote speaker, bestselling author, and highly sought after expert on stress and happiness. Leading expert on transforming stress into happiness Medical Practitioner in Stress, Anxiety and Behavioral Medicine Avid researcher on the impacts of happiness and stress on performance in the workplace International speaker named one of the Top 10 Speakers in America by the American Society of Association Executives Author of the bestsellers Power Over Stress and The Time To Be Happy Is Now Dr. Ken Nedd is a practicing Medical Doctor who treats stress related disorders in both one-to-one clinical as well as corporate settings. As President of the International Stress Control Centre, Dr. Nedd spends a great deal of time researching the physiological impact of happiness and stress. He treats patients from far and wide for anxiety, headache, pain, and stress disorders. Dr. Ken Nedd is a member of the Canadian Medical Association, the American Headache Society, the International Headache Society, the National Headache Foundation, and the College of Physicians and Surgeons of British Columbia. In addition to medicine, Dr. Nedd shares his care, compassion, and inspiring messages with audiences worldwide as a corporate keynote speaker. He began public speaking at age 16 and throughout his career has engaged audiences across North America, Europe, and the Caribbean. He has received rave reviews from organizations such as the American Hospital Association, American Airlines, Barclay's Bank, Alcan, Telus, AT&T, Shoppers Drug Mart, Insurance Bureau of Canada, and many more. Dr. Nedd has also been called upon to present to Prime Ministers, Cabinet Ministers, and Mayors of the United States. Audience participants often describe Dr. Nedd and his keynote presentations as dynamic, energetic, passionate, inspiring, and spiritually engaging and repeatedly rate them higher than 10/10 in their evaluations. Dr. Ken Nedd is the bestselling author of Power Over Stress – which is used as a textbook at New York University – and The Time to be Happy is Now. He has hosted the television show, Changes, and has been a regular local and national contributor to CBC Television. His daily television program, One Minute with Dr. Ken Nedd, has aired on Canada's CTV and other networks. Over 500 episodes of his radio show have been syndicated in several countries. Dr. Ken Nedd delivers captivating and inspirational corporate programs – both in-person and through self-directed video, audio, and text curriculums. They are delivered with humor and focus on creative alertness; how to engineer the body and brain for peak performance; how to use your brain in new ways; and how to become happier and more motivated in stressful times. Throughout all his content, Dr. Nedd leverages a solid understanding of the human psycho-physiological system along with a wide array of scientific knowledge from which he has developed specific practical techniques that are continuing to change the lives of many people every day. Sample seminar topics include “The Essence of Creative and Innovative Leadership,” “How to Be Happy and Motivated in Stressful Times,” “Building Happier Relationships with Clients and Customers,” “Happiness: The Antidote to Stress,” “How to Stand Out in a Crowded Competitive Marketplace,

1) Acute headache diagnosis in pregnant women and 2) Topic of the month: Updates in tele-neurology. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Teshamae Monteith interviews Dr. Matthew Robbins about his paper on acute headache diagnosis in pregnant women. Dr. Sarah Wesley is reading our e-Pearl of the week about primary lateral sclerosis. In the next part of the podcast Dr. Andy Southerland interviews Dr. Jack Tsao about the topic of reimbursement, credentialing, and policy updates. The participants had nothing to disclose except Drs. Monteith, Robbins, Wesley, Southerland and Tsao.Dr. Monteith serves as an editorial advisory board member for Neurology Now; and receives research support from the NIH.Dr. Robbins serves as an editorial board member of Headache and The Einstein Journal of Biology and Medicine; received honoraria for educational content and presentation American Headache Society and Prova Education and receives royalties from the publication of the book Headache (Neurology in Practice series).Dr. Wesley serves on the editorial team for the Neurology® Resident and Fellow Section.Dr. Southerland serves as Podcast Deputy Editor for Neurology®; serves as Clinical Research Advisor for Totier Technologies, Inc.Dr. Tsao receives royalties from the publication of the book Traumatic Brain Injury: A Clinician's Guide to Diagnosis, Management, and Rehabilitation and receives research support from the US Army Medical Research and Materiel Command and the Wounded, Ill & Injured Directorate, US Navy Bureau of Medicine and Surgery.

1) Neurology® Clinical Practice: Medical Marijuana: Between a plant and a hard place and 2) Topic of the month: Updates in tele-neurology. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Matthew Wong interviews Dr. David Gloss about his Neurology Clinical Practice paper on medical marijuana: Between a plant and a hard place. Dr. Sarah Wesley is reading our e-Pearl of the week about arterial retinal ischemic disease. In the next part of the podcast Dr. Andy Southerland interviews Dr. Bert Vargas about the topic of teleconcussion. The participants had nothing to disclose except Drs. Gloss, Wesley, Southerland and Vargas.Dr. Gloss serves as an evidence-based medicine consultant for the American Academy of Neurology; serves as an LOE associate editor for Neurology® and receives royalties from the publicationof the book Neurology for the Specialty Boards.Dr. Wesley serves on the editorial team for the Neurology® Resident and Fellow Section.Dr. Southerland serves as Podcast Deputy Editor for Neurology®; serves as Clinical Research Advisor for Totier Technologies, Inc.Dr. Vargas serves on the scientific advisory boards Allergan, Inc and Zogenix, Inc.; receives honoraria for travel from the American Headache Society.NO CME WILL BE OFFERED THIS WEEK.

1) Incident Parkinson disease and 2) Topic of the month: Headaches. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. John Morgan interviews Dr. Tien Khoo about his paper on incident Parkinson disease. Dr. Jen Fugate is reading our e-Pearl of the week about paroxysmal dysarthria and ataxia. In the next part of the podcast Dr. Mike Sowell interviews Dr. Alan Finkel about the topic of post-traumatic headache. The participants had nothing to disclose except Drs. Morgan, Khoo, Fugate and Finkel.Dr. Morgan has served on the speakers' bureau of GE Healthcare, GlaxoSmithKline, Teva Pharmaceuticals Industries Ltd., and UCB Pharma; has performed CME for Oakstone Publishing, LLC; is a consultant for Veloxis Pharmaceuticals, Chelsea Therapeutics, and Impax Laboratories, Inc.; receives research support from NIH as a sub-investigator and received compensation for review of medical records and expert witness testimony in multiple cases of litigation involving neurological conditions.Dr. Khoo receives speaker honoraria from Teva and Lundbeck; receives funding for travel from GlaxoSmithKline and receives educational support from a grant with UCB Pharma.Dr. Fugate serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Finkel serves on the speakers' bureau of Allergan, Inc. receives research support from American Headache Society, DVBIC and the American Academy of Neurology.

1) Evidence-based guideline updates on episodic migraine prevention and 2) Topic of the month: Obesity and the neurology patient. This podcast for the Neurology Journal begins and closes with Dr. Robert Gross, Editor-in-Chief, briefly discussing highlighted articles from the print issue of Neurology. In the second segment Dr. Ted Burns interviews Drs. Stephen D. Silberstein and Starr Holland on the guideline updates about treatments for episodic migraine prevention in adults. Dr. Chafic Karam is reading our e-Pearl of the week about scapular winging. In the next part of the podcast Dr. Ted Burns interviews Dr. Lisa Davis about her recent paper titled: Clinical strategies for managing the overweight neurology patient published in the March Neurology Clinical Practice Journal. All participants have disclosures.Dr. Burns serves as Podcast Editor for Neurology®; performs EMG studies in his neuromuscular practice (30% effort); and has received research support from the Myasthenia Gravis Foundation of America and Knopp Neurosciences Inc..Dr. Silberstein serves on scientific advisory boards for AGA Medical Corporation, Allergan, Inc., Amgen, CAPNIA, Coherex Medical, GlaxoSmithKline, Iroko Pharmaceuticals, LLC, Eli Lilly and Company, MAP Pharmaceuticals, Inc., Medtronic, Inc., Merck Serono, Neuralieve Inc., the NIH/NINDS, NuPathe Inc., Pfizer Inc, and St. Jude Medical; serves on the editorial boards of Cephalalgia and Current Pain and Headache Reports; serves on the speakers' bureaus for Allergan, Inc., Endo Pharmaceuticals, GlaxoSmithKline, Zogenix, and Merck Serono; serves as a consultant for Amgen, Nautilus, Inc., Novartis, Opti-Nose, and Zogenix; receives publishing royalties for Wolff's Headache, 8th edition (Oxford University Press, 2009) and Handbook of Headache (Cambridge University Press, 2010); his employer receives research support from Allergan, Endo, GlaxoSmithKline, MAP, Merck Serono, the NIH/NINDS, Novartis, and Neurolieve; receives research support from the American Headache Society and the International Headache Society.Dr. Holland serves as a consultant for MAP Pharmaceuticals, Inc.; receives research support from Albert Einstein College of Medicine and the American Headache Society.Dr. Karam serves on the editorial team for the Neurology® Resident and Fellow Section. Dr. Davis serves as a consultant for Medifast, Inc. and the Coleman Research Group and is a shareholder in Medifast, Inc.