Dr. Linder has a private practice in Dallas, TX, where he treats children and adolescents with migraine. He discussed neurostimulators (occipital and supra-orbital nerves) in adolescents. He was very knowledgeable, and answered audience questions.
Dr. Krusz has a private practice in North Texas (Anodyne Headache and PainCare), where he treats pain, headache disorders, sleep, mood and neuropsychiatry/neurobehavioral disorders. He spoke primarily about treatment options for migraine.
* The goal of medication is to improve function *
Acute Medication Treatment:
- Not more than 2 days per week
- Treat early (don't wait until severe)
- Use adequate dose, combine meds
- Keep headache diary
- Goal is to get you back to 'normal' within 2-4 hours
- Can repeat meds, if not getting relief
- Go to sleep (sometimes, no matter what you do, some headaches get out of control)
- Some examples:
- NSAIDs - Aspirin, Ibuprofin, Naproxen, Diclofenac, Indocin
- Anti-Nausea - Reglan, Compazine, Zofran, Phenergan
- Others - Excedrin, Tramadol
- Triptans - Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Zomig
- Ergots - DHE, Migranal, Ergotamine
Rescue Medication Treatment (when acute treatments don't work):
- Sedatives - get to sleep
- IV or IM injections (often requires office or ER visit)
- Avoid narcotic pain meds
- Examples: Corticosteroids, Depacon, Magnesium, Toradol
Medication Overuse Headache:
- Rebound (use acute/rescue meds too often)
- Acute meds become less effective
- Headache frequency increases, eventually becoming daily
- Narcotics (opioids)/barbituates - high rebound
- No preventative works well
Preventive Therapy:
- Control other medical problems
- Diet
- Exercise
- Sleep
- Medication
- Anti-depressants (SNRIs)
- Anti-hypertensives
- Anti-epilepsy (neurostabilizers)
- Anti-inflammatory
- Muscle relaxants
- Sleep aids
Supplements:
- 5-HTP
- Magnesium
- Riboflavin (Vitamin B-2)
- CoQ-10
- Butterbur
- Feverfew
