The Curbsiders Internal Medicine Podcast #122 Headaches Advanced Class
4 snips
Oct 29, 2018 Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center, dives into advanced headache management. She discusses the complexities of chronic versus episodic migraines and how medication overuse can complicate care. Burch highlights various migraine types, including those with aura, and explains the latest treatments such as botulinum toxin and CGRP therapies. She emphasizes a holistic approach, combining pharmacologic and non-pharmacologic strategies to improve patient quality of life.
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Resident Error Led To Systemic Learning
- Rebecca Burch once forgot to continue a hospitalized patient's home amitriptyline while treating status migrainosus.
- The experience taught her to acknowledge mistakes, analyze causes, and improve systems-level support.
Don't Avoid Triptans With SSRIs Without Cause
- Co-prescription of SSRIs/SNRIs and triptans is not a proven cause of serotonin syndrome; counsel patients but do not reflexively avoid combination.
- Choose preventives to treat comorbid depression/anxiety when appropriate, e.g., venlafaxine for dual benefit.
When To Use Botox And CGRP Antibodies
- Reserve onabotulinum toxin A for chronic migraine after failing multiple oral preventives.
- Reserve CGRP monoclonal antibodies for patients who fail other preventives due to limited long-term real-world safety data and insurance rules.
