Pre PACES Podcast #135 Headache (part 2)
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Mar 15, 2026 Dr Yezin Samaraiee, neurology registrar and founder of QuezMed. They tackle medication-overuse headaches and withdrawal strategies. They cover distinguishing migraine and aura mimics, when imaging is needed, acute treatments and preventatives. Red flags for raised intracranial pressure, cough/postural headache clues, tension headache tips, trigeminal neuralgia signs, and IIH recognition and urgent management.
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Stop Medication Overuse Quickly
- Stop excess analgesics quickly to break medication overuse headache cycles.
- Advise abrupt cessation of paracetamol/NSAIDs/triptans and offer transition options like occipital nerve block and long-term preventatives.
Always Ask About Past Headaches
- Always dig into prior headache history to detect migraine patterns.
- Ask about past headaches, aura, photophobia and typical features because patients often say 'no' until probed with specific symptoms.
Stepwise Acute And Preventative Migraine Treatment
- Use simple acute migraine treatments first and escalate based on response.
- Start paracetamol/NSAID or aspirin 900 mg, consider metoclopramide for nausea and triptans; use propranolol, amitriptyline or candesartan for prevention.