Neurology Minute

Dr. Tesha Monteith discusses menstrual migraine and treatment options. Show transcript: Dr. Tesha Monteith: This is Tesha Monteith with the Neurology Minute. Welcome back to our series on headache medicine and women's health. I'm continuing our discussion on menstrual migraine, and I want to focus on treatment. We talked about increasing the yield of diagnosis for menstrual migraine, but what are the best ways to treat our patients? I think there are two broad categories we can think about: We can think about non-hormonal methods or hormonal methods. The non-hormonal methods include a combination of abortive therapies, as well as preventative therapies that can be used for a mini prophylaxis, as well as when patients have a higher burden of overall migraine, considering the general highly effective preventive therapies. Common mini prophylaxis include triptans such as Frovatriptan, Naratriptan, and Zolmitriptan when used twice per day. Nonsteroidal anti-inflammatories can be used for five to seven days around menses, such as naproxen, 550 milligrams twice per day. Magnesium, 360 milligrams daily or higher, can also be started mid-cycle, so day 15, towards menstruation. Although considered off-label, gepants, ubrogepant, as well as rimegepant, can also be used during the susceptible window. This is Tesha Monteith. Thank you for listening to the Neurology Minute.

In the January episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss AAN's plans for 2026, including a general neurology boot camp, Autoimmune Conference, and new resources for members. Stay informed by watching the President's Spotlight video. Show transcript: Dr. Jason Crowell: Hello, and welcome to today's Neurology Minute. This is the first installment of 2026 that we have with the president of the AAN, Natalia Rost. Natalia, thanks so much for joining us today, we look forward to our monthly chats to talk about things going on with the AAN. Before we start talking about the plans for 2026 with the American Academy of Neurology, what are the things that are on your mind? Dr. Natalia Rost: Happy new year, Jason, great to join you today. Well, first of all, I think 2026 is going to be a strong year, and as I think what's coming down our pipeline, it's our work to promote brain health and to support neuroscience research. It's the fight that we have to fulfill Medicare payments, and to protect patient access to care. Our efforts to advance physician-led neurology teams and to reduce burnout. And to always stand firmly for science and evidence-based medicine. Dr. Jason Crowell: Now, I know every year the AAN has new programming and content that they're putting out, what's going to be in store for 2026? Dr. Natalia Rost: First of all, we're launching a brand new general neurology bootcamp at the annual meeting, high impact learning, real connections, and great energy guaranteed. Also back by popular demand, the Autoimmune Conference will take place again this summer, featuring all the latest science, so I'm excited about that. For our advanced practice provider members, expect a new online toolkit to improve your neurology knowledge and patient care skills. For our residents, we are adding a new pediatric neurology option for our RITE exam lineup. And last but not least, we are fully reimagining our patient education on brainandlife.org, because as you know and as our members know, an informed public makes powerful partners in our Brain Health For All movement. Dr. Jason Crowell: Terrific. And so, are there any efforts from last year that will continue to be a focus for this coming year? Dr. Natalia Rost: Two things immediately come to mind, and our work will only grow stronger there. Number one is to continue to modernize our digital platforms and provide resources to our members to tackle AI and emerging technologies. As you know, this is a big issue. And number two is to advocate relentlessly for fair reimbursement and access to care. Our advocacy is only going to grow stronger in 2026. Dr. Jason Crowell: So, Natalia, most of us are still working to keep our New Year's resolutions intact, I'm a few days into my exercise program, we'll see how long that goes. But what would you say are the New Year's resolutions, if you will, for the AAN? Dr. Natalia Rost: Well, this year is going to be the year to fully embrace our Brain Health For All approach, I think. Neurologists are the experts in brain health, so our promise is for the AAN to continue tirelessly support our members so they can lead, care, and thrive as they do. Dr. Jason Crowell: Terrific, Natalia. Thanks so much. Happy New Year again. Dr. Natalia Rost: Happy New Year.

Dr. Derek Stitt and Drs. Joseph Safdieh and Matthew S. Robbins discuss subspecialization's impact on patient care, why preserving a core neurologist identity matters, and how training can reinforce it. Show citation: Safdieh JE, Robbins MS. Opinion & Special Articles: The Core Identity of the Neurologist. Neurology. 2025;105(9):e214265. doi:10.1212/WNL.0000000000214265

Dr. Shuvro Roy and Dr. Rosa Cortese discuss new ways to improve MS and MOGAD diagnosis, including how AI and imaging could enhance accuracy and influence future care. Show citations: Cortese R, Sforazzini F, Gentile G, et al. Deep Learning Modeling to Differentiate Multiple Sclerosis From MOG Antibody-Associated Disease. Neurology. 2025;105(6):e214075. doi:10.1212/WNL.0000000000214075

Dr. Bradley Ong discusses evidence for candesartan in migraine prevention. Show citation: Øie LR, Wergeland T, Salvesen Ø, et al. Candesartan versus placebo for migraine prevention in patients with episodic migraine: a randomised, triple-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2025;24(10):817-827. doi:10.1016/S1474-4422(25)00269-8

In the second part of this two-part series, Dr. Shuvro Roy examines the study's findings and their implications for clinical practice moving forward. Show citation: Kim M, Park YH, Song YS, et al. Gait Improvement Following CSF Tap Test in NPH Patients With and Without Striatal Dopaminergic Deficit: A Preliminary Study. Neurol Clin Pract. 2025;15(6):e200549. doi:10.1212/CPJ.0000000000200549

In part one of this two-part series, Dr. Shuvro Roy explains idiopathic normal pressure hydrocephalus (iNPH), its diagnostic challenges, and a study on whether dopamine transporter (DAT) scan results affect gait improvement after a CSF tap test. Show citation: Kim M, Park YH, Song YS, et al. Gait Improvement Following CSF Tap Test in NPH Patients With and Without Striatal Dopaminergic Deficit: A Preliminary Study. Neurol Clin Pract. 2025;15(6):e200549. doi:10.1212/CPJ.0000000000200549

Drs. Mahinda Yogarajah, Benjamin Tolchin, and Jon Stone discuss recommendations for clinicians, patients, and other stakeholders on the management of functional seizures. Show citation: Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466 Show transcript: Dr. Mahinda Yogarajah: Welcome to this edition of Neurology Minute. I'm your host for this. My name's Mahinda Yogarajah. I've just finished interviewing Dr. Ben Tolchin and Jon Stone for this week's Neurology® Podcast. For today's Neurology Minute, I'm hoping Ben can tell us the main points of the podcast and the paper discussed in that podcast. Dr. Ben Tolchin: We discussed the AAN guideline on the Management of Functional Seizures. This is the first American Academy of Neurology evidence-based guideline on functional neurologic disorder. It includes a systematic review of the randomized controlled trials relating to the treatment of this disorder, which found that psychological interventions are possibly effective in improving the chance of achieving freedom from functional seizures, in reducing the frequency of functional seizures, in improving quality of life, and in improving anxiety. In addition to the systematic review, there are clinical recommendations based on the systematic review and on related evidence. The recommendations deal with all stages of the diagnosis, management, and treatment of functional seizures and are particularly relevant to neurologists caring for patients with functional seizures. In addition, there are recommendations for future research relating to the diagnosis and management of functional seizures. Dr. Mahinda Yogarajah: Thank you, Ben. For more information, I'd recommend go to the main podcast or go and have a read of the article that's been published in Neurology® on the Management of Functional Seizures Practice Guidelines.

Drs. Greg Cooper, Natalia Rost, and Behnam Sabayan discuss preventive neurology and the need for neurologists to move beyond diagnosis and treatment toward proactive strategies for brain health. Show citation: Sabayan B, Boden-Albala B, Rost NS. An Ounce of Prevention: The Growing Need for Preventive Neurologists. Neurology. 2025;105(1):e213785. doi:10.1212/WNL.0000000000213785 Show transcript: Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Behnam Sabayan and Natalia Rost for this week's Neurology® Podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper, An Ounce of Prevention, the Growing Need for Preventative Neurologist. Dr. Behnam Sabayan: We are living in a very exciting time for the field of neurology where we are not just getting very good at diagnosis and treatment of neurological condition, but also we are stepping one step back, and that means that we will find the root causes of neurological conditions. We would act as preventive specialists and we would decrease the burden of neurological conditions, not just at the individual level, but also at the population level. And this paper calls for thinking about playing roles at different levels and stages from our offices and our rounds all the way to the community to be brain health advocates and helping other fields and disciplines to reduce the burden of neurological conditions. Dr. Greg Cooper: Well, thank you for that summary and for all of your work on this topic. Please check out this week's podcast to hear the full interview or read the full article published in Neurology®, An Ounce of Prevention: The Growing Need for Preventative Neurologists. Thank you.

In the final episode of this seven-part series, Dr. Jon Stone and Dr. Gabriela Gilmour wrap up the conversation discussing future directions. Show citations: Functional Neurological Disorder Society Finkelstein SA, Carson A, Edwards MJ, et al. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin. 2023;41(4):729-743. doi:10.1016/j.ncl.2023.04.002 Show transcript: Dr. Gabriela Gilmour: This is Gabriela Gilmour with the Neurology Minute. Jon Stone and I are back for our final episode of our seven-part series on functional neurological disorder. Today, we will discuss future directions for the field of FND. So Jon, where do you see the field of FND going in terms of diagnosis and treatment? Dr. Jon Stone: So we've seen a tremendous increase in interest in FND, particularly in the last five years since we started the FND Society. I think there's much more awareness of making rule-in diagnoses compared to before. There's much more positivity about treatment and I think people who experience their own patients doing very well with treatment makes them want to see that again. But we've got a long way to go. I think the diagnostic ruling features that we talked about in an earlier episode are still largely clinical. I think we could really benefit from seeing those becoming more laboratory supported, particularly for research, particularly for looking at FND comorbidity and other neurological conditions like MS and Parkinson's. So I think we might see more of that, AI helping us with that maybe, but things like quantifying some of the physical signs that we use. In terms of treatment, I think it's great all the different ideas about treatment that we've had and we know that the rehabilitation therapy for FND benefits from a more FND focused approach. But we have to be honest as well and say that the treatments, there's still large numbers of patients who are not improving. And so we do need to think about other ways to help people. People are interested in treatments, modalities such as using virtual reality, people looking at medications such as psychedelics or things like that. We've got to be careful with that obviously in peoples where their brains don't work properly. But I think we can do better than we are and people are exploring those options interestingly. Dr. Gabriela Gilmour: Yeah. And I think on the note of treatment, as we've sort of spoken through this podcast series, we've talked about places or environments where there's already services set up for patients. And so I think another major goal for the future for the FND Society is to build more services and have more expertise and knowledge across the world. What would you tell neurologists to do or how would you support them if they don't have other health professionals to help in their local environment? Dr. Jon Stone: Well, I'm aware that that's probably what most neurologists feel like. That they can recognize FND, but they don't have people to refer to or therapists who know about FND. So I certainly share that frustration. What I would say has happened locally here in Edinburgh, and also I see this in other centers as well. If you just start referring patients, helping to send patients to your colleagues who want to have therapy, educating your colleagues, then the people around you can develop that expertise that's needed. You don't necessarily need a whole new team. If you're an enthusiastic neurologist interested in FND, be careful about doing it just on your own because I think there's a lot of good you can do, but it'd be quite easy to burn out there without some help. So I think it's a slow process of gathering together interested health professionals. Ideally, of course, you want to have a psychologist to do therapy, a psychiatrist for more detailed assessments of complex patients, physio, OT, speech and language therapy. Once you get that, what I find is that then locally, they will start to teach each other because this is work that most people in rehabilitation actually enjoy when they know how to do it. They like seeing people with FND. They like the fact that this is a disorder that will often be static for many years or a long time anyway, and where therapy can actually change that trajectory. So just sort of hang in there. There are articles you can read about more details about how to set up services and think about that as well. Dr. Gabriela Gilmour: Well, thank you so much, Jon, for joining me for this series. This is our final episode of the Neurology Minute series on Functional Neurological Disorder. And thank you to all of our listeners. Dr. Jon Stone: Thank you very much, Gabriela.