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.
Assess Frequency And Medication Overuse
- Ask about frequency and acute medication use to distinguish episodic vs chronic migraine and medication overuse.
- Stop or limit overused agents and start preventive treatment rather than withholding prevention during withdrawal.
Medication Overuse Has Unpredictable Reversibility
- Medication overuse headache is a real entity but only ~50% improve after stopping the overused drug.
- You cannot predict who will improve, so try withdrawal while still offering preventive therapies.
