1/26/2014 A PRACTICAL OPTOMETRIC HEADACHE APPROACH A PRACTICAL OPTOMETRIC HEADACHE APPROACH A PRACTICAL OPTOMETRIC HEADACHE APPROACH
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1 1/26/2014 A Practical Optometric Approach To Headaches Leonid Skorin, Jr., OD, DO, MS, FAAO, FAOCO Mayo Clinic Health System in Albert Lea Assistant Professor of Ophthalmology Mayo Clinic College of Medicine skorin.leonid@mayo.edu Ubiquitous symptom 73% of adults experienced headache in past year 10 million outpatient visits per year Only 15% actually sought medical help ESTIMATED PREVALANCE OF MIGRAINE SUFFERERS IN THE UNITED STATES IMPACT OF MIGRAINE SOCIETAL COSTS IMPACT OF MIGRAINE PERSONAL COSTS 1
2 IMPACT OF MIGRAINE HEALTH SURVEY SCORES FOR MIGRAINE AND OTHER CHRONIC CONDITIONS HEADACHE CLASSIFICATION International Headache Society criteria 1. Primary headache disorders Migraine Tension-type Cluster 2. Secondary headache disorders Headache is symptomatic of an underlying condition such as temporal arteritis, brain tumor, stroke BASIS OF DIFFERENTIAL HEADACHE DIAGNOSIS THOROUGH PATIENT INTERVIEW APPROPRIATE GENERAL EXAMINATION ADEQUATE NEUROLOGIC EXAMINATION HEADACHE DIAGNOSIS P - Provokes, Palliates Q - Quality R - Region S - Severity, Associated signs/symptoms T - Timing 1. Onset 2. Frequency 3. Duration Pathophysiology Vascular Neural Unified or neurovascular Serotonin (5-HT) neurotransmission 2
3 POTENTIAL TRIGGERS OF MIGRAINE: MIGRAINE PREVALENCE BY AGE AND SEX DRUGS HORMONES SENSORY STIMULI CARBON MONOXIDE EMOTIONAL STRESS FOODS AND BEVERAGES ENVIRONMENTAL CHANGES CHRONOBIOLOGIC CHALLENGES MIGRAINE CLASSIFICATION MIGRAINE WITHOUT AURA (COMMON MIGRAINE) Migraine without aura (common migraine) Migraine with aura (classic migraine) Complicated migraine 1. Ophthalmoplegic migraine 2. Basilar migraine 3. Migraine equivalents MIGRAINE WITH AURA (CLASSIC MIGRAINE) 3
4 OPHTHALMOPLEGIC MIGRAINE ONSET BEFORE AGE 10 3RD, 6TH, OR 4TH NERVE PARESIS MIGRAINE EQUIVALENTS ACEPHALGIC MIGRAINE EPISODIC, TRANSIENT DYSFUNCTION OF AN ORGAN OR SYSTEM NO ACCOMPANYING HEADACHE POSITIVE FAMILY HISTORY PERMANENT WITH REPEAT EPISODES Nonpharmacologic 1. Eliminate trigger factors 2. Stress management 3. Biofeedback 4. Acupuncture Physical Techniques Massage, acupressure Acupuncture + OTC painkillers: 44% < HA Trigger point injections Muscle stretching exercises Osteopathic manipulation Chiropractic spinal manipulation Peripheral Nerve Stimulation Eon Mini IPG Stimulation of occipital nerves for intractable chronic migraine: changes the pain signal 41% reduction in overall disability 89% of patients would recommend to others 27% reduction in number of headache days 68% improved quality of life Homeopathic Feverfew herb, mg daily, (parthenolide parthenolide) Can cause oral ulcers, tongue irritation, lip swelling. Riboflavin Vitamin B mg daily Increases energy efficiency of mitochondria. Vitamin B Complex B 6 25 mg, B mcg, folic acid 2 mg: 50% < HA Butterbur herb, 75 mg BID x 4 months: 50% <HA Use the brand Petadolex. Magnesium 600 mg daily: 50% < HA Start with 200 mg daily, slowly increase to 600 mg. 4
5 Botulinum Toxin Injection Peripheral effect muscle relaxant Central effect inhibits release of trigeminal cell-mediated neurotransmitters Symptomatic (Abortive) 1. Over-the-counter medication a. Aspirin b. Acetaminophen c. Non-steroidal anti-inflammatory drugs Motrin Migraine Pain Advil Migraine d. Combination drugs: Excedrin Migraine Symptomatic (Abortive) 2. Prescription medication a. Combination drugs with narcotic b. Ergotamine tartrate c. Dihydroergotamine: Migranal d. Narcotics: Stadol NS e. Midrin Selective Serotonin Receptor Agonists Imitrex (sumatriptan) Zomig (zolmitriptan) Amerge (naratriptan) Maxalt (rizatriptan) Axert (almotriptan) Frova (frovatriptan) Relpax (eletriptan) Treximet (sumatriptan/naproxen) Selective Serotonin Receptor Agonists Efficacy: if first triptan does not work, try another may require trial and error Onset: injection minutes nasal spray 15 minutes troche no faster than oral tablets Route: nasal spray or injection for N/V Duration: longest acting Frova and Amerge 5
6 Prophylactic (Preventive) a. Beta blockers b. Tricyclic antidepressants c. Nonsteroidal anti-inflammatory drugs d. Calcium channel blockers e. Monoamine oxidase inhibitors: Nardil f. Anticonvulsants: Depakote, Depakene, Topamax Topamax 50% < HA by 6 weeks 6
8/23/2015 A PRACTICAL OPTOMETRIC HEADACHE APPROACH A PRACTICAL OPTOMETRIC HEADACHE APPROACH A PRACTICAL OPTOMETRIC HEADACHE APPROACH
8/23/2015 A Practical Optometric Approach To Headaches Leonid Skorin, Jr., OD, DO, MS, FAAO, FAOCO Consultant, Department of Surgery Community Division of Ophthalmology Mayo Clinic Health System in Albert
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