Advanced Headache Therapy: Outpatient Strategies by Lawrence Robbins

By Lawrence Robbins

This state-of-the-art booklet will conceal numerous points of headache administration, with a spotlight on tricky sufferers. useful, step by step recommendation for treating hard complications, together with migraine, refractory and cluster complications, can be supplied intimately besides find out how to method sufferers of alternative a while and people with mental problems. precise and intricate case experiences and whole causes to the sizeable array of medicines may also be featured. Authored by way of one of many top specialists on refractory complications, complicated Headache administration might be a useful consultant for the resident or clinician and an easy-to-read source for plenty of patients.

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In diagnosing migraine, it helps to look at consistent triggers—such as menses, weather, and under-sleeping. If weather changes bring on migraine, it is always confusing, since the migraineur is often told (and feels) that they have a sinus headache. To confuse the picture, the OTC sinus meds often help all types of headache. Most sinus headaches turn out to be migraines. There have been several large studies indicating that 95 % of people presenting with chronic sinus headaches actually have migraines, not sinus headaches.

We want to seek treatments outside of the pharmacy. We need to promote active coping. We must have other modalities involved. Pharmacotherapy may be important, but certainly we want to try everything else, whether it is physical therapy, yoga, biofeedback, etc. Psychotherapy is often important and I strongly recommend it as part of treatment. However, whether it is because of money or time, most people will not see a therapist. Cognitive-behavioral therapy is the usual approach, but with PDs one must take more of a dialectical tack.

Bicarbonate levels should be monitored because this agent may cause doserelated metabolic acidosis. This acidosis may lead to “tingling,” which sometimes may be counteracted by potassium (in foods or supplements). 5–10 mg/day 25–50 mg/day 25–100 mg/day 60–120 mg/day Usual dose: 500–1000 mg/day, in divided doses Total dose varies from 25 or 50 mg/day up to 400 mg/day Dose: Varies (FDA official dose is 155 units, via 31 injections, every 3 months) Usual dosage Better tolerated than the other β-blockers with the fewest respiratory effects Fewer respiratory effects than propranolol Fewer respiratory effects than propranolol Side effects include dizziness, insomnia, fatigue, GI upset, respiratory distress, weight gain Liver function levels need to be monitored in the beginning of treatment.

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