slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
New Study Finds Americans Need 6 Hours Of Sleep At Work PowerPoint Presentation
Download Presentation
New Study Finds Americans Need 6 Hours Of Sleep At Work

Loading in 2 Seconds...

play fullscreen
1 / 22

New Study Finds Americans Need 6 Hours Of Sleep At Work - PowerPoint PPT Presentation


  • 63 Views
  • Uploaded on

New Study Finds Americans Need 6 Hours Of Sleep At Work.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'New Study Finds Americans Need 6 Hours Of Sleep At Work' - noah


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

“…And then a throb hits you on the left side of the head so hard that your head bobs to the right…There's no way that came from inside your head, you think. That's no metaphysical crisis. God just punched you in the face.” --Andrew Levy, A Brain Wider Than the Sky: A Migraine Diary

migraine prevention

Migraine Prevention

LT Sara Pope, MD

7 February 2013

objectives
Objectives
  • Briefly reviewed treatment of migraines
  • Explored the importance of prophylaxis
  • Assessed when to start prophylaxis
  • Discussed treatment types
migraines in brief
Migraines: In Brief
  • Common, complex and recurrent
  • >30 million people have 1+ migraines/year
  • 13% prevalence, 75% female
  • 80% have a 1st degree relative with a history
  • Environmental, behavioral triggers
migraines sensitive cns
Migraines: Sensitive CNS?
  • Intracranial vasoconstriction + rebound dilation
  • Neurogenic process w/2°changes in cerebral perfusion
    • Classic: +AURA, gradual, unilateral, pulsating, +sensory
    • Common: NO AURA, episodic vs. chronic
true migraine
True Migraine?
  • Head pain + nausea + sensory sx
  • >4 h, <72h
  • Starts young, rare >50 yo
  • Common in reproductive years
  • Predictable triggers
  • Red flags
why prophylaxis
Why Prophylaxis?
  • Reduce frequency, severity and duration
  • Improve responsiveness to acute tx
  • Improve function, reduce disability, +QOL
  • Reduce costs
  • Only 13% on preventive therapy
when to start
When to Start?
  • Recurrent, interfere w/ADL’s despite tx
  • >4 attacks/month
  • Contraindications or failure/overuse of acute tx
  • Adverse events to acute tx
  • Hemiplegic, basilar, prolonged aura, infarction
  • Menstrual: mini-prophylaxis
slide10
How?
  • Several medications
  • Varied mechanisms of action
  • No ‘gold standard’, pt specific
  • Success: reduction in migraine frequency by 50% in first 3 months
small groups
Small Groups
  • Three Groups
  • Three Medication Categories
  • Three Teaching Points
  • Three Cases
anti hypertensives1
Anti-Hypertensives
  • Propanolol, metoprolol,timolol: Effective
  • Verapamil, nimodipine: Insufficient
  • Lisinopril, candesarta: Possibly effective
  • Telmisartan: Possibly not effective
anti convulsants1
Anti-Convulsants
  • Topiramate: Effective, as good as BB, VA, TCA
  • Divalproex, valproate: Effective
  • Gabapentin: Insufficient
  • Lamotrigine, oxcarbazepine: Ineffective
anti depressants
Anti-Depressants
  • Fluoxetine: Limited, conflicting data
  • Venlafaxine: Probably Effective
  • Amitriptyline: Probably Effective, as good as topiramate, maybe Venlafaxine
others
Others…
  • Triptans
  • Botox
  • Butterbur
  • Co-enzyme q10
  • Feverfew
  • Magnesium
  • Methylsergide
  • Riboflavin
  • Acupuncture
  • Relaxation, biofeedback
  • CBT
  • Hypnosis
  • TENs
  • Hyperbaric oxygen
principles of prophylaxis
Principles of Prophylaxis
  • Start low, go slow
  • Adequate trial in duration, dosage
  • Avoid overuse: analgesics, opioids, triptans
  • Caution: women of child bearing age
  • Address expectations, preferences, side effects, commitment
  • Slowly taper w/improvement, recommend 6-9 months
objectives1
Objectives
  • Briefly reviewed treatment of migraines
  • Explored the importance of prophylaxis
  • Assessed when to start prophylaxis
  • Discussed treatment types