Thread by @DrNicoleC

Late to the headache workshop but here now! Learning about importance of treating migraines, children with migraines miss significantly more school than those who do not. #SAHM23

Patients with migraines with aura have increased risk of strokes. Important to avoid estrogen when possible as well as smoking to not compound this risk. #SAHM23

Complicated migraines: can have brainstem auras - sx of dizziness, tinnitus, ataxia, dysarthria, vertigo.

Vestibular migraine: dizziness with the headache part

Alice-in-wonderland syndrome: visual hallucinations, visual distortions

#SAHM23

Principles of treatment for migraines:
- Goal is to treat within 1 hour to avoid prolongation of HA
- Try to limit NSAIDs/APAP to 2-3x/week

#SAHM23

Headache prophylaxis:
- hydration: 2L daily (do as I say, not as I do)
- limiting caffeine to 2x a week (see above)
- regular meals (👀)
- regular exercise
- screen for med overuse
- Mg oxide 400-500mg/day + B2 has class B evidence

#SAHM23

Topiramate is most commonly used med ppx. Side effects are appetite suppression, sedation/cognitive slowing

Zonisamide is also a good option, dosed daily and less side effects. Not FDA approved for kids

Amitriptyline/nortriptyline (latter has better SE profile)

etc
#SAHM23

Great question about migraines with aura and estrogen. Even if haven’t have auras in a long time, avoid estrogen. Blurry vision (esp during the headache) is not an aura! Auras precede pain! #SAHM23

Babies with infantile colic have higher risk for migraines as adolescents. #SAHM23

SO MANY QUESTIONS about estrogen! 😅😅😅😅 The adolescent med docs understand the assignment. #SAHM23