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

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More from @DrNicoleC

Mar 10
It was a hard decision on which workshop to go to this morning, but I'm in the pelvic pain workshop now! #SAHM23
Definitions
Primary dysmenorrhea: painful menses in absence of pelvic pathology

Secondary dysmenorrhea: painful menses due to pelvic pathology or medical condition (e.g. endometriosis)

Chronic pelvic pain: >6 months, intermittent or constant, not always gynecologic

#SAHM23
Evaluation:
- history (gynecologic/menstrual/FHx)
- bleeding pattern
- qualifying pain, intensity, timing
-confidential history is important

Pelvic exam is not recommended in adol patients unless STI/PID highly suspected

Same for imaging unless anatomic concern

#SAHM23
Read 22 tweets
Mar 8
Symposium on the #HPVvaccine! Some key points here:
>90% of sexually active men and 80% of sexually actively women WILL BE INFECTED #SAHM23
Only 2 doses if given < 15 years of age are needed. Much better immune response if given younger. #HPVvaccine #SAHM23
Opt out approaches increase rates of #HPVvaccine uptake. #SAHM23
Read 8 tweets
Feb 28
By request, here's a brief thread on avoidant restrictive food intake disorder (ARFID). 🧵 #EDAW2023

ARFID emerged as a diagnosis with the DSM-5 in 2013. In short, patients with ARFID have restrictive eating w/o evidence of body image disturbance. But let's dig a little more...
Here are the diagnostic criteria. You'll notice that other medical/mental health conditions don't prevent a dx of ARFID from being made (e.g. autism spectrum). However, if another condition is present the feeding disturbance has to be beyond what is typical for that condition...
I conceptualize ARFID in 3 major categories.
1⃣ Pts w/ fear of an adverse consequence (e.g. vomiting, choking abd pain)
2⃣ Pts w/ sensory concerns (e.g. sensitivity to food texture, smell, temperature)
3⃣ Pts w/ a lack of interest in eating, minimal appetite, a chore to eat
Read 6 tweets

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