Why you should listen to and believe your patients. A ..

I saw a patient and diagnosed them with a common condition. However, I was wrong. How did I know I was wrong?

Because the treatment wasn’t helping and the patient was feeling worse. 1/

#MedTwitter I did some tests to evaluate for other conditions. They were all normal. I began trying to treat the symptoms because it was affecting quality of life. I still went with the original diagnosis. The patient continued to decline. 2/

For those who do Prior Auths for Nurtec, pro tip: I have had many claims for this med denied because I put the “incorrect” diagnosis. I prescribe it for as needed but the patient typically has episodic migraine. So this question leads me to choose “episodic migraines” 1/ This leads to a denial because the patient is not on preventive therapy. If patient is having less than 4 HA days per month, I’m not going to put them on preventive therapy. Turns out the first option is for as needed Nurtec and the second option is for preventive Nurtec. 2/

I was asked if I see a lot of patients with neurological conditions after getting COVID. Taking a moment to think about it, I said “at least one to two patients a day.” And while I know the huge effect this virus has had on the population, actually quantifying it was terrifying. There are neurological conditions that occur after viral infections (NDPH, MS, and AIDP immediately come to mind). But I didn’t often see those (maybe one or two a month). Not like I’m seeing issues post COVID infection. And it’s terrifying.

Let’s talk about #topiramate for #migraine. Love it or hate it, you’re probably gonna prescribe it for your patients. Unfortunately, I see a lot folks prescribe it in a way that it is either not effective or causes side effects, leading to the general disdain for the med. A 🧵1/n This #tweetorial is more for medical providers but patients can learn from it to. Here are some ways to take topiramate that may lead to decrease in frequency and severity of migraine symptoms with less side effects. #MedTwitter #NeuroTwitter #MedEd 2/n

Something I learned recently is there are 3 different types of photophobia associated with #migraine.

Type 1 is when light worsens migraine headache pain. This is due to the receptors in the eye then going to the thalamus and being transmitted out to the trigeminal nerves 1/4 which transmit pain receptors in the face and head. Therefore light makes the pain worse.

Type 2 is increased sensitivity to light. Light seems brighter but it doesn’t make the headache worse. This is due to dysfunction in the brain pathways that mediate response to light. 2/4

If you’re having a migraine prodrome clap your hands! 👏🏽👏🏽 If you are dealing with severe fatigue and irritability and that anxiety knowing a migraine attack is about to happen but you don’t know when and you’re out of your usual rescue so you’re also sad, clap your hands. 👏🏽👏🏽 It’s me. I’m clapping my hands. #migraine #NotJustAHeadache