Contact Information Denis G Patterson DO Nevada Advanced

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Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists www. nvadvancedpain. com patterson@nvadvancedpain.

Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists www. nvadvancedpain. com [email protected] com

Education and Training • DO – Michigan State University College of Osteopathic Medicine (1998

Education and Training • DO – Michigan State University College of Osteopathic Medicine (1998 – 2002) • Pain Fellowship – Emory University (2006 – 2007) • Residency – Mayo Clinic (2003 – 2006)

Certifications • Board Certified, Pain Medicine (2007) • Board Certified, Physical Medicine and Rehabilitation

Certifications • Board Certified, Pain Medicine (2007) • Board Certified, Physical Medicine and Rehabilitation (2007)

Chronic Daily Migraines/Headaches ECHO Project January 20, 2019

Chronic Daily Migraines/Headaches ECHO Project January 20, 2019

Definition • Chronic daily migraines/headaches must occur > 15 days a month, for at

Definition • Chronic daily migraines/headaches must occur > 15 days a month, for at least 3 months

Classification • Chronic daily migraines/headaches are classified by how long they last – more

Classification • Chronic daily migraines/headaches are classified by how long they last – more than four hours or less than 4 hours

Classification • Chronic migraine • Chronic tension – type headache • New daily persistent

Classification • Chronic migraine • Chronic tension – type headache • New daily persistent headache • Hemicrania continua

Chronic Migraine

Chronic Migraine

Chronic Migraine • These headaches evolve from episodic migraine without aura

Chronic Migraine • These headaches evolve from episodic migraine without aura

Chronic Migraine • Must have two of the follow characteristics: 1) Affect only one

Chronic Migraine • Must have two of the follow characteristics: 1) Affect only one side of the your head 2) Cause a pulsating, throbbing sensation 3) Cause moderate to severe pain 4) Are aggravated by routine physical activity

Chronic Migraine • And they cause at least one of the following: 1) Nausea,

Chronic Migraine • And they cause at least one of the following: 1) Nausea, vomiting or both 2) Sensitivity to light and sound

Chronic Tension-Type Headache

Chronic Tension-Type Headache

Chronic Tension-Type Headache • These headaches evolve from episodic tension-type headaches

Chronic Tension-Type Headache • These headaches evolve from episodic tension-type headaches

Chronic Tension-Type Headache • Must have two of the follow characteristics: 1) Hurt on

Chronic Tension-Type Headache • Must have two of the follow characteristics: 1) Hurt on both sides of the your head 2) Cause mild to moderate pain 3) Cause pain that feels pressing or tightening 4) Are NOT aggravated by routine physical activity

Chronic Tension-Type Headache • They cause no more than one of the following: 1)

Chronic Tension-Type Headache • They cause no more than one of the following: 1) Nausea (mild) 2) Sensitivity to light and sound

New Daily Persistent Headache

New Daily Persistent Headache

New Daily Persistent Headache • These headaches become constant within a few days of

New Daily Persistent Headache • These headaches become constant within a few days of the moment you have your first headache

New Daily Persistent Headache • Must have two of the follow characteristics: 1) Hurt

New Daily Persistent Headache • Must have two of the follow characteristics: 1) Hurt on both sides of the your head 2) Cause mild to moderate pain 3) Cause pain that feels pressing or tightening 4) Are NOT aggravated by routine physical activity

New Daily Persistent Headache • They cause no more than one of the following:

New Daily Persistent Headache • They cause no more than one of the following: 1) Nausea (mild) 2) Sensitivity to light and sound

Hemicrania Continua

Hemicrania Continua

Hemicrania Continua • These headaches cause pain on only one side of your head

Hemicrania Continua • These headaches cause pain on only one side of your head and doesn’t shift sides

Hemicrania Continua • They also: – Are daily and continuous with no pain-free periods

Hemicrania Continua • They also: – Are daily and continuous with no pain-free periods – Cause moderate pain but with spikes of severe pain – Respond to the prescription pain reliever indomethacin – May sometimes become severe with development of migraine-like symptoms

Hemicrania Continua • And they cause at least one of the following: 1) Tearing

Hemicrania Continua • And they cause at least one of the following: 1) Tearing or redness of the eye on the affected side 2) Nasal congestion or runny nose 3) Drooping of the eyelid or constriction of the pupil

Cause • True (primary) chronic daily headaches don’t have an identifiable cause

Cause • True (primary) chronic daily headaches don’t have an identifiable cause

Risk Factors • • Anxiety Depression Sleep disturbance Obesity Snorning Overuse of caffeine Overuse

Risk Factors • • Anxiety Depression Sleep disturbance Obesity Snorning Overuse of caffeine Overuse of pain medications Regular use of physical postures that put strain on the your head or neck

Tests and Diagnosis • Diagnosis of exclusion

Tests and Diagnosis • Diagnosis of exclusion

Treatment • • • Antidepressants Beta Blockers Anti-seizure medications NSAIDs Botulinum Toxin

Treatment • • • Antidepressants Beta Blockers Anti-seizure medications NSAIDs Botulinum Toxin

Questions

Questions

Discussion

Discussion