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Contact Information. Denis G. Patterson, DO Nevada Advanced Pain Specialists www.nvadvancedpain.com patterson@nvadvancedpain.com. Education and Training. DO Michigan State University College of Osteopathic Medicine (1998 – 2002) Pain Fellowship Emory University (2006 – 2007) Residency
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Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists www.nvadvancedpain.com patterson@nvadvancedpain.com
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 (2007)
Chronic Daily Migraines/Headaches ECHO Project January 20, 2019
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 than four hours or less than 4 hours
Classification • Chronic migraine • Chronic tension – type headache • New daily persistent headache • Hemicrania continua
Chronic Migraine • These headaches evolve from episodic migraine without aura
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, vomiting or both 2) Sensitivity to light and sound
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 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) Nausea (mild) 2) Sensitivity to light and sound
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 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: 1) Nausea (mild) 2) Sensitivity to light and sound
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 • 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 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
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
Treatment • Antidepressants • Beta Blockers • Anti-seizure medications • NSAIDs • Botulinum Toxin