Treating Migraine in the Elderly: Navigating Polypharmacy and Comorbidities
Considering individual patient factors, effects of aging, and using online tools for drug interactions will aid in treatment of migraines in the elderly.
Features
FEATURES
Medicaid Work Requirements Are Increasing the Cost of Being Sick in America
On the surface, a plan to get able-bodied individuals back to work in order to maintain their Medicaid benefits sounds reasonable — until it’s not.
Opioid-Induced Constipation: Insights Into Diagnosis and Effective Treatment
Conventional approaches to treatment of opioid-induced constipation include the use of treatment modalities that address non-opioid-related constipation as well as new medications that target the OIC mechanism of action.
Migraine and Alcohol: Encouraging a Healthy Balance of Indulgence and Vigilance
Based on the literature, investigators found no reason to tell patients with headache to abstain from alcohol.
Case Study: Shoulder Injury Following a Biking Accident
A 41-year-old man presents with a shoulder injury sustained as the result of a fall from his road bike.
In the Spotlight: How Racism Affects the Healthcare Workforce
Racism is embedded in all US institutions, including medicine — so what steps are being taken to improve the well-being of the healthcare workforce?
ACIP Updates Recommendations for US Adult Immunization Schedule
The ACIP and CDC have approved and released 2019 recommendations for the adult immunization schedule in the US.
Mobile Health Apps for Headache: An Ongoing Search for Clinical Relevancy
The main objection among clinical researchers is that commercially developed products often lack a scientific basis for their selection of features.
Protecting Your Practice From Data Breaches: An Expert Interview
To shed light on issues of cybersecurity in medical practices, MPR spoke to Michael J Sacopulos, JD, CEO of Medical Risk Institute (MRI), a firm that provides “proactive counsel” to the healthcare community to identify where liability risks originate and to reduce or remove those risks.
An Evidence-Based Road Map to Navigating the Opioid Epidemic
This rise in prescribing of prescription opioids in the last 2 decades of the 20th century occurred at a time during which medical professionals were urged to resort to prescription opioids to manage untreated and chronic noncancer pain.
Navigating Social Media Issues in Medical Practice: An Expert Interview
Issues that affect employees in all industries are compounded by a unique set of additional concerns that affect employees of medical practices.
Mentoring Women in the #MeToo Era: Expert Roundtable
Despite record numbers of women working in medicine, instances of gender discrimination and sexual harassment continue to proliferate.
Surgical, Nonsurgical Treatments for Chronic Migraine: Evidence and Relevancy
There are many procedural treatments for migraine that are effective and safe, including peripheral nerve blocks, trigger point injections, botulinum toxin injections, and sphenopalatine ganglion blocks.
Approved in Migraine, CGRP Antagonists Also Promising in Cluster Headache
Cluster headache and migraine are distinct primary headache disorders that are associated with substantial pain and disability.
Neuroimaging in Headache Disorders: When Is It Necessary?
The use of neuroimaging as a diagnostic tool remains at the discretion of the clinician, necessitating more research to improve clinical understanding of primary and secondary headaches.
Hemicrania Continua: Diagnosis and Treatment
Hemicrania continua, one of the trigeminal primary headaches, causes intense unilateral pain for ≥3 months.
Experts Offer Tips on Integrating Medical Marijuana Into Geriatric Practice
A study by the National Survey of Drug Use and Health (NSDUH) found that from 2002-2014 the proportion of adults aged 50 to 64 who reported cannabis use in the past year more than tripled from 2.9% to 9.0%. Among adults age 65 or older, there was more than a ten-fold increase (from 0.2% to 2.1%).
Migraine Treatment in the ED: Overcoming Our Penchant for Opioids
There is significant evidence that opioids are not the right treatment of choice for migraine in the emergency department.
Persistent Poststroke Headache: Finding Its Place in Stroke Aftercare
The continued observation of this delayed headache syndrome may point to a different pathophysiology from tension-type headache or acute poststroke headache.
The Unintended Consequences of the CDC Opioid Guideline According to Pain Management Specialists
The guideline formulated by the Centers for Disease Control and Prevention in an effort to curb opioid overdose-related deaths included a recommendation for steep reductions in opioid doses for patients taking high doses of the drug for chronic pain.
Striking a Balance Between Opioid Surveillance and Patient Privacy
Big data has enabled public health authorities to identify doctor-shopping patients and those who needed treatment for opioid abuse. The trade-off, however, could be patient and provider privacy.
Popular Heroin Inhalation Method Tied to Leukoencephalopathy
“Chasing the dragon” is an increasingly popular method of heroin inhalation among drug users.
The Opioid System: The Foundation for Social Risk and Reward
The opioid system is responsible for social pain and reward in the brain; therefore, understanding its underpinnings may help clinicians manage patients with depression and suicidal ideation.
Managing Comorbid Opioid and Alcohol Use Disorder
When alcohol and opioid addiction occur together, managing them concomitantly becomes challenging. Whereas some patients may not need medication for alcohol addiction, opioid abuse does require pharmacotherapy.
Perioperative Pain Management in Patients With Opioid Use Disorder
The perioperative management of pain in patients with opioid use disorders presents multiple challenges to clinicians. A recent review offered clinical guidance for various subgroups of these individuals.
The Role of Psychological Factors in Phantom Limb Pain Reviewed
Up to 85% of amputees experience phantom limb pain: sensations in the missing limb that patients may describe as burning, cramping, tingling, itching, stabbing, throbbing, or a feeling of “pins and needles.”
Pediatric Migraine and Obesity: What We Know and Where We’re Going
Data in children do support an association between pediatric obesity and headache disorders in general, but more research is needed to confirm the association specifically with pediatric migraine.
Leveraging the Placebo Effect to Reduce Opioid Requirements
Emerging evidence indicates that the placebo effect can in some instances reduce patients’ pain. The current debate is whether clinicians need to disclose to patients that they are using placebos instead of active ingredients.
Descriptive, Predictive Data at Odds in Medical Malpractice Courtroom
Because they’re busy looking in different directions, “innocent until proven guilty” and “first, do no harm” don’t always get along.
Comorbid Bipolar Disorder and Substance Abuse: A Challenge to Diagnose and Treat
Bipolar disorder is often comorbid with substance use disorders, with alcohol being the top substance. Clinicians should take a thorough history to uncover substance use disorder because it will guide the management of both disorders.
Pediatric Chronic Musculoskeletal Pain: Diagnosis and Management
Chronic, noninflammatory pain in children and adolescents encompasses a wide range of pain syndromes. Clinicians need to consider not only the physical manifestations of pain but also the psychosocial and academic impact of the child’s pain and impairment.
Identifying Intracranial Hypertension in Children: Added Challenges
Pediatric neurologist Lalitha Sivaswamy, MD, discusses challenges in diagnosing primary intracranial hypertension in pediatric patients.
Reducing Mortality After Overdose: Is Treatment for Opioid Use Disorder Effective?
Adults who received pharmacologic treatment for opioid use disorder following a non-fatal overdose may have a reduced risk for opioid-related and all-cause mortality in the subsequent 12 months compared with adults who did not receive medication-assisted treatment.
Tumor-Related Headache: Path to Diagnosis, Treatment Isn’t Always Obvious
Headaches are a common occurrence in the general population and are often present in patients with an underlying brain tumor, although it is not yet clear to what degree they are related.
Abuse-Deterrent Opioid Formulations: Barriers to Broader Use
Abuse-deterrent opioid formulations have not yet been widely accepted despite their proposed value in reducing opioid abuse and related mortality. Many of the current barriers to broader use are related to their higher cost compared with conventional formulations.
Exploring the Clinical Implications of Cannabinoid Use in Rheumatoid Arthritis
Preliminary evidence has found an association between the cannabinoid system and other rheumatic conditions, but the studies have not provided conclusive results that could drive recommendations.
Opioid Use Disorders: Advances in Pharmacotherapy Provide Long-term Results
Despite the availability of long-acting opioid antagonists, many patients with OUD never receive adequate treatment.
Should You Record Your Patient Encounters? An Interview With Dr James Ryan
Patients are increasingly recording physician visits on their phones, should physicians do the same. MPR spoke with physician who advocates for recording in clinical practice.
Managing Comorbid Migraine and Mood Disorders: A Synergistic Approach
People with migraines and comorbid mood disorders often need treatments that address both conditions, as well as management of sleep, stress, and lifestyle issues.
Addressing Rare Headache Disorders: Acute Confusional Migraine
Acute confusional migraine has not been specifically studied and many clinicians remain unaware of the condition, which may result in underestimation of the prevalence.
Optimal Strategies for Opioid Weaning After Ambulatory Surgery
Although there is a scarcity of evidence pertaining to the management of postoperative pain medication in the ambulatory setting, some findings suggest an approach similar to that used for the treatment of acute pain.
Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?
Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.
Stat Consult: Chronic Low Back Pain
Chronic low back pain (LBP) defined as persistent or fluctuating musculoskeletal pain of lower back and lumbar spine lasting >3 months.
Gender Differences in Axial Spondyloarthritis: Comparing Disease Burden and Treatment
An improved understanding of the gender differences in axial spondyloarthritis can improve disease treatment and reduce disease burden.
Treating Osteoporotic Pain: Expert Interview
Pain resulting from osteoporotic fractures should be treated with a multimodal approach that includes pharmacological and nonpharmacological strategies.
Functional Restoration for Chronic Pain and Depression in the Elderly: Pharmacotherapy and Beyond
Functional restoration is a multimodal approach to chronic pain and depression, and includes psychoeducation about pain, biofeedback, mindfulness training, physical and occupational therapy, and detoxification of narcotics.
Should Physicians Treat Family and Friends? Three Experts Weigh In
Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.
Case Study: Sudden Abdominal Pain
A 90-year-old woman with a history of coronary disease and gallstones presents to the emergency department with generalized abdominal pain that started suddenly about 7 hours prior.
Confronting Postdural Puncture Headache in Clinical Practice
Nonpharmacological strategies, including bed rest, have a lack of evidence supporting their use in the treatment of postdural puncture headache.
Recommendations for Perioperative Pain Management in Patients With Opioid Tolerance
With the increasing number of patients presenting to surgery with opioid tolerance, clinicians should be familiar with their specific analgesic needs.
A Few Bad Apples: Managing Malpractice Claims
Ranking or otherwise gauging physician quality isn’t just a way to assign bragging rights — performance metrics can be used to set reimbursement levels, tailor insurance, and identify physicians who are falling behind.
Court-Mandated Substance Abuse Treatment: Exploring the Ethics and Efficacy
While many treatments for substance use disorder are not evidence based, several evidence-based approaches have shown effectiveness in court-mandated treatment settings.
Addressing Psychiatric Comorbidities in Inflammatory Rheumatic Diseases
Rheuatology Advisor speaks with a psychologist about addressing mental health in patients with inflammatory arthritis.
Substance Abuse and Primary Psychosis: A Closer Look
Patients will still be at risk for schizophrenia or bipolar disorder even several years after an episode of substance-induced psychosis.
Addressing Migraine That Mimics Stroke
Neurology Advisor spoke with Dr Peter McAllister about how to best discern migraine with aura from stroke.
Alleviating Fibromyalgia-Related Muscle Pain Through Nutrition
Providing guidance to improve dietary behavior, which may include supplementation to achieve an optimal nutritional status, can contribute to improved control of fibromyalgia symptoms.
Addressing Depression in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Clinicians address issues relating to treating patients with comorbid chronic fatigue syndrome and mood disorders.
Detox vs Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Expert Roundtable
Based on current evidence, there is a strong consensus that medication-assisted treatment is recommended over detoxification in the treatment of opioid use disorder during pregnancy.
Managing Pediatric Migraine: Current Therapies and Future Directions
Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.
#MeToo: Helping Victims Cope With Sexual Harassment
Mental health professionals regularly grapple with the best way to support clients navigating an onslaught of sexual violence in their daily lives.
When Sparks Stop Flying: How Is Clinician Burnout Tied to Patient Outcomes?
Physician burnout has gained traction as a public health concern because more physicians are leaving medical practice altogether, resulting in decreased patient access and continuity of care.
What a Building Contractor Taught Me About Informed Consent
Identifying a patient’s preferences and goals leads to a care plan that can reflect those goals, and this may improve patient satisfaction.
The Pilot, the Physician, and the Whistleblower: When Is it Okay to Sound the Alarm?
Airplane cockpits have a lot in common with operating rooms: both host a small team that’s trusted to perform an extraordinarily complex task with the clear understanding that any misstep could spell doom.
Peripheral Nerve Blocks for Headache Disorders: Expert Roundtable
Although high-quality studies on the use of peripheral nerve blocks for the treatment of headache disorders are scarce, results observed in clinical practice support their use.
Under the Microscope: Medicine’s #MeToo Moment
No single solution to address sexual harassment in medicine exists, but physicians of all genders must come together to make progress.
Headache in Older Adults: Unique Causes and Treatments
It is important for clinicians to quickly and accurately determine potential underlying causes and to prescribe treatments that take into account comorbidities and medications that older patients may be taking for them.
Expert Q&A: Effects of Collaborative Care Models on Patient Satisfaction in Rheumatoid Arthritis
John M. Davis III, MD, MS, from the Mayo Clinic in Rochester, Minnesota, and Jennifer Gorman, MD, MPH, from The Polyclinic in Seattle, Washington, discuss the evolving collaborative care therapy model in RA.
Intrathecal Drug Delivery and Spinal Cord Stimulation for Cancer Pain: A Review
Intrathecal drug delivery systems and spinal cord stimulation have shown promise for the treatment of cancer pain in initial studies.
Overlapping Headache and Sleep Disorders: Which Comes First and How to Treat?
Clinicians discuss the clinical implications of headache and comorbid sleep disturbances.
Surgical Outcomes and Social Media Reviews: When a 5-Star Rating Isn’t All It Seems
Customer service is a critical part of every physician’s job, but there’s a big difference between a Yelp review and a risk-adjusted mortality rate in determining
Honoring Women in Medicine: Reader Responses
We are sharing your stories about the women behind the white coats.
Sphenopalatine Ganglion Stimulation for Refractory Cluster Headache
Emerging evidence suggests that sphenopalatine ganglion stimulation may be an effective treatment for refractory cluster headache.
Radiofrequency Ablation for Chronic Hip Pain: Reviewing the Evidence
The available evidence suggests that radiofrequency ablation is a feasible treatment option for chronic hip pain associated with degenerative diseases.
Diagnosing Medicine’s Intractable Gender Pay Gap
The #MeToo movement has inspired many women to relate stories of harassment, and medicine is no exception.
Evaluating Headache in the Elderly: Primary vs Secondary Causes
Given the unique challenges presented by aging, new cases of headache in older adults should be evaluated carefully for a differential diagnosis of primary headache and to exclude underlying causes of secondary headache.
The Pros and Cons of Direct-to-Consumer Genetic Testing
Direct-to-consumer genetic testing has been receiving a lot of attention over the past 10 years from medical providers, consumers, consumer advisory boards, regulatory entities, and ethicists.
Low Back Pain: Contributing Factors, Prophylactic Strategies, and Effective Treatments
A Lancet series of articles outlines the array of factors that contribute to low back pain and presents effective prophylactic strategies and treatment options for the condition.
Betel Quid Addiction and Implications for Substance Use Disorder
New findings suggest that DSM-5 criteria may apply to betel use disorder and offer opportunities to advance the study and understanding of substance use disorder in general.
Recognizing the Pioneering Women in Medicine for Women’s History Month
Women continue to propel medicine into the future. Take a glimpse at just a handful of the remarkable women in medicine making history today.
Peripheral Neuropathy Management in the Primary Care Setting: A Guide
Although peripheral neuropathy is one of the most common neurologic problems seen in the primary care setting, recognizing and evaluating peripheral neuropathy in a patient can be challenging due to its diverse presentations.
The Link Between Medical Malpractice and Defensive Medicine
Many studies attempt to quantify the effect of the various malpractice claim regulations on physician practice by linking it to the prevalence of defensive medicine, which is when a physician alters his or her clinical approach for the purpose of reducing malpractice exposure.
Non-Opioid Therapies for Pain Management in the ED
The use of non-opioid analgesic therapies is increasing among ED physicians.
Targeting Remission in Axial Spondyloarthritis With Pharmacological Treatment
Although current guidelines define remission as the absence of clinical and laboratory evidence of significant inflammatory disease,the parameters against which axial spondyloarthritis is assessed to demonstrate clinical remission are unclear.
Too Early to Formulate Recommendations on Medical Cannabis vs Opioids for Pain?
Various strategies to reduce opioid overdose deaths have been implemented and it has been suggested that access to medical cannabis may lead to a reduction in opioid use for pain management.
Exploring the Connections Between Neuropathic Pain and Comorbid Mood Disorders
Substantial evidence suggests a close connection between neuropathic pain and mood disorders.
Growing Number of Genetic, Neuroimaging Markers for Migraine With Advances in Research
Advancements in research have led to the identification of a growing number of genetic and neuroimaging markers of migraine.
Optimal Approaches to the Management of Burn Pain: Expert Insight
Depending on the extent of the injury, pain due to burns can range from mild to severe to excruciating.
Drawing the Line Between Personal Beliefs and Patient Rights
There’s only one way to resolve the dissonance between personal beliefs and professional obligations: remembering that physicians take an oath pledging fealty to patients’ health, not their own belief systems.
Addressing Barriers to Translational Pain Research
Many translational barriers exist between preclinical research and clinical practice.
Reviewing the Effectiveness of Lidocaine for the Management of Chronic Pain
Systemic lidocaine administered via IV or patch has consistently shown effectiveness for the treatment and prevention of chronic pain.
Physician Suicides: A Public Health Crisis
Suicide among physicians is a staggering public health crisis that has gone largely ignored; one physician shares his insight.
Managing Headache During Pregnancy: Expert Insight
Headache screening should be a routine part of a prenatal visit so that if and when a patient presents with an attack, a suitable plan of action is already established.
Atypical Antipsychotics as Adjuncts in Chronic Pain Management: How Effective Are They?
In recent years, atypical antipsychotics – particularly olanzapine and quetiapine – have gained increasing attention as adjuncts in pain management regimens.
Erenumab for Episodic Migraine Prophylaxis: Current Evidence
The monoclonal antibody erenumab has shown favorable results regarding efficacy and safety for the prevention of migraine.
OnabotulinumtoxinA for Tension-Type Headache: Research vs Real-Life Settings
Despite its prevalence, tension-type headache is often complicated by overlapping symptoms and a weak understanding of tension-type headache etiology.
Staying in Line With Medical Ethics by Altering Opioid Prescribing Practices
One physician shares his thoughts on the importance of balancing autonomy, beneficence, and nonmaleficence when prescribing opioids to patients.
Pain Management Challenges In Severely Obese Patients
Special caution is warranted in the administration of pain treatment to patients with severe obesity, and additional research in this population is needed.
Telehealth Research: Areas to Prioritize to Improve Patient Care
The adoption of telehealth technology continues to expand, but requires further research to fully realize the potential it has to address socially desirable goals such as improving the patient experience of care.
Providing Support, Therapy for Patients Who Are Victims of Sexual Harassment
An expert shares his insight on how victims of sexual harassment respond to trauma, and how you can best support your patients who have experienced sexual harassment or abuse.
Expert Shares Insights on Compassion Fatigue and Physician Burnout
Dike Drummond, MD, and CEO of The Happy MD, an organization focused on physician burnout prevention and leadership, shares his insights on how to tackle compassion fatigue and burnout in the emergency department.
Want to read more?
Please login or register first to view this content.