I agree with Dr. @Alessi-LaRosa about the treatment for chronic migraine and MOH for patients on opiates and/or barbiturates. If they are taking frequent opiates, I prefer to have a pain management doctor detoxify them. In the past, I slowly decreased their medication while giving them long-acting c...

Chronic migraine is treated with a combination of transitional, abortive, and preventive medications. If a patient is on opiate medications or medications with barbiturates, they are at a very high risk of having rebound headaches even if used only 5 times in a month per the literature. Therefore, i...

The worst to control in these scenarios are the patients who are on chronic opioids for chronic intractable other pain, not headaches. I usually go through the standard first-line meds and at times, CGRP antagonists alone with no luck. I have a few on combination therapy of Botox, topiramate, and a ...

Just to add to all traditional treatments. Most of the time, neck abnormality is a trigger so include instructions for better neck posture, neck stretching, and release technique for a more successful treatment.

I'm in pain management and work with our headache specialists. I spend a lot of my time having conversations with patients about opioid wean and the most important thing is to get patients on board. A process of trust, as they have to understand things may feel "worse" (when they initially get off o...

I educate patients about the pitfalls of medication overuse headaches and try my best to transition them to a CGRP inhibitor. However, challenges arise when patients require opiates for concurrent arthritis and face difficulties tapering off these medications with their pain specialists. If MOH stem...