Howell Jarrard

I like tweets about Jesus, neurology, headache medicine, @GeorgiaTechFB, @Steelers and @Penguins. Neurologist @MUSChealth via @GeorgiaTech, @MCG_AUG, @UPMCneuro

[Howell Jarrard @HowellJarrard]

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[Howell Jarrard @HowellJarrard]

Migraine across the menopausal transition and beyond: A narrative review - Korn - Headache: The Journal of Head and Face Pain - Wiley Online Library https://t.co/nO4bBLSOAg

[JAMA Neurology @JAMANeuro]

GLP-1 RA therapy may offer an alternative management strategy for idiopathic intracranial hypertension. https://t.co/BJN2loeEqH @rivetdj @WilliamMualem

[Howell Jarrard @HowellJarrard]

@money_cruncher Backdoor

[Amy Gelfand, MD @aagelfand]

Secondary hemicrania continua can occur; response to indomethacin does not necessarily mean it's a primary HA disorder. Read more in @headachejournal #headacheedu @melissarayhill https://t.co/bec8l2tR8O. .

[Howell Jarrard @HowellJarrard]

Have a high index of suspicion for a secondary headache disorder before settling on a diagnosis of primary cough headache.
3/3

https://t.co/WFyDTi9HKb

[Howell Jarrard @HowellJarrard]

Headaches triggered EXCLUSIVELY by valsalva = cough headache.
1/3

[Howell Jarrard @HowellJarrard]

Exclusive triggering is important as many primary headache disorders will worsen with coughing and other forms of valsalva. So focus on differentiating absolute triggering of the headache vs just exacerbation of established headache in the history.
2/3

[Howell Jarrard @HowellJarrard]

@JCephalalgia But should a slightly elevated opening pressure in a headache patient without papilledema, who has already failed adequate doses of acetazolamide, prompt a change in the overall direction of targeted headache phenotype management?

[Howell Jarrard @HowellJarrard]

The road searching for a CSF leak can be long. But when orthostatic headaches are present, use the Bern score to triage patients for more testing in suspected spontaneous intracranial hypotension. There is more than just smooth dural enhancement.

https://t.co/yJZgJxomew

[Howell Jarrard @HowellJarrard]

Ask each patient with unilateral headaches if they ever experience pain on the opposite side. Be direct with your questioning. If pain is locked to one side, consider a trial of indomethacin to assess for hemicrania continua
#headachemedicine #neurology

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[Howell Jarrard @HowellJarrard]

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[Howell Jarrard @HowellJarrard]

Well controlled idiopathic intracranial hypertension (IIH), indicated by improving papilledema and visual fields, should not prevent women from attempting to conceive. When IIH is well managed, weight gain during pregnancy is unlikely to worsen the condition. 1/3

[Howell Jarrard @HowellJarrard]

High headache frequency in IIH ≠ uncontrolled IIH. Fundoscopy and visual field assessments are essential for evaluating the status of IIH. Many continue to experience headaches even after ICP improves, and this shouldn’t prevent them from considering conception.

[Howell Jarrard @HowellJarrard]

Think about new daily persistent headache in patients with daily headaches. Headache features don’t matter for diagnosis, just how it all started. Management of NDPH isn’t that different compared to other headache disorders, but prognosis certainly is.

https://t.co/EAaosh6wBV

[Howell Jarrard @HowellJarrard]

Don’t forget about Zonisamide for migraine prophylaxis. Especially in someone who had benefit with Topiramate but stopped due to side effects.

#headachemedicine #migraine

https://t.co/mBqxTVqyEK

[Howell Jarrard @HowellJarrard]

Not all facial pain is trigeminal neuralgia.
Primary headache disorders can present with facial involvement up to 10% of the time. Sometimes the pain from “headache disorders” can even be exclusively in the face.

https://t.co/RlCxWdVuMq

[Howell Jarrard @HowellJarrard]

Track patient’s headache severity in an objective manner. Document total/severe headache days per month, MIDAS or HIT-6 each visit. Patients often don’t recall how bad their headaches were and treatment benefit could be missed if relying 100% on their subjective assessment.

[Howell Jarrard @HowellJarrard]

Don’t rely on headache improvement as a marker of successful treatment of IIH. Acetazolamide was no better than placebo in improving headache severity (measured via HIT-6) in the IIH treatment trial. Follow the visual fields and papilledema.

https://t.co/30CIOhx7bZ

[Howell Jarrard @HowellJarrard]

So perhaps when SVPs are present, it can be used to help building a case in “ruling out” IIH in a patient with headache.

[Howell Jarrard @HowellJarrard]

It is an objective (present or absent) marker that can be seen with fundoscopy at the bedside with an undulated pupil.

[Howell Jarrard @HowellJarrard]

When present, SVPs reliably indicate normal intracranial pressure near 100%. But their absence doesn’t necessarily mean raised ICP as 10-30% of patients with normal ICP can lack these.