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

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

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

5. ECHO Project January 20, 2019 Chronic Daily Migraines/Headaches

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

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

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

10. Chronic Migraine

11. These headaches evolve from episodic migraine without aura Chronic Migraine

12. 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

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

14. Chronic Tension-Type Headache

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

16. 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

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

18. New Daily Persistent Headache

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

20. 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

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

22. Hemicrania Continua

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

24. 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

25. 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 Hemicrania Continua

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

27. 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 Risk Factors

28. Diagnosis of exclusion Tests and Diagnosis

29. Antidepressants Beta Blockers Anti-seizure medications NSAIDs Botulinum Toxin Treatment

31. Questions

32. Discussion