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0:00
Hello, I'm Larry Robbins.
The talk today is
Refractory Migraine.
0:07
You can always email me at
Irobb98@icloud.com and
I've been involved in
publishing and
writing guidelines
for Refractory
Migraine for 22 years.
Recently and I'll go over,
we have some new guidelines
through the World
Headache Society.
Videos of this talk
are also on VuMedi.
I have a Youtube channel
with a lot of videos too
that are related and
you can reach me.
This talk is updated,
the one today.
The previous talks that I
have on the Internet are
a year, two, three
years old and things
get out of date in Refractory
Migraine fairly quickly.
0:52
I'm a speaker for Abbvie,
it should not
influence this talk.
0:57
Some questions that will go
over is 'Medication
Overuse Headache (MOH)
easy to identify,
but difficult to
treat' and it's not
so easy to identify.
It's often conflated with
medication overuse and
I'll go over that.
Number 2, 'Migraine surgery
is a reasonable option'.
That's not true, in my opinion.
I think the jury is
still out although
posterior decompression surgery
is a reasonable option.
'Comorbidities often determine
where we go with therapy'.
That's absolutely true.
They drive where we go.
Number 4, 'onabotulinumtoxinA,
trade name is Botox,
is our third best preventive,
and that 155 units is the only
dose', and that's not true.
We chase the pain,
we do various doses.
It's really probably
our best preventive
overall, considering
safety and efficacy.
Finally, 'resilience has
a strong genetic component',
is absolutely true.
Long arm and short arm of
serotonin transporter
gene is crucial.
