I am often asked about if supplements are useful for vestibular migraine and if so, which ones. Yes, supplements can be effective for preventing vestibular migraine. Much of what we know and use come from studies of people with migraine.

When you find out @UHC @OptumRx told your patient timolol isn’t covered and they will need to pay $1800 for 3 months but you know it’s on @GoodRx for less than $20 a month…

In conclusion, it is reasonable to say that migraine spots are a common MRI finding that should be a cause for worry.

In fact, a new study in the journal Headache, using data from the UK Biobank, suggests that they may become fewer in middle-aged and older adults with migraine.

Reassuringly, according to the CAMERA study, the spots did not predict any long term brain damage. Also, they don't grow in size or number over time.

The precise cause of migraine spots is not precisely known at this time. The most compelling theory is that migraine triggers inflammatory changes in certain brain regions, which results in changes in blood supply (an initial increase then decrease in blood flow).

These spots can resemble those seen in hypertension or a prior head trauma. While radiologists often mention demyelinating diseases (i.e., multiple sclerosis; MS) , the lesions of MS are quite different. MS lesions are usually larger and more elongated or finger-like.

According to the CAMERA study which looked at Dutch adults, these spots are more common in women. They also appear to be more common in patients who smoke, have high blood pressure, and have used oral contraceptives for a long time.

Migraine spots refer to small lesions on specific MRI sequences (T2 and FLAIR). These findings are not specific or diagnostic of migraine but are up to 4 times more commonly seen among people with migraine. These spots can also be present on the MRIs of children with migraine.

MIGRAINE SPOTS. People with migraine are often concerned when they see their brain MRI reports stating “a few white matter hyperintensities” or in more familiar terms, migraine spots. What do these findings mean? . Read more…

That explains the grey hairs….

With any new medication, long-term safety is of high concern, especially in chronic disorders like migraine. It’s very encouraging to see more evidence that CGRP meds are safe for long-term use

An honor to speak to the Acoustic Neuroma Association about postoperative headache management today

Let me tell you how pharmacy benefit managers (PBMs) “save” money for employers and customers. My patient has @OptumRx (owned by @UHC). They told her a 90 day prescription of good ol generic timolol eye drops will cost her $2000. She gets it from @costplusdrugs for $24.56

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Virtual visits allow patients to see doctors without the need to travel. However, in the US, doctors must be licensed in the state the patient resides in. Because many have asked, our clinic now offers consultation appointments for those where I am not licensed for telemedicine.

RT @MigraineSummit: TODAY IS THE DAY! The #MigraineWorldSummit starts Day 1 of its 10th year of bringing you direct access to leading neuro….

RT @DGlaucomflecken: In case you didn’t know, this account is the PBM lobby. PBMs force patients to switch from generics to more expensive….

While these guidelines can be helpful for non-neurologists, insurance companies always use them to justify denying medications to patients who need to be on them.

The idea of tiered migraine prevention medications (first, second, third line, etc) is outdated. Physicians should discuss options with their patients to select the best possible candidate. I would never use Valproate as a “first line” med.

RT @InsOligopoly: @elonmusk .“What is a PBM?”. Imagine if there were 3 banks that offer vehicle financing. These 3 banks have 79% of market….