Migraine Education Day – Questions for an Expert

At this year’s Migraine Education Day, Dr. Elliott Schulman, a neurologist from the Jefferson Headache Center, provided an informational overview of updates in migraine treatment including new oral acute treatments that are pending FDA approval. Following this review, he took some questions from the audience which are outlined below.

CGRP

What is CGRP good for in the body? Will there be side effects blocking a key function?

“That is a great, great question! You are now a 3rd year medical student! We know as age progresses, CGRP decreases. If you get older, you have potentially a lot fewer headaches. Is it because your CGRP is not often as stimulated? We also know that CGRP is also important in lots of different organs. It’s in the gut, the heart, not only in the brain. And it has to do with hypertension. Is CGRP protective? If you’re on CGRP antagonist, are you subject to other problems that we haven’t seen because we haven’t used CGRP antagonists yet. It’s certainly something we’ll be looking at.”

Botox

Can Botox be given for patients under age 18?

“Pediatric migraines are often different. While it’s only indicated for people over age 18, if you have a 16 or 17 year who will be a good candidate for Botox, it’s worth having your doctor write a letter of appeal.”

Medical marijuana

Can you talk about the use of medical marijuana?

“The American academy of neurology has come out with an official position on medical marijuana.
We are looking for any agent that meets the criteria for rigorously tested. There needs to be good medical science backing up our decision. There is no good evidence that marijuana works for migraine. I can give you 5 ways it may work for migraine, for example, it may make you less anxious, it gives you an appetite, and makes you want to drink to help with migraine. Since it’s not approved in Pennsylvania, I cannot condone it. But if patients want to use it, it’s up to them. The answers aren’t all in, we don’t fully understand how marijuana works, nor do we understand all the intricacies of migraine.”

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