9:00–10:00 (Pacific time) — Clinical Concepts of Headaches (60 minutes)
This presentation will review the anatomical origin of headaches, various types of headaches, and differential diagnosis of headaches. An approach will be provided to identify key features to distinguish the type of headache and its potential treatment application. The role of functional medicine in supporting headache relief and headache prevention with personalized approaches will be discussed.
A. Anatomical origins of headaches
- Vasculature
- Muscle tissues
- Nerve plexus
- Sinus
B. Types of headaches
- Migraine
-
- Migraine with aura
- Migraine without aura
- Tension
-
- Dehydration (heat, alcohol, exercise)
- Exertional (physical exercise, sexual activity, cough, bowel movement straining, eye strain, high-altitude, blowing nose, laughing, crying vigorously)
- Caffeine excess or withdrawal headache
- Stress
- Lack of sleep
- Drug reaction
- Hypoglycemia
- Muscle trigger points
- Cervicogenic
- Hypertensive headache
- Sinus headaches (allergy, infection)
- Hormone headaches (menstrual, pregnancy, postpartum, hypothyroidism)
- New daily persistent headache (NDPH)
- Medication overuse headaches (MOH) (overuse of medications to treat headaches and pain)
- Post-traumatic brain injury headache
- Cluster
- Headache secondary to pathology (intercranial and extracranial) — (vascular disease, tumor, infection CSF pressure disease, neuralgia)
C. Differential diagnosis of headaches
- Location
-
- Front of head
- Over the eye
- Over the sinuses
- From the neck
- Entire head
- Ipsilateral or bilateral
- Type of pain
-
- Pulsating
- Vice-like
- Sharp/electric
- Length of headache
- Triggering event
-
- Menstrual headache
- Postpartum headache
- Alcohol
- Dehydration
- Missing meals
- Hypertension
D. The role of functional medicine with headache disorders
10:00 – 10:15 am: Break
10:15 – 11:15 am (Pacific time) – Clinical Features of Migraine (60 Minutes)
This lecture will review the clinical presentation of migraine and provide a review of current understandings of the neurophysiology of migraines. The use of standardized migraine assessment tools will be presented. A review of the literature regarding comorbidities and the potential role they may play with migraines will be discussed. The lecture will conclude with current guidelines for treatment of migraine and the pathophysiological web of migraine that should be considered clinically.
A. Clinical features of migraine
- Clinical presentation and categories of migraines
- Neurophysiology of migraine
- Standardized migraine assessment tools
-
- Headache diary
- Headache calendar
- Three-item Identify Migraine Questionnaire (ID-Migraine)
- Migraine Screen Questionnaire (MS-Q)
- Migraine Disability Assessment Questionnaire (MIDAS)
- Comorbidities with migraine and depression, anxiety, chronic pain, sleep disturbances and obesity
B. Current management of migraine and MOH (medication overuse headaches)
C. The pathophysiological web of migraine
11:15 – 11:30 am: Break
11:30 – 12:30 pm (Pacific time) – Clinical Management of Migraines (60 Minutes)
This presentation will review clinical strategies to reduce migraine severity, frequency, and duration. Standardized migraine evaluation tools that can be used to monitor patient outcomes to treatment will be discussed. Evidence-based approaches to manage migraine conditions with diet, nutrition, and lifestyle strategies will be presented.
A. Migraine evaluation tools to determine outcomes
- Headache diary
- Headache calendar
- HURT (Headache Under-Response to Treatment) questionnaire
- mTOQ-4 (Migraine Treatment Optimization Questionnaire)
B. Migraine pathophysiology and nutraceutical strategies
- Impaired mitochondria — neurons close to threshold
- Neuroinflammation — microglia
- Kynurenine pathway
- Disrupted neuron signaling
- Neurotropic factors (GDNF, NGF, NT3)
C. Migraine clinical strategy #1 — Nutraceutical literature review
- Magnesium
- CoQ10
- Riboflavin
- Alpha-lipoic acid
- Essential fatty acids
- Vitamin D
- Melatonin
- Feverfew
- Butterbur
D. Migraine clinical strategy #2 — Systems biology approach
- Methylation dysfunction
- Insulin resistance
- Microbiome dysregulation/Gluten sensitivity
- Hypothyroidism
- Menstrual migraines
- Androgen deficiency in males
E. Migraine clinical strategy #3 — Reduce comorbid risk factors associated with migraine
12:30 – 1:30 pm: Lunch
1:30 – 2:30 pm (Pacific time) – Clinical Features of Non-Migraine Headaches (60 Minutes)
This presentation will review the anatomical origin of non-migraine headaches and provide a detailed guide on how to differential diagnosis of various headaches. A step-by-step approach to identify the underlying trigger and potential causes of non-migraine headaches will be presented. Clinical considerations from the medical history, physical examination, and laboratory tests will be discussed.
A. Anatomical origins of headaches
- Vasculature
- Muscle tissues
- Nerve plexus
- Sinus
B. Types of non-migraine headaches
- Tension
-
- Dehydration (heat, alcohol, exercise)
- Exertional (physical exercise, sexual activity, cough, bowel movement straining, eye strain, high-altitude, blowing nose, laughing, crying vigorously)
- Caffeine excess or withdrawal headache
- Stress
- Lack of sleep
- Drug reaction
- Hypoglycemia
- Muscle trigger points
- Cervicogenic
- Hypertensive headache
- Sinus headaches (allergy, infection)
- Hormone headache (menstrual, pregnancy, postpartum, hypothyroidism)
- New daily persistent headaches (NDPH)
- Medication overuse headaches (MOH) (overuse of medications to treat headaches and pain)
- Post-traumatic brain injury headache
- Cluster
- Headaches secondary to pathology (intercranial and extracranial) — (vascular disease, tumor, infection CSF pressure disease, neuralgia)
C. The neurology of headaches
D. The physiology of headache triggers
E. The links between headaches and underling imbalances in physiology
- Dysglycemia
- Dehydration and electrolyte imbalances
- Inflammation
- Allergy
- Gastrointestinal disorders
- Metabolic and endocrine conditions
2:30 – 2:45 pm: Break
2:45 – 3:45 pm (Pacific time) – Clinical Management of Non-Migraine Headaches (60 Minutes)
This presentation will review clinical strategies to reduce headache severity, frequency, and duration. Standardized headache evaluation tools that can be used to monitor patient outcomes to treatment will be discussed. Evidence-based approaches to manage headache conditions with diet, nutrition, and lifestyle strategies will be presented.
A. Development of clinical management goals for frequency, duration, and severity of various of specific headaches
B. Identifying underlying factors and triggers for specific headaches
C. Dietary, nutrition, and lifestyle strategies for specific headaches
3:45 – 4:00 pm: Break
4:00 – 4:45 pm (Pacific time): Review of Concepts and Clinical Red Flags with Headaches (45 Minutes)
This lecture will summarize the key principles of headache diagnosis and clinical management strategies presented earlier in the course with an emphasis on its utilization in clinical practice. Furthermore, red flags for secondary headaches will be discussed and when to consider imaging and immediate medical referrals for headaches that may be due to underlying pathology. The role of determining headaches that may be responsive to a functional medicine approach and headaches that require further medical evaluation will be presented.
A. Review of concepts
- Headache presentation
- Headache differential diagnosis
- Headache prevention management plan
B. Clinical red flags for secondary headaches
- Distinguishing primary versus secondary headache
- Imaging criteria and guidelines
- Medical referral criteria and guidelines
4:45–5:00 (Pacific time): — Question and Answers (15 Minutes)
