Clinical Research Oriented Workshop (CROW) Meeting: May 5, 2017

Present:   Marianne Burke, Juvena Hitt, Kairn Kelley, Ben Littenberg, Jennifer Oshita, Gail Rose, Adam Sprouse-Blum, Connie van Eeghen

Start Up: It’s Friday

1.                   Grand Rounds OB/G: test run – Adam Sprouse-Blum

a.       Goal: improve quality of care for women with headaches

b.       Title: Headache in Women (Headache in OB/GYN Practice or Headache Management for the OB/G Practice)

c.       Overview: This is about reproductive women, who have additional life stages (menarche, menopause)

d.       Contraception section

                                                   i.      Migraine prevalence: limited ability to explain the “menopausal” bump for men, who don’t go through menopause

                                                 ii.      Phases of Migraine:

1.       Set the context: how to talk about migraines

2.       Specifics about contraceptives for patients with aura prior to migraine           

                                               iii.      Physiological representation of aura: informational; is it connected to the message?

1.       Alternative approach

a.       Classic migraine

b.       Why aura is interesting; physiology; why interesting

                                               iv.      Literature on Migraine aura and stroke: focus on the RR related to contraceptives

                                                 v.      Estrogen dose matters: contraceptives and stroke (not about migraines)

                                               vi.      Relationship of estrogen and migraine (not about strokes)

1.       To not rile up migraine, low estrogen and few steps

a.       A fall in estrogen produces headache

b.       “In my practice, non-variable estrogen…” tell the story

                                              vii.      Progestin alternatives, including analysis of serum progesterone levels

1.       For patients who need an oral contraceptive but have migraine and aura, an IUD will limit the progesterone delivered to the brain which is related to migraine

e.       Pregnancy section

                                                   i.      Red flags: final dx for headache in pregnant women who presented emergently

1.       Kinds of secondary headaches

2.       History indicators

3.       Physical indicators

4.       Green Lights: psychiatric comorbidity – but a psychiatric condition does not rule out an emergency headache

                                                 ii.      Management of migraine during pregnancy

1.       Risk of triptans: talk about the complications of migraines

a.       Babies probably won’t have problems, but there may be the following problems…

f.        Post-Dural Puncture Headache

                                                   i.      What kind of needle to use/not use

g.       Lactation

                                                   i.      Pumping and discarding

h.       Menopause

                                                   i.      Add back therapy

i.         Notes:

                                                   i.      Avoid “abortive therapy;” use “acute therapy”

                                                 ii.      Pick three stories; tell them coherently with matching data/slides

                                               iii.      Eliminate excess material/words; watch for inconsistencies

                                               iv.      Be yourself; it will be excellent.

2.                   Next Workshop Meeting(s): Fridays, 2:00 p.m. – 3:15 p.m., at Given Courtyard South Level 4 until end of Dec.   

a.       May 12: Ross Colgate

b.       May 19: open

c.       May 26:

d.       Future topics:

a.       Juvena: protocol development

b.       LaMantia: predictors of successful R01 applications: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155060

Recorder: Connie van Eeghen