Carol B. Miles, MD Jeffrey P. Krall, OD

The Headache Center

What is Chronic Daily Headache?

 15 or more days per month  4-5% of the general population

Issues for General Practice

 Hard to diagnose  Hard to Treat  Leads to Unhappy Patient Population

What are the consequences of Constant Daily Pain for the Patient?

CDH Subtypes

 Chronic migraine  Chronic tension type headache  Cluster  EyeGraine  Medication overuse

Chronic Migraine

 Episodic  daily  Unilateral, pulsating, moderate to severe pain, nausea/vomiting, photo/phonophobia, aggravated by physical activity,  Full blown migraines superimposed on background of less severe headaches

Chronic Tension-Type HA

 Bilateral pressure  Mild to moderate intensity  Does not worsen with exertion

Cluster Headaches

 Severe, unilateral sharp pain  Occasional nausea and photophobia  Associated with unilateral lacrimation and rhinorrhea  More common in males and smokers  Pace and become suicidal

EyeGraine

 Unilateral or bilateral headaches that tend to start later in the day  Headaches and lethargy with reading and working on the computer  Light sensitive, especially with headlights  Sensation of eye dryness  Neck pain and stiffness

Medication Overuse HA

 When tx >2-3 days /week  Nondescript diffuse, dull, “annoying” headache that is “just there”  Less responsive to prophylactic meds

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Break the cycle

Ketoralac IM/IV  Steroids po/IV  DHE SQ/IV  Valproic acid IV

DHE SQ

 1 mg BID x 5-7 days  1 mg q one hour x 3 prn.  Must wait 1 hour between doses  No more than 3mg per day

DHE IV

 Metochlopramide 10mg/ prochlorperazine 10mg  Wait 10 min  DHE test dose of 0.5mg  Wait 30 min and repeat 0.5mg if no chest pain or significant nausea  Repeat 0.5-1 mg q 8 hours prn x 5

Valproic acid

 500mg in 100cc NS at 20 mg/min  May repeat q 8 hours prn

Add preventive med

 Antidepressants-nortriptyline, venlafaxine  Antihypertensives- propranolol, verapamil, candesartan, Lisinopril  Antiepileptics – divalproex sodium, topiramate, gabapentin  Botulinum toxin

Add Symptomatic Med

 NSAIDs  Triptan  DHE NS/SQ

Complications from Current Therapies

 GI distress  Chest pain or tightness  Teratogenicity  Lightheadedness  Cognitive issues  Weight gain  Tremor

• • • A new root cause diagnosis A new no risk treatment, A New Positive outcome

Proposed Pathophysiologic Root Cause

Symptomatic Profile ( exacerbated by reading or working on the computer ):  Syndrome of:    Chronic daily headaches (frontal and occipital) Dry eyes Photophobia   Stiffness in shoulders or neck Lethargy

Working Hypothesis:

An imbalance between the patients peripheral vision (controlled by saccadic eye movements) and central vision (controlled by slow pursuits). Proprioceptive fibers of the extraocular muscles are activated which causes an overstimulation of the Trigeminal nerve. This in turn over activates the Trigeminal nucleus caudalis which causes the chronic daily head pain and neck pain. This stimulation also triggers the exacerbation of migraine type headaches. Dry eyes and the perception of dryness mediated through the Trigeminal nerve is thought to be a symptom of the eyeGraine syndrome. We also have considered if the overstimulation of the occipital cortex causes cortical spreading depression, initiating the onset of the headache component of the eyeGraine syndrome.

Animated video

SightSync Testing

 SightSync is a Neuro Adaption tool–Tracks the dynamic movements of the patients eye and creates a template for correction.  SightSync is NOT an eye exam – No chart, no testing of Visual Acuity at distance or near  Measures the Brain positioning of a target in space isolating one’s central vision from a peripheral image  Does this in 3D

eyeGraine Solution

 Full Neurological Work Up  eyeGrain Specialist examination  SightSync –Measure the 3D misalignment between central and peripheral vision  Custom neurolens dispensed… from sightSync 3D modeling (fingerprint)  Scheduled neuroLens fine tunes that are needed over the next 12 month period…  Manage changes in medical therapy over a 12 month period

Pilot Study Subjective Responses

(refractory, end-of-line patients)

Pilot Study Subjective Responses

Patient Willingness to Recommend (WTR)

PILOT STUDY DATA

Patient Willingness to Recommend Headaches have decreased substantially or are basically gone

Study (n=153) 87%

COMMERCIAL DATA

Day 30 (n=56) 93% Day 90 (n=21) 100% 62% 70% 86%

Medication Reduction (90 Days)

Average medication reduction = 51% Reporting medication reduction = 72%

NOTE

: Patients have not been prompted by their physician to reduce their medication usage. All results were self-directed by the patient as a result of positive eyeGraine treatment results.

n = 21

What patients are saying… • Although my headaches are not completely gone, they have decreased so much that I am able to do what I have always loved. Before my headaches hindered me from running long distances, but now I am training for a half marathon, running long distances every other day. I am now able to focus more when studying and I have to time to spend with friends. Before I would just sleep because I had such bad headaches. I ’ m not 100% but I am so much closer!

• I really thought this was a joke at first, but after wearing wearing the lenses, I am impressed. I am really impressed. Thank you so much.

• After adjustments, the glasses are working very well and decreased my migraines substantially. I can live again!

• The NeuroLenses have taken away my headaches and given me back a normal life.

• Since wearing NeuroLenses my headaches are basically gone and I am feeling better than I have in a long time. I would recommend this to anyone having this type of headache.

• Life changing!!! Headaches almost gone! It ’ s worth every penny! Thank you for changing my life!

• It is absolutely wonderful and I would recommend it to everyone.

• Have had a great response to the lenses and have hardly had a headache that has interrupted my daily schedule! Can not say thank you enough for your efforts to make the connections for helping with eyeGraines! I am not without them since I took them out of the box!

Key Learnings after 2 Years of eyeGraine Treatments

 Patients are attracted to the safety of the eyeGraine Treatment Plan  The proprioceptive feedback from of eyes to the brain requires Neurolens changes when headaches return  eyeGraine Treatment now plays a prominent role in headache management at Neurology Associates

The Headache Center

 605-334-2662  IMA Building Suite 103 6709 S. Minnesota Ave Sioux Falls, SD 57108