Ehlers Danlos Syndrome & Headache

Diana Lebron MD

July 10, 2014

Goal • To discuss the various headache

types described in patients with EDS

• An approach in treating the headaches and potentially improving quality of life.

Objectives • Will briefly discuss the International

Classification for Headache Disorders.

• Discuss the headache types in patient with EDS.

• Discuss potential treatments.

Introduction Pediatric Headache is the 3rd most

common complaint seen in the ER.

While migraine is certainly common, it is

by no means the only headache type.

Introduction

Understanding the various headache

types can potentially help tailor the

treatment and improve quality of life.

ICHD II www. ihs-classification.org

Part 1: Primary headache disorders – 1. Migraine

– 2. Tension type headache

– 3. Cluster headaches and Trigeminal autonomic cephalalgia

– Other primary headaches

Secondary Headaches

Headache temporal pattern

Primary Headaches & EDS

• Migraine

• Chronic migraine

• Status migrainosus

• Tension type headaches

• Chronic tension type headaches

Secondary Headaches & EDS

• Headaches due to neck issues

• Headaches due to TMJ issues

• Headaches due to disorders of homeostasis – Sleep

– Poor food intake

– Orthostatic intolerance

Secondary headaches and EDS

• Headaches due to intracranial hypertension

• Headaches due to spontaneous CSF leaks

Headache & EDS • The children will often present with

primary and secondary headache types.

• Treatment will vary depending on the headache type.

Dysautonomia

Dysautonomia, EDS and Migraine

• The dysautonomia is a constant problem in EDS with or without a headache

• Dysautonomia typically occurs during a migraine attack but not when a person is headache free.

EDS and Headache

“Necessity is the mother of invention”

Potential Treatments for

Headaches

Medications Physical Medicine

Cognitive Behavioral Therapy

Atlas orthogonal

Lifestyle

Surgery & Devices

Treatments

Abortives

• Triptans – Maxalt

– Axert

– Zomig

– DHE

• Anti inflammatory – Toradol

– Diclofenac

Preventatives

• Anti epileptics – Topamax

– Depakote

– Keppra

• Calcium Channel Blockers – Flunarizine

• Beta Blockers – Propanolol

– Atenolol

Treatments

Psychology/psychiatry

• Psychotherapy

• Behavioral therapy – CBT

Procedures/PT

• Nerve blocks

• Botox

• Myofascial release

• Transmagnetic stimulation (TMS)

• Occipital nerve decompression

• Neck stabilization

Conclusion • A thorough history, physical

examination is the only thing you need to diagnose headaches.

• Screen for dysautonomia

• Screen for EDS

• Treat based on the headache type