Clinical Assistant Professor, Neurology & Neurological Sciences
Fellowship:Stanford School of Medicine (2014) CAUnited States of America
Residency:University of California at Irvine (2013) CA
Internship:University of California at Irvine (2010) CA
Medical Education:University of Toledo College of Medicine (2009) OH
Board Certification: Neurology, American Board of Psychiatry and Neurology (2013)
Improving the detection of chronic migraine: Development and validation of Identify Chronic Migraine (ID-CM)
2016; 36 (3): 203-215
Migraine, particularly chronic migraine (CM), is underdiagnosed and undertreated worldwide. Our objective was to develop and validate a self-administered tool (ID-CM) to identify migraine and CM.ID-CM was developed in four stages. (1) Expert clinicians suggested candidate items from existing instruments and experience (Delphi Panel method). (2) Candidate items were reviewed by people with CM during cognitive debriefing interviews. (3) Items were administered to a Web panel of people with severe headache to assess psychometric properties and refine ID-CM. (4) Classification accuracy was assessed using an ICHD-3β gold-standard clinician diagnosis.Stages 1 and 2 identified 20 items selected for psychometric validation in stage 3 (n = 1562). The 12 psychometrically robust items from stage 3 underwent validity testing in stage 4. A scoring algorithm applied to four symptom items (moderate/severe pain intensity, photophobia, phonophobia, nausea) accurately classified most migraine cases among 111 people (sensitivity = 83.5%, specificity = 88.5%). Augmenting this algorithm with eight items assessing headache frequency, disability, medication use, and planning disruption correctly classified most CM cases (sensitivity = 80.6%, specificity = 88.6%).ID-CM is a simple yet accurate tool that correctly classifies most individuals with migraine and CM. Further testing in other settings will also be valuable.
View details for DOI 10.1177/0333102415583982
View details for Web of Science ID 000371311100001
View details for PubMedID 26002700
What the Gut Can Teach Us About Migraine
CURRENT PAIN AND HEADACHE REPORTS
2015; 19 (7)
During gestation, cells of the brain and gut develop almost simultaneously into the central nervous system (CNS) and enteric nervous system (ENS), respectively. They remain connected via the vagal nerve lifelong. While it is well known that the brain sends signal to the gut, communication is in fact bidirectional. Just as the brain can modulate gut functioning, the gut, and likely what we ingest, can in fact influence our brain functioning. We will first review both gastrointestinal (GI) function and migraine pathophysiology and then discuss evidence linking the migraine brain to various GI disorders. Lastly, we discuss the effects of gut microbiota on brain functioning and speculate how the gut and particularly diet may affect migraine.
View details for DOI 10.1007/s11916-015-0501-4
View details for Web of Science ID 000356254100004
View details for PubMedID 26049770
Does exercise make migraines worse and tension type headaches better?
Current pain and headache reports
2013; 17 (12): 380-?
Many non-pharmacological treatments have been implicated in the treatment of primary headache, with exercise being a common recommendation. In this review we first provide an overview of the relationship between exercise and primary headaches. We then review the physiology of pain modulation, with focus on the endogenous opioids, endocannabinoids, and neuropeptides calcitonin gene-related peptide (CGRP) and brain-derived neurotrophic factor (BDNF), and their associations with primary headache and exercise. Finally, we summarize current literature evaluating effects of exercise on primary headache in an effort to understand the benefits and disadvantages of exercise in primary headaches.
View details for DOI 10.1007/s11916-013-0380-5
View details for PubMedID 24234818
- Does Exercise Make Migraines Worse and Tension Type Headaches Better? CURRENT PAIN AND HEADACHE REPORTS 2013; 17 (12)