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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 

    Follow these six tips to prevent and treat skin damage caused by winter dryness.

    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 

    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.

    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.

    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.

    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.

    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.

    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.

    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 

    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.

    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 

    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog:
    Click to Tweet


    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.

    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.


    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!

    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • June 30, 2017

    By MedStar Health

    MedStar and Georgetown University have partnered with Forte Research Systems to implement a Clinical Trial Management System (CTMS), called OnCore. OnCore is a robust clinical trial management system and it includes all components of the clinical research lifecycle. OnCore will serve as a workflow manager and repository of all clinical research administrative and management activities. This new system represents a significant investment in our clinical research infrastructure and will greatly enhance and standardize our clinical trial management activities.

    The implementation of OnCore across both MedStar and Georgetown will provide a unified structure for clinical research. The process of choosing a CTMS, planning, testing and the ongoing implementation began in 2014-2015.

    As part of the phased rollout that was announced in Focus, we have continued to work with our associates to process study protocols and entered them into OnCore. Currently, OnCore is active for entry of all new studies and tracking for regulatory coordinators, but not yet open for patient visits and study information in all cases.

    • Regulatory Coordinators have entered all of our existing studies that are currently open or in follow up in sixth months into OnCore, and continue to add new studies as they come down the pipeline. Study entry in OnCore includes study staff, sponsor, and IRB detail.
    • Budget and Coverage Analysts are working hard to load study calendar and budgets for existing and new studies into OnCore. A third party vendor, Nimblify, has been contracted to support the study calendar build-out. Additional resources have been identified to support the entering of budgets for each protocol.
    • Study Teams are gradually beginning to use it to track study patient data and study visits.

    We have reached 100% of end-users for training, including all new hires. The training program continues with weekly engagement sessions for all associates who will utilize the system. There are also daily WebEx sessions for support of those trials that are open to accrual. It is the intention that all active studies will be using OnCore by the end of the summer. If you are not using OnCore regularly, please use the training environment in to maintain your skills.

    As part of this roll-out, MHRI and Georgetown University Medical Center have been collaborating to create and implement joint policies and procedures to ensure that both entities are following the same protocols when utilizing the system. These policies can be found on the MHRI StarPort page, under the MedStar Georgetown sections.

    We encourage all associates to support one another during this transition period, especially those colleagues who are most affected. Associates can find more information on StarPort, including documentation, training tools, and information for engagement sessions. If you have any questions, please contact

  • June 29, 2017

    By MedStar Health

    We’re reminded every spring and summer to beware the return of the tick. These tiny, bloodsucking parasites carry a wide range of infections they can pass on to the humans they bite.

    But ticks have cropped up more in the news in spring and summer 2017 than in years past. This is thanks to a couple milder-than-normal winters leading to a rise in the tick population and increased awareness of a tick bite-induced meat allergy.

    I’ve yet to see a patient who has developed an allergy to red meat after a bite by the lone star tick, but we do treat plenty of patients every year for Lyme disease – the most common tick-borne illness. In 2015, the most recent year for which we have stats, 2,429 cases of Lyme disease were reported in the District of Columbia, Maryland and Virginia. In fact, 95 percent of Lyme disease cases are reported in 14 states, including Maryland and Virginia.

    Even if you live in the city, you are not safe from ticks. While they are more common in rural areas, they can still be found in city parks and your yard. Ticks also can hitch a ride into your home on the backs of pets. Let’s look at the infections that ticks in our area can spread, how to remove ticks correctly and how to prevent getting bitten in the first place.

    Tick-borne infections in our area

    Three main types of ticks found in our area are deer ticks (also known as black-legged ticks), lone star ticks and brown dog ticks. Each type of tick can spread various diseases.

    Lyme disease

    This illness is transmitted by deer ticks. The first sign often is a rash at the site of the bite. This angular or oval rash can expand to the size of your hand and take on a “bullseye” appearance. You’ll also likely experience flu-like symptoms such as fever, chills, headache, and muscle and joint aches.

    Close up view of a tick
    Lyme disease bullseye rash

    Rocky Mountain spotted fever

    The first symptoms of Rocky Mountain spotted fever, spread by the brown dog tick, appear a couple days after the bite and include fever, headache, vomiting and muscle pain. A rash also may develop later in the disease. It will look like small pink spots on the arms and legs.


    Ehrlichiosis, transmitted by the lone star tick, is a name for several less-common bacterial diseases and can cause fever, headache, fatigue and muscle aches. While a rash may develop, it’s not common.


    Some people with this rare deer tick-borne disease don’t experience any symptoms. Others may develop fever, headache, nausea, vomiting and loss of appetite. Babesiosis also can cause a type of anemia that leads to your skin turning yellow (known as jaundice) and dark urine.


    This virus spread by the deer tick is rare but very serious, as it can cause inflammation of the brain. About 10 percent of people who develop it will die, and half of survivors will have permanent neurological symptoms, such as frequent headaches or memory problems. Early symptoms include fever, headache, weakness and vomiting. Later symptoms can include confusion, loss of coordination or speech difficulties and seizures. There are no medications to treat Powassan directly, and patients may need respiratory support or treatment to reduce swelling in the brain.  

    While most tick-borne diseases are easily treated with oral antibiotics if caught early, you can become very ill if treatment is delayed. Let your doctor know you’ve spent time outdoors even if you don’t remember being bitten.

    You likely won’t feel a tick bite, and the tick may fall off before you spot it, so it’s important to know the symptoms of these illnesses and seek treatment as soon as possible.

    How to remove ticks from your skin

    If you find a tick on yourself or on your child, don’t panic. There’s likely no need to race to the emergency room. A tick needs to be attached to the body at least 24 hours to transmit most diseases. So if you remove it the same day, you’ll likely be fine.  

    The best way to remove a tick is to use tweezers to grab it as close to the skin as possible and pull straight out. Don’t twist as you pull, because it can cause the tick’s mouth parts to break off and remain in the skin. Then clean the area with rubbing alcohol or soap and water.  

    There are a few methods you shouldn’t use:

    • Don’t use your fingers: If you crush the tick, you run the risk of the juices spreading on your hands.
    • Don’t burn it off: I’ve seen people try to use cigarettes to kill the tick, but they usually just end up with a burn and a tick bite.
    • Don’t use Vaseline to smother it: This is a myth. It doesn’t work.  

    How to prevent tick bites

    The best way to prevent illnesses such as Lyme disease is to avoid exposure to ticks. If possible, stay out of wooded or brushy areas. If this isn’t possible, here are some tips to protect yourself and your loved ones.

    Tips to repel ticks: 

    • Use repellent that contains 20 percent or more DEET or picaridin on any exposed skin. The Environmental Protection Agency has a tool to help you find the best repellent for you and your family.
    • Treat clothes with products that contain permethrin, an insecticide.
    • Wear long sleeves and pants.
    • Tuck your pants legs into your socks.
    • Treat your pets with flea and tick collars, sprays or topical treatments to avoid them bringing ticks home with them.  

    Tips to find ticks on your body and clothing:

    • Check every inch of your body after spending time outdoors. Don’t forget around your ears, the backs of knees and elbows, armpits and hairlines. Do the same for your pets.
    • Take a shower within a couple hours of spending time outside. Ticks tend to wander around a bit before attaching, and you may be able to wash them off before they attach. This is also a good time to do a tick check.
    • Don’t forget about your clothes. Throw them in the dryer on high heat for 10 minutes to kill any hiding ticks. 

    Ticks will return every year. And we must remain vigilant to prevent tick bites and notice the symptoms of tick-borne diseases as soon as they appear.


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  • June 26, 2017

    By Jeffrey Dubin, MD, Chief Medical Officer

    A mainstay of the “Star Trek” TV and movie franchise is the medical tricorder. This versatile piece of technology allows doctors to scan a patient and instantly receive a complete diagnosis of their injury or illness.  

    Though we don’t yet have tricorders, we have access to sophisticated information-gathering and diagnostic programs in our emergency department. And one of our most vital pieces of equipment is something many of us have in our pockets or purses: the smartphone. With access to the internet and dedicated medical apps wherever we are, we can spend more time with patients and less time searching books for medical information. These tools help us make specific medical recommendations for each patient.  

    In my experience, patients appreciate that we double-check our recommendations with medical apps and additional research. It’s comforting to them to know that there’s additional evidence supporting medical decisions besides an emergency-department doctor they’ve never met before telling them they’re OK or that they need additional treatment. 

    Patients appreciate that we double-check our recommendations with medical apps and additional research. -Dr. Jeffrey Dubin via @MedStarWHC

    Click to Tweet

    The transition away from medical books

    It’s simply not possible for doctors to memorize every piece of medical information needed to treat patients. That’s especially true in the emergency department, where we care for everything from cases of heart attacks,  trauma and burns and everything in between, as well as other conditions that just can’t wait for a doctor’s visit in the morning.

    When I was doing my medical training, and for a number of years after that, every emergency department used to have reference books. These textbooks were there for doctors to refer to when they needed to refresh their memories on how to do a procedure or treat a condition. But nobody does that anymore.

    The internet has replaced the old practice of reading pages of dense medical textbooks to find the snippets of information we need. Medical textbooks are available online, and they’re searchable, which saves us valuable time. Many e-book versions of medical textbooks include embedded videos that demonstrate procedures. Videos of many procedures are available online specifically for doctors’ reference.  

    Powerful medical apps for smartphones

    Our emergency department doctors spend less time finding information and more time treating patients thanks to mobile medical apps. We’ve incorporated some of these clinical decision-making tools into our electronic medical record to help us make patient care decisions.  

    Mobile medical apps let emergency-department doctors spend less time finding information and more time treating patients. via @MedStarWHC

    I don’t like cluttering my phone with screen after screen of medical apps. I tend to find one or two apps that do the jobs I need and stick with them. Two I use frequently are MDCalc and Epocrates.  


    MDCalc provides a range of clinical decision-making tools that include calculators for determining patients’ risks for various conditions and rules for when to order diagnostic tests or provide treatments.

    A good example of how I use MDCalc is when a patient comes in after a car accident. Cars are so well-built these days that they usually absorb all the forces from a typical fender-bender. Most people walk away with no significant injuries, but they may want to get X-rays to make sure nothing’s broken.

    MDCalc has collected clinical decision rules from published research doctors for determining when someone who’s been in a car accident actually needs to have X-rays taken and when we shouldn’t to minimize the person’s radiation exposure. If I need to double-check these rules, it’s really easy. I just open the app, type in the rule I’m looking for and refer to it during the patient’s exam.  

    Some other features of MDCalc that I use include:

    • A list of questions to determine if a person has a problem with drinking alcohol
    • Scoring systems for a person’s risk for stroke
    • Key identifiers that a patient may have appendicitis  


    Epocrates is a database of medications and their safety information, including dosing, side effects and potential interactions with other medications. I can pull up a specific medication’s listing and walk the patient through its possible side effects.  

    Epocrates also is useful for comparing a patient’s symptoms to their listed medications. I often have patients come in and tell me they feel dizzy or have an itchy rash, and sometimes those are side effects of a new medication or a possible interaction between two medications.  

    We no longer have to refer just to textbooks from 10 or 15 years ago for clinical data. With smartphone apps built specifically for doctors, we can access the most accurate, up-to-date information to help us make accurate recommendations for our patients. These and other innovations will continue to improve the way emergency department doctors like me practice medicine and care for our patients. 

  • June 22, 2017

    By MedStar Health

    Who is Dr. Paufler?

    Many physicians have pursued other careers before entering medicine, but the path Pamela Paufler, MD took to becoming an attending Critical Care physician at MedStar Washington Hospital Center was, literally and figuratively, somewhat circuitous.

    After earning an electrical engineering degree from MIT, the Charlotte, N.C., native began working in semiconductor development for a manufacturer of pacemaker and defibrillator products. Uncertain about making the field her career, Dr. Paufler happened upon a fortuitous opportunity to shadow some physicians, gaining some clarity about her future in the process.  

    Why Choose Medicine?

    “I decided I liked what they did better than what I was doing,” Dr. Paufler recalls. “As I’d planned to go back to school anyway, I took the prerequisite courses to get into medical school.”

    Dr. Paufler earned a medical degree at the University of Minnesota Medical School, followed by a fellowship in Critical Care Medicine at Hennepin County Medical Center in Minneapolis, and another in Cardiovascular Surgery Critical Care at Johns Hopkins Hospital. As she pursued her training, the parallels between her once and future careers were evident.  

    “Engineering and medicine are both about solving problems—what’s going on and why, and how to make it work better,” Dr. Paufler says. She adds that the sense of immediacy associated with treating some of the hospital’s sickest patients was likewise appealing.  

    “I like the pace of doing a test, getting a result and using that information to make a change if needed,” she says.

    But surgical critical care is much more than dealing with black-and-white, if/then outcomes. There’s also the human aspect, working with family members who must often make difficult post-surgery decisions for patients unable to speak for themselves. As such, Dr. Paufler believes maintaining open lines of communication is critical.  

    “It’s essential to explain treatment options and outcomes in plain terms, and empowering them to make good decisions with the patient’s best interests in mind,” she says. “We want them to know that whatever they decide, we’re rooting for them.”  

    Dr Paufler’s dedication to helping residents and fellows understand the intricacies of surgical critical care was recognized after her first year at the Hospital Center with the Keystone Education Award for resident education. Now, she’s leading several quality and performance improvement initiatives at MedStar Heart & Vascular Institute’s Surgical Intensive Care Unit. 

    Life Outside the Hospital

    One constant in Dr. Paufler’s life is her love of competitive and offshore sailing, a sport she’s pursued since age 12. She also enjoys swimming and travel, with her most exotic adventure being a visit to the Galapagos Islands. “The wildlife is unbelievable,” she says. “Each island is better than the last.” 

  • June 21, 2017

    By MedStar Health

    Quest for Better Health Leads to a New Outlook on Life

    Four years ago, Angelo Campanella was far from the picture of health he is today. Only 53 years old, he weighed close to 400 pounds and had a number of health issues, including diabetes, high cholesterol, high blood pressure and sleep apnea. “I made a lot of poor life choices over time and knew I needed to make some changes. But it wasn’t until I developed diabetic foot ulcers that wouldn’t heal that my journey really started,” Campanella says. “Diabetes can cause a lot of serious problems and foot ulcers are just one of them. It can also affect your heart health and your ability to lose weight,” explains Adline Ghazi, MD, director of the Diabetes Care Program at MedStar Good Samaritan Hospital, who Campanella sees for his diabetes.

    Campanella was referred to the Hyperbaric Medicine and Wound Healing Center at MedStar Good Samaritan, but ended up needing surgery to effectively treat the ulcers. While recovering, his doctors noticed some abnormalities in his blood work that concerned them and ordered additional tests. They found heart disease so severe, they immediately admitted him to MedStar Union Memorial Hospital for cardiac bypass surgery.

    Adline Ghazi, MD

    After his bypass, Campanella started to take better care of himself. He enrolled in the cardiac rehabilitation program in the Good Health Center at MedStar Good Samaritan and his diabetes stabilized. But he couldn’t lose weight, which was hindering his efforts to manage his diabetes. He decided to look into weight loss surgery. At the suggestion of his doctors, he scheduled a consultation with Christopher You, MD, FACS, FASMBS, medical director of Minimally Invasive and Bariatric Surgery at MedStar Franklin Square Medical Center.

    “In addition to being overweight, Angelo was on insulin and many other medications for his diabetes and other related health conditions. I recommended a gastric bypass, which would not only help him lose weight but could also reduce the severity of his diabetes,” Dr. You says.  Gastric bypass surgery works by changing the anatomy of the gastrointestinal tract to limit the amount of food you can eat. The surgery also changes the absorption rate of food, which results in beneficial metabolic changes.

    Christopher You, MD, FACS, FASMBS

    “When combined with a comprehensive treatment plan, bariatric surgery can be an effective tool for achieving long-term weight loss and a better quality of life. More importantly, it helps improve many obesity-related conditions, including type 2 diabetes, high blood pressure, heart disease and more,” adds Dr. You.

    Dr. You stresses that individuals considering bariatric surgery need to understand and be committed to the lifestyle changes required after surgery. “It’s important to remember that weight loss success depends on other factors too, such as nutrition, exercise and behavior modification. Angelo was committed to making the changes needed and was enthusiastic throughout the entire process,” says Dr. You.

    Prior to the surgery, Campanella attended MedStar Franklin Square’s preoperative weight management program, dropping quite a bit of weight as a result. When he went in for the surgery in June 2015, he weighed around 330 pounds. The day after surgery, Campanella’s diabetes was in remission and he no longer needed multiple medications or daily injections.

    He still sees Dr. Ghazi at MedStar Good Samaritan and is on medication for blood sugar maintenance. “Angelo had a lot of health problems for someone his age and his quality of life was not good. But, he truly wanted to get better and took charge. That really makes a difference,” Dr. Ghazi notes.

    Angelo before weight loss

    Today, Campanella is 100 pounds lighter and his former 56-inch waist is now just 36 inches. Healthier than ever, he frequently takes water aerobics classes at the Y, plays billiards with a number of Amateur Pool Player Association teams several nights a week, and enjoys walking his dog, Sahara, a couple of hours every day.

    Angelo after weight loss

    He is extremely grateful for the support he received during the past four years. “My parents, Vito and Laura, my brother, Pietro and my girlfriend, Marye, all took care of me and helped keep me motivated throughout this process. And my colleagues at Calvert Mechanical Solutions, where I have worked for 29 years, have been great. I was out a lot, especially after my foot and heart surgeries, and there was never any question that my job would be waiting for me,” he says.

    He is also thankful for the compassionate care he received from the many healthcare providers at MedStar Health who helped him turn around his life. “This part of my journey—sharing my story—was never expected. I love talking to people who are on the fence about getting healthier, especially about gastric bypass,” Campanella adds. “I hope my experience encourages others who are struggling with health issues.”

    This article appeared in the summer 2017 issue of Good HealthRead more articles from this issue.

    Need Diabetes Care?

    Click below to learn more about our Diabetes Care Program or call 443-444-3991 for a physician referral.

    Diabetes Specialists

  • June 21, 2017

    By MedStar Health

    More than 38 million people in the U.S. are affected by migraines, a neurological disorder that causes intense headache episodes. That’s about 12 percent of the country’s population. And despite the availability of effective treatment options, it’s estimated that at least half of people with migraine are undertreated – and most don’t seek help from a doctor.  

    “At least half of people with #migraine are undertreated – and most don’t seek help from a doctor.” via @MedStarWHC

    Click to Tweet


    Migraine causes a range of symptoms beyond headaches. These symptoms often are debilitating -- more than 90 percent of people with migraine are unable to work or function normally during an episode.

    Migraine symptoms can include:

    • Throbbing or pulsating pain
    • Light, smell and sound sensitivity
    • Nausea
    • Blurred vision    

    As a headache specialist, people often tell me they’ve tried over-the-counter (OTC) medications and various remedies to find migraine relief, to no avail. I assure them that there are other options, and that they don’t have to accept painful, debilitating migraines as a regular part of their lives. But for every person who seeks treatment from a specialist, there are countless others who choose not to.  

    Why is that the case? For one thing, many people aren’t aware they’re having migraines. They’ve never been diagnosed, and they’re hesitant to seek care when they think they “just have a headache.”  

    And going to the doctor takes time. It’s faster to stop by the pharmacy and pick up an OTC headache medication. But that time you saved won’t mean much if you’re laid up with migraine symptoms later when the OTC medication doesn’t work. Neurologists like me can prescribe more effective treatments than you’d find at the drug store.    

    When to see a headache specialist for migraines

    The frequency, length and severity of migraine episodes vary – some people have migraine headaches that last a few hours, while others are cooped up in bed with debilitating symptoms for days at a time.  

    With so much variance, it’s difficult to give a broad recommendation on the symptoms that indicate when you should seek migraine treatment. But here’s a good rule of thumb: If your migraines are frequent or severe and proper use of OTC medications isn’t helping, it’s time to seek treatment from a specialist. 

    By “proper” use of OTC medications, I mean that you should take the recommended dosage as early as possible during a migraine episode. If you wait to see how bad the migraine will be before you take medication, it’s less likely to work.

    Some people with migraines find relief from OTC medications. Yet many people aren’t satisfied with the results or suffer such severe symptoms that OTC drugs don’t help. Additionally, if you rely on migraine medications too heavily, they actually can make migraine symptoms worse.  

    This condition – known as rebound headache – occurs when the effects of a medication dose wear off, and people take more medication. If these people take medications too often, they can begin to trigger headaches instead of relieve them. Some people with rebound headaches have near-constant migraines, one melding into the next without relief.

    If someone suffers from migraines that last more than four hours at least 15 days per month, we consider them to have chronic daily headaches. Though chronic daily headaches affect a smaller portion of people than migraines – less than five percent of the U.S. population – the condition can be debilitating and damaging to mental health. We can prevent chronic daily headaches by treating migraines before they get worse.    

    If medications aren’t helping your migraines, request an appointment with a headache specialist or call 202-877-DOCS.


    Request an Appointment

    Advanced migraine treatments

    Migraine treatment falls into two categories: abortive and preventive. Abortive treatments usually are designed to stop migraine symptoms after they start, while preventive treatments aim to reduce the frequency or severity of migraines.  

    Typically, we try to treat migraines first with abortive treatment. Any abortive treatments we provide should be taken as soon as you notice migraine symptoms. If severe, frequent and long-lasting migraines persist, we’ll look at preventive treatments.  

    My migraine patients have access to a range of abortive and preventive treatments, including:

    • Botox therapy: Botulinum toxin injections are an effective treatment for chronic daily headaches.  
    • External nerve stimulation: An egg-sized device placed on the forehead stimulates the trigeminal nerve, producing a sedative effect that can help reduce the frequency of migraines.
    • Medications: A variety of prescriptions, such as antidepressants, anti-seizure medications and painkillers, can improve migraine symptoms.  
    • Nerve blocks: A medication is injected near the occipital nerve in the back of the head to reduce migraine pain.
    • Surgery:  People with migraines who also have chronic daily headache may benefit from surgery to reduce pressure on certain nerves.  
    • Transcranial magnetic stimulation: A special device held against the back of the head delivers a magnetic pulse to stop migraines as they start.  

    With these advanced treatments, we’re able to give many people with severe migraines the relief they’re looking for. And with promising new types of migraine medication on the horizon, people with debilitating migraines soon might have even more options available.