Approach to the Diagnosis and Treatment of Headache
Headache is consistently one of the most common complaints reported by patients in the medical setting worldwide. Headache can be a symptom of another condition or illness, secondary to the disruption of homeostasis, or can be a primary disorder with inherent variability and patterns. Headache disorders, whether primary or secondary, can cause significant disability and loss of quality of life for those affected. As such, it is important for primary care providers to feel confident evaluating and treating patients with headache, especially given the limited access to Headache Medicine subspecialists. (Source: Primary Care:...
Source: Primary Care: Clinics in Office Practice - March 26, 2024 Category: Primary Care Authors: Jennifer R. Evan Source Type: research

The Thread of Time
The prominent American Canadian neurosurgeon Dr Wilder Penfield once said “Among the millions of nerve cells that clothe parts of the brain there runs a thread. It is the thread of time, the thread that has run through each succeeding wakeful hour of the individual.” As most primary care providers encounter patients who have neurologic complaints or conditions, they u nderstand and empathize with how these issues can negatively impact the lives of our patients. Many patients with chronic headaches, seizures, sleep disorders, and chronic back pain are limited in activities of their daily living and employment. (Source: ...
Source: Primary Care: Clinics in Office Practice - March 26, 2024 Category: Primary Care Authors: Joel J. Heidelbaugh Tags: Foreword Source Type: research

The Evaluation and Management of Concussion to Optimize Safe Recovery
Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1  month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be c leared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning ...
Source: Primary Care: Clinics in Office Practice - March 23, 2024 Category: Primary Care Authors: Mark Roberts, Michael Popovich, Andrea Almeida Source Type: research

Conquering Neurologic Diseases in Primary Care
Neurologic diseases are the leading cause of disability and second leading cause of death worldwide.1 In 2017, more than 60% of the US population had at least one neurologic disorder.2 This burden is only expected to grow as the population ages and as the prevalence of conditions that predispose to the development of these diseases, like hypertension and diabetes, increases. By 2040, nearly 12 million Americans will have dementia and, by 2060, an estimated 14.5 million will have had a stroke.3,4 (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - March 23, 2024 Category: Primary Care Authors: Kara J. Wyant, Melissa A. Elafros Tags: Preface Source Type: research

Recognizing Myopathy in Patients with Muscle Weakness or Pain
Muscle weakness and pain can be seen in orthopedic, rheumatologic, cardiac, and musculoskeletal conditions in addition to neurologic disorders. Myopathy, which describes a heterogenous group of hereditary and acquired disorders that affect muscle channels, structure, and metabolism, is one possible cause. This review focuses on essential information to support primary care providers as they assess patients with muscle weakness and pain for myopathy. As with most neurologic disorders, a thorough clinical history and physical examination are essential first steps. These findings will then guide diagnostic testing and facilit...
Source: Primary Care: Clinics in Office Practice - March 21, 2024 Category: Primary Care Authors: Melissa A. Elafros, Arjun Seth Source Type: research

Autonomic Dysfunction from Diagnosis to Treatment
Autonomic disorders can present with hypotension, gastrointestinal, genitourinary symptoms, and heat intolerance. Diabetes is the most common causes of autonomic failure, and management should focus on glucose control to prevent developing autonomic symptoms. The most prevalent cause of dysautonomia, or autonomic dysfunction, is Postural Orthostatic Tachycardia Syndrome (POTS). Autonomic testing characterizes causes for nonspecific symptoms but is not necessary in patients with classic presentations. Treatment for autonomic dysfunction and failure focus on discontinuing offending medications, behavioral modification, and p...
Source: Primary Care: Clinics in Office Practice - March 20, 2024 Category: Primary Care Authors: Amanda C. Peltier Source Type: research

Insomnia
Sleep significantly impacts health. Insomnia, characterized by difficulty with sleep onset, maintenance, and subsequent daytime symptoms, is increasingly prevalent and increases the risk of other medical comorbidities. The pathophysiology involves hyperarousal during non-REM sleep and altered sleep homeostasis. The 3P model explains the development and persistence of insomnia. Assessment is primarily clinical and based on appropriate history while distinguishing from other sleep disorders. “Somnomics” suggests a personalized approach to management. Cognitive behavioral therapy for insomnia is the first-line treatment i...
Source: Primary Care: Clinics in Office Practice - March 13, 2024 Category: Primary Care Authors: Ashley M. Paul, Rachel E. Salas Source Type: research

Evaluation and Management of Tremor
Tremor is a commonly encountered condition in the primary care setting and can manifest at rest, with action, or both. Common causes include Parkinson disease, essential tremor, and drug-induced tremor. In this article, the authors discuss how to examine a patient with tremor and which features of the history and examination can help clue the provider in to the appropriate diagnosis. They also review treatments for varying types of tremor and when referral to a neurologist may be necessary. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - March 9, 2024 Category: Primary Care Authors: Sydney Spagna, Amy Ferng, Kelvin Chou Source Type: research

Neurologic Approach to Radiculopathy, Back Pain, and Neck Pain
Back pain and neck pain are common in clinical practice, but significant challenges and pitfalls exist in their diagnosis, treatment, and management. From the neurologic standpoint, cervical radiculopathy and lumbosacral radiculopathy are characterized by neck pain or back pain accompanied by sensory and motor symptoms in an arm or leg. The basic neurologic examination is vital, but testing like electromyography and MRI is often needed especially in cases that fail conservative management. Oral medications, injection-based therapies, physical therapy, and surgical evaluation all have a place in the comprehensive neurologic...
Source: Primary Care: Clinics in Office Practice - March 9, 2024 Category: Primary Care Authors: Canaan Coker, Jade Park, Ryan D. Jacobson Source Type: research

Cardiovascular Diseases
PRIMARY CARE: CLINICS IN OFFICE PRACTICE (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 25, 2024 Category: Primary Care Authors: Anthony J. Viera Source Type: research

Copyright
ELSEVIER (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 25, 2024 Category: Primary Care Source Type: research

Contributors
JOEL J. HEIDELBAUGH, MD, FAAFP, FACG (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 25, 2024 Category: Primary Care Source Type: research

Contents
Joel J. Heidelbaugh (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 25, 2024 Category: Primary Care Source Type: research

Forthcoming Issues
Neurology (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 25, 2024 Category: Primary Care Source Type: research

Dizziness in Primary Care
This article focuses on high yield information to support primary clinicians in the efficient and effective evaluation and management of dizziness. Key points are as follows: do not anchor on the type of dizziness symptom, do use symptom timing and prior medical history to inform diagnostics probabilities, do evaluate for hallmark examination findings of vestibular disorders, and seek out opportunities to deliver evidence-based interventions particularly the canalith repositioning maneuver and gaze stabilization exercises. (Source: Primary Care: Clinics in Office Practice)
Source: Primary Care: Clinics in Office Practice - January 9, 2024 Category: Primary Care Authors: Kevin A. Kerber Source Type: research