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New Perspectives on Tough Strategic Decisions
Strategic planning offers a great opportunity to generate new ideas, confirm or refocus direction, and gain momentum. However, to arrive motivated, confident, and in a better place usually involves a bit of a journey.At the heart of our strategic expeditions, divergent needs and competing demands are likely encountered. The biggest chal

The Real Secret for Improving your Success with Women
How do you get better at talking to women?It's easy......Simply talk to as many women as possible!Now if you're like most guys, then you might have trouble with walking up to dozens of women each day and initiating conversations. If you're nervous and filled with tension, then you're chances of success will be minimal.nd reduced work productivity. The direct and indirect cost of migraines to the economy is estimated at $50 billion a year.

Using botulinum toxin injections is a controversial treatment to prevent migraine headaches. Reports in the scientific literature (including retrospective case series, uncontrolled and nonblinded studies, small controlled trials and case reports) suggest botulinum reduces migraines in some patients.

However, recently several larger and randomized, double-blind, placebo-controlled clinical trials that were differently designed don?t favor botulinum toxin as a treatment. A clinical trial entitled “A Study Using Botulinum Toxin Type A as Headache Prophylaxis for Migraine Patients with Frequent Headaches” is currently underway.

Today some clinicians use botulinum toxin injections trying to manage patients who have severe and frequent migraines. Given the varying clinical experiences reported, one of the criteria proposed for doctors to select patients for this treatment is their failure to respond to other migraine treatments; but each migraine sufferer is unique.

Doctors considering botulinum toxin therapy for a migraine patient should take a thorough review of the patient?s clinical history; conduct an in-depth physical examination; perform or review diagnostic studies; consider past and current treatments and the patient?s responses to them; and consider any co-morbid illnesses or conditions.

Until the results of the current and future clinical trials of botulinum toxin for migraine headache prevention can provide definitive answers about its

raines in some patients.

However, recently several larger and randomized, double-blind, placebo-controlled clinical trials that were differently designed don?t favor botulinum toxin as a treatment. A clinical trial entitled “A Study Using Botulinum Toxin Type A as Headache Prophylaxis for Migraine Patients with Frequent Headaches” is currently underway.

Today some clinicians use botulinum toxin injections trying to manage patients who have severe and frequent migraines. Given the varying clinical experiences reported, one of the criteria proposed for doctors to select patients for this treatment is their failure to respond to other migraine treatments; but each migraine sufferer is unique.

Doctors considering botulinum toxin therapy for a migraine patient should take a thorough review of the patient?s clinical history; conduct an in-depth physical examination; perform or review diagnostic studies; consider past and current treatments and the patient?s responses to them; and consider any co-morbid illnesses or conditions.

Until the results of the current and future clinical trials of botulinum toxin for migraine headache prevention can provide definitive answers about its

oxin injections trying to manage patients who have severe and frequent migraines. Given the varying clinical experiences reported, one of the criteria proposed for doctors to select patients for this treatment is their failure to respond to other migraine treatments; but each migraine sufferer is unique.

Doctors considering botulinum toxin therapy for a migraine patient should take a thorough review of the patient?s clinical history; conduct an in-depth physical examination; perform or review diagnostic studies; consider past and current treatments and the patient?s responses to them; and consider any co-morbid illnesses or conditions.

Until the results of the current and future clinical trials of botulinum toxin for migraine headache prevention can provide definitive answers about its

iew of the patient?s clinical history; conduct an in-depth physical examination; perform or review diagnostic studies; consider past and current treatments and the patient?s responses to them; and consider any co-morbid illnesses or conditions.

Until the results of the current and future clinical trials of botulinum toxin for migraine headache prevention can provide definitive answers about its efficacy and safety, doctors should use it on a case-by-case basis. Only an individualized approach allows the doctor to balance all the considerations when using botulinum toxin. For now, doctors should carefully preselect patients who might potentially benefit from the therapy until further evidence-based research deepens our understanding about its clinical use.

Unless plan language specifically excludes this treatment, case managers should be aware of the evolving nature of botulinum toxin injections for migraines and that it needs case-by-case consideration. This makes it a good candidate for review by an independent review organization with a physician panel up-to-date on the latest medical literature about the treatment.