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  New Migraine Prevention Guidelines - Q&A Q: What is new? A: The American Academy of Neurology and the American Headache Society released new prevention guidelines on August 31, 2026. The old ones were from 2012. The biggest change is they now include newer, migraine-specific drugs that block a protein called CGRP, which helps trigger migraines. These are pills like atogepant (Qulipta) and shots like eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality). Q: Who should think about taking a preventive medicine? A: Anyone with migraine should be told that prevention exists. You should be offered it if you have: 4 or more migraine days per month, OR 4 or more days per month with moderate-to-severe headaches, OR Migraines that really interfere with your work, family, or daily life. Prevention can mean fewer headache days and less disability, and may help stop occasional migraines from becoming chronic. Right now, many people who could benefit...

Horner’s syndrome is a pattern of eye and facial changes caused by reduced “sympathetic” nerve signals to one side of the face. It isn’t a disease by itself—it’s a clue that something along that nerve pathway has been affected, so clinicians focus on finding the underlying cause. Q: What is Horner’s syndrome? A: A condition where the nerves that help control the eyelid, pupil size, and sweating don’t work normally on one side of the face. Q: What are the usual signs? A: A droopy upper eyelid (ptosis), a smaller pupil on that side (miosis), and sometimes less sweating on that side of the face (anhidrosis). Some people also notice the affected eye looks “less open.” Q: Does it hurt or affect vision? A: Horner’s syndrome itself doesn’t usually damage the eye or directly cause vision loss, but the pupil difference can be more noticeable in dim light and may be associated with other symptoms depending on the cause. Q: What causes it? A: Anything that disrupts the nerve pathway from the brai...

  Cancer: Questions and Answers Q: What are the earliest warning signs of cancer? A: Cancer can cause many different symptoms depending on where it begins. Some general warning signs include unexplained weight loss, persistent fatigue, unexplained fever or night sweats, a new lump, persistent pain, changes in bowel or bladder habits, unusual bleeding, a persistent cough, changes in a mole, or a symptom that is new and does not go away. These symptoms are often caused by conditions other than cancer, but persistent or unexplained changes should be evaluated by a healthcare professional. Q: Does having one of these symptoms mean that I have cancer? A: No. Most individual symptoms have many possible causes, and many are not related to cancer. The concern increases when a symptom is new, unexplained, persistent, worsening, or accompanied by other concerning symptoms . A medical evaluation is the best way to determine the cause. Q: How long should I wait before seeing a doctor about a...

  Thyroid Eye Disease (TED): Why Do Eyes Bulge? If you or someone you love has thyroid problems, you may have noticed a change in the eyes — they seem to push forward or look more open than usual. This is called Thyroid Eye Disease, or TED , and the bulging is called exophthalmos or proptosis . It can be alarming to see, but understanding why it happens makes it much less mysterious. What's Happening Behind the Eye? Think of your eye socket (the orbit) like a fixed-size bony cup. Inside that cup, there are: Extraocular muscles - the tiny muscles that move your eye Orbital fat - a cushion of fatty tissue that supports the eye The eyeball itself (globe) In TED, your immune system mistakenly attacks the tissues behind the eye. This is an autoimmune inflammation. It doesn't affect the eye itself, but it inflames the muscles and fat around and behind the eye (doctors call this retrobulbar tissue). When those tissues become inflamed, two things happen: The eye muscles swell and ...

 # Glaucoma Early Signs: When to Get Screened in Brookline, MA Glaucoma is often called the silent thief of sight - early signs are subtle. At Paddy Kalish, OD - Coolidge Corner, 1296 Beacon St, Brookline, MA 02446 - Dr. Paddy Kalish, OD provides early glaucoma testing as part of comprehensive eye exams for adolescents and adults. **Early signs to watch:** - No signs at first - that is why screening matters - Later: peripheral vision narrowing, eye pain, headaches, halos around lights, fluctuating vision **Who is at higher risk in Brookline?** - Age over 40, family history, high eye pressure, high myopia, history of eye injury or iritis. **How we screen at paddykalish.com:** - Eye pressure measurement, optic nerve evaluation, visual field discussion, and Optical Coherence Tomography (OCT) to measure nerve fiber layer thickness. Dr. Kalish completed residency at Hadassah University Hospital in Jerusalem and has 30+ years detecting early glaucoma and iritis. He customizes treatment p...