Migraine and You An Educational Guide for Migraine Headache Sufferers

Who gets migraine? About 20% of women get migraine at one time or another in their life Migraine Prevalence % Age (years) Males Females Migraine peaks during the most productive time… 30-60 years of age Migraine is disabling – some miss work, school or activities; many have reduced productivity during attacks 10 20 30 40 50 60 70 80

About 20% of women get migraine at one time or another in their life

10 20 30 40 50 60 70 80

How do you know you might have migraine? Usually one-sided Moderate or severe pain Throbbing pain Pain aggravated by routine activity Nausea or vomiting Aversion to light or sound If you checked 3 or more of the YES boxes, you have several of the diagnostic criteria for migraine. You should talk to your doctor about diagnosing and treating your headaches. Yes No Symptoms associated with your headaches

Usually one-sided

Moderate or severe pain

Throbbing pain

Pain aggravated by routine activity

Nausea or vomiting

Aversion to light or sound

What is migraine? A clear biological disorder Like asthma, diabetes, or hypertension A disorder of the central nervous system Hypersensitive to specific triggers and stimuli Often a family/genetic connection A disorder of nerve cells in the brain and the blood vessels surrounding the outside of the brain

A clear biological disorder

Like asthma, diabetes, or hypertension

A disorder of the central nervous system

Hypersensitive to specific triggers and stimuli

Often a family/genetic connection

A disorder of nerve cells in the brain and the blood vessels surrounding the outside of the brain

Why do I get migraine? Neurons in the brain are activated by a mechanism not well understood This, in turn, causes a cascade of secondary events leading to: Release of inflammatory substances surrounding the blood vessels of the brain Inflammation of the blood vessels and the surrounding tissue on the outside of the brain Pain pathways are activated

Neurons in the brain are activated by a mechanism not well understood

This, in turn, causes a cascade of secondary events leading to:

Release of inflammatory substances surrounding the blood vessels of the brain

Inflammation of the blood vessels and the surrounding tissue on the outside of the brain

Pain pathways are activated

What type of doctor should you see? Ask for a specific headache appointment and get a specific diagnosis Primary Care Neurologist Headache Specialist Family physician, internal medicine specialist Headaches frequent and difficult to manage or if there are other medical conditions to manage simultaneously May need referral from primary care Headaches not responsive to routine care; other existing medical conditions making treatment plan complex Headaches are severe and disabling; may need referral

Ask for a specific headache appointment and get a specific diagnosis

Family physician, internal medicine specialist

Headaches frequent and difficult to manage or if there are other medical conditions to manage simultaneously

May need referral from primary care

Headaches not responsive to routine care; other existing medical conditions making treatment plan complex

Headaches are severe and disabling; may need referral

What should I tell my doctor about my migraine attacks? How long have you had headaches? How frequent? How disabling? When did they start? What happens when you have a headache? Describe the pain and other symptoms Who else in your immediate family gets headaches? Any type of headache (migraine, tension or sinus) What might cause you to get a headache Alcohol, too little sleep, stress, missed meals

How long have you had headaches? How frequent? How disabling?

When did they start?

What happens when you have a headache?

Describe the pain and other symptoms

Who else in your immediate family gets headaches?

Any type of headache (migraine, tension or sinus)

What might cause you to get a headache

Alcohol, too little sleep, stress, missed meals

What else will the doctor need to know? What medicines do you take now and have you taken in the past? Include over-the-counter medicines, vitamins, caffeine, and other medicines What other medical conditions have you had? Head injury, depression, etc., weight problems, etc.

What medicines do you take now and have you taken in the past?

Include over-the-counter medicines, vitamins, caffeine, and other medicines

What other medical conditions have you had?

Head injury, depression, etc., weight problems, etc.

What kinds of treatments will help? Medications Acute Taken when a migraine is experienced Treats pain and other symptoms after the attack has begun Preventive Taken on a daily basis Reduces the frequency and intensity of attacks

Medications

Acute

Taken when a migraine is experienced

Treats pain and other symptoms after the attack has begun

Preventive

Taken on a daily basis

Reduces the frequency and intensity of attacks

What kinds of treatments will help? Behavioral approaches Limit caffeine and other triggers Reduce stress Exercise Regular sleep Counseling or psychotherapy Biofeedback / relaxation Eat regularly / don’t skip meals

Behavioral approaches

Limit caffeine and other triggers

Reduce stress

Exercise

Regular sleep

Counseling or psychotherapy

Biofeedback / relaxation

Eat regularly / don’t skip meals

Are all migraine medications the same? Migraine medications can all be different and work differently in the brain and on different pathways. Many patients will need both an acute treatment AND a preventive treatment Acute : Triptans Analgesics Preventives Antiepileptics Beta-blockers Antidepressants (TCAs)

Migraine medications can all be different and work differently in the brain and on different pathways.

Many patients will need both an acute treatment AND a preventive treatment

Acute :

Triptans

Analgesics

Preventives

Antiepileptics

Beta-blockers

Antidepressants (TCAs)

How do you know which type of treatment is right for you? Acute Infrequent Short duration Do not impact routine functioning Preventive Frequent headaches (=  2 per month) that cause disability Recurring headaches that significantly interfere with daily routines Overuse of acute medications (  2 times per week) Acute medications are not effective, well tolerated or are contraindicated Behavioral Can always be used

Acute

Infrequent

Short duration

Do not impact routine functioning

Preventive

Frequent headaches (=  2 per month) that cause disability

Recurring headaches that significantly interfere with daily routines

Overuse of acute medications (  2 times per week)

Acute medications are not effective, well tolerated or are contraindicated

Behavioral

Can always be used

What can you expect from your acute headache treatment? Acute medications should work within 2 hours Improve response if you take medicines early Decreased pain, nausea, photophobia and throbbing Get instructions from your doctor: When to take rescue medicines What normal side effects might occur High pain No pain Time

Acute medications should work within 2 hours

Improve response if you take medicines early

Decreased pain, nausea, photophobia and throbbing

Get instructions from your doctor:

When to take rescue medicines

What normal side effects might occur

What can you expect from your preventive headache treatment? Preventive treatments will not “cure” migraine but CAN : Reduce frequency of attacks by 20% to >60% Reduce severity of attacks Improve response to acute therapy Reduce use of acute and rescue medications You need to give these medications adequate time to demonstrate benefit ( 2- 3 months to fully evaluate) # attacks January 7 February 6 March 4 x x x x x x x x x x

Preventive treatments will not “cure” migraine but CAN :

Reduce frequency of attacks by 20% to >60%

Reduce severity of attacks

Improve response to acute therapy

Reduce use of acute and rescue medications

You need to give these medications adequate time to demonstrate benefit ( 2- 3 months to fully evaluate)

Improving treatment success Be pro-active, seek help Understand your headaches so that you can appropriately communicate with your provider Discuss your goals Develop realistic expectations Work closely with your provider and follow instructions Ask for specific instructions for taking each medication Understand the side effects of each medication Take only the medicines and dose prescribed

Be pro-active, seek help

Understand your headaches so that you can appropriately communicate with your provider

Discuss your goals

Develop realistic expectations

Work closely with your provider and follow instructions

Ask for specific instructions for taking each medication

Understand the side effects of each medication

Take only the medicines and dose prescribed

Taking care of your headaches… What else can you do? Account for your headaches Keep a diary Record medications Monitor response Follow the treatment plan Take medications only as instructed Monitor lifestyle factors: exercise, diet, and medications / drugs

Account for your headaches

Keep a diary

Record medications

Monitor response

Follow the treatment plan

Take medications only as instructed

Monitor lifestyle factors: exercise, diet, and medications / drugs

Can lifestyle make a difference? Lifestyle factors play a significant role in migraine Triggers that can be controlled or recognized: Too much caffeine Too many over-the-counter medications Sleep deprivation or change in sleep patterns Hormone fluctuations Menstruation Fasting or low blood sugar Stress or stress let-down

Lifestyle factors play a significant role in migraine

Triggers that can be controlled or recognized:

Too much caffeine

Too many over-the-counter medications

Sleep deprivation or change in sleep patterns

Hormone fluctuations

Menstruation

Fasting or low blood sugar

Stress or stress let-down

Tips for acute and preventive medication success Acute Medications Tips More is not always better… Take acute medications specifically as instructed Limit acute medications to once or twice a week Take only the dose that was prescribed If medications appear to not work after treating 2 or 3 attacks, call your doctor Preventive Medication Tips Take the dose instructed– no more… no less Give the medication time to work (2-3 months) Track your headache patterns… a gradual decrease in attack frequency or severity may be hard to see

Acute Medications Tips

More is not always better…

Take acute medications specifically as instructed

Limit acute medications to once or twice a week

Take only the dose that was prescribed

If medications appear to not work after treating 2 or 3 attacks, call your doctor

Preventive Medication Tips

Take the dose instructed– no more… no less

Give the medication time to work (2-3 months)

Track your headache patterns… a gradual decrease in attack frequency or severity may be hard to see

Tips to recognizing medication overuse Taking acute medication for headache becomes part of an almost daily routine Should be limited to 1-2 days per week Medication appears to become less effective so we tend to want to take more of it Stopping/slowing the medication may result in worsening of headache

Taking acute medication for headache becomes part of an almost daily routine

Should be limited to 1-2 days per week

Medication appears to become less effective so we tend to want to take more of it

Stopping/slowing the medication may result in worsening of headache

Why is it important to see your doctor regularly? Other problems can arise-or other illnesses Overuse of medicines Biological changes in the brain Migraines can get more difficult to control Headaches may get worse More severe More frequent

Other problems can arise-or other illnesses

Overuse of medicines

Biological changes in the brain

Migraines can get more difficult to control

Headaches may get worse

More severe

More frequent

Don’t be confused by migraine myths… Myth: Migraine is all in your head… like a psychological disorder… Fact: Migraine is a true biological disorder with clear genetic links and underlying changes in the brain. Myth: Nobody understands my headaches… Fact: Approximately one in four households in the US have at least one migraine sufferer. Myth: Nothing works to treat my headaches… it is hopeless.. Fact: Actually, there are now very sophisticated migraine-specific medications and very effective preventive therapies.

Where to go for more information The American Council for Headache Education 19 Mantua Road Mount Royal, NJ 08061 Phone: 856-423-0043 / 856-423-0258 Fax: 856-423-0082 E-mail: achehq@talley.com Web: www.achenet.org

The American Council for Headache Education

19 Mantua Road Mount Royal, NJ 08061 Phone: 856-423-0043 / 856-423-0258 Fax: 856-423-0082

E-mail: achehq@talley.com

Web: www.achenet.org

Supported by: Ortho-McNeil Pharmaceutical, Inc.

Ortho-McNeil Pharmaceutical, Inc.