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
How do you know you might have migraine?
Moderate or severe 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
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
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
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
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
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 kinds of treatments will help?
Taken when a migraine is experienced
Treats pain and other symptoms after the attack has begun
Taken on a daily basis
Reduces the frequency and intensity of attacks
What kinds of treatments will help?
Limit caffeine and other triggers
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
How do you know which type of treatment is right for you?
Do not impact routine functioning
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
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
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
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
Taking care of your headaches… What else can you do?
Account for your headaches
Keep a diary
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
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
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
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
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.