2. Introduction
Welcome to a patient’s guide to managing chronic
headaches!
This packet will teach you about:
1. Different types of headaches and how they impact
patients and families?
2.The most common headaches and identify ways to
prevent and/or drastically reduce the frequency and
intensity of occurrences.
3. Headache “triggers” and how to avoid them.
4.And you’ll get information on how to partner with your
Headache Specialist to better manage your condition.

3. Why Suffer in Silence?
*More than half of people with
chronic headaches suffer for at
least one year before they are
diagnosed
*38% suffer for 3 or more years
before diagnosis

4. Which Doctor should I see?
If headaches are persist,
Primary Care Physicians
typically refer the patient
to a Neurologist.
Primary Care
Neurologist
Headache Specialist
Primary Care Physicians are
usually the first point of
contact for patients suffering
from chronic headaches.
Not all Neurologist
specialize in the
treatment of chronic and
recurrent headaches.
Neurologist are trained in
the management and
treatment of many
neurological disorders.
They handle headaches not
responsive to treatments
provided by primary care
physicians and/or general
nuerologist.
Headache specialist are
specially trained to manage
care for patients suffering
from acute and chronic
headaches.

6. Is it A 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”.
Which is the most common type of chronic headache.
Yes No
Symptoms associated with your headaches

7. What Is A Migraine?
*A neurological disorder characterized by
hyperexcitability
of the nervous system
*Defining characteristics
*Recurrent headache attacks lasting 4-72 hours
*One-sided, pulsating, moderate-to-severe pain
*Aggravated by or causing avoidance of routine activities
*May be accompanied by nausea/vomiting, photophobia, or
phonophobia
*Presence of 2 of 3 key characteristics suggests
migraine
*Inability to function
*Photophobia or phonophobia
*Nausea/vomiting

8. How Many People Have Migraines?
12% of adults (30 million patients in the US)
*Most common between ages 15 and 55
*More common among women (17%) than men (6%)
0
2
4
6
8
10
12
1%
6% 6%
12% 12%
Affected Americans
Rheumatoid Arthritis
Asthma
Diabetes
Osteoarthritis
Migraine
Centers for Disease Control and Prevention and American Migraine Prevalence and Prevention study
results (Lipton RB et al. Neurology. 2007;68:343-349).

9. Why do I get migraine?
Neurons in the brain become
hyper-excited and:
*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

10. Migraine Symptoms
Before an attack
*Feeling of well-being or surge of
energy
*Talkativeness or restlessness
*Increased appetite
*Drowsiness or depression
*Irritability or tension
During an attack
*Nausea, vomiting, or diarrhea
*Sweating or cold hands
*Sensitivity to light or sounds
*Scalp tenderness or pressure
pain
*Pale color
*Pulsing pain

11. Impact on Productivity
Missed ≥ 1 day of work/school 25%
Work/school productivity reduced by ≥ 50% 28%
Did no household work 48%
Household productivity reduced by ≥ 50% 34%
Missed family or social activity 29%
School, Work, and Social Impact in Previous 3 Months
American Migraine Prevalence and Prevention study results (Lipton RB et al. Neurology. 2007;68:343-
349).

12. Medications: Abortive vs. Preventive
Abortive
*Taken when a
migraine first begins
*Treats the immediate
pain & symptoms
Preventive
*Taken daily to prevent
and/or reduce the
frequency & intensity
of headaches.

13. Tips for 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

14. Holistic treatment is the Key
Holistic Approach
*Focuses on “Headache
Hygiene”
*Focuses on physical, mental
and social factors that influence
chronic headaches.
*Identifying and reducing
situations, behaviors,
environments, food and/or
people that precipitate
headaches.
Multidisciplinary Team
• Neurological Headache
Specialist: Coordinates and monitors care;
utilizes pharmacological and non-pharmacological
therapies to reduce frequency and intensity of
headaches.
• Registered Dietician: Nutritional
Counseling
• Psychiatrist: Behavioral Health Assessments,
Mental Health Therapy
• Neuropsychologist: Psychotherapy,
Biofeedback
• Physical Therapist: Stretching &
Strengthening Exercises
• Pain Management Specialist:
Relaxation Therapy, Nonpharmacological Pain
Reduction Strategies.

15. Migraine Triggers
* Food
* Disturbed sleep pattern
* Hormonal changes
* Drugs
* Physical exertion
* Visual stimuli
* Auditory stimuli
* Olfactory stimuli
* Weather changes
* Hunger
* Psychological factors

16. Headache Triggers
Diet
Alcohol
Some foods
Caffeine
Some medications
Changes in Daily Cycles
Menses
Skipping meals
Late hours
Oversleeping
Environment
Weather
Smoke, perfume, or odors
Altitude
Bright light or loud sounds
Mental
Anxiety
Anger
Fear
Depression
Identify your triggers

17. Headache & Diet
Avoid skipping meals
*An empty stomach or low blood sugar can
trigger a headache
*Eat regular, well-balanced meals
Avoid foods that can trigger a
headache
*Ripe cheeses
*Processed meats
*Chocolate

18. Headaches & Sleep
Maintain a regular sleeping
schedule
*Try to go to sleep and awaken at
the same time everyday
*Get enough sleep, but do not
oversleep

19. Headaches & Stress
Reduce your stress
*Implement stress reduction techniques
into your daily routine
*Schedule personal (alone) time
*Exercise regularly

20. Headache Diary
Record
*Frequency, severity, and duration of
headache
*Treatments you used and how well
they worked
*Possible triggers (environmental,
diet, stress, sleep,
changes in daily routine)
Keep the journal for at least 3 months
Look for patterns and share the results
with your healthcare provider

21. Educate Yourself
Learn more about migraine and how
to manage your symptoms
*Talk to your healthcare provider
*Become better educated about your
condition
*Read patient education materials

22. Be an Active Partner in Your Treatment
*Make an appointment to discuss your headache
*Describe the headache
*Where is the pain? How severe is the pain? How
long
does it last? How often do you have a headache?
*How do you feel before, during, and after?
Is there an aura?
*Do you have other symptoms?
*Nausea, vomiting or diarrhea
*Sensitivity to light or sound
*Other symptoms
*Communicate how migraine is affecting your life
*Develop a treatment plan; follow up on
your progress

23. Keys to 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

24. Summary
1. Although migraine is common and causes
substantial impairment, you can learn to
manage your symptoms
2. Multidisciplinary Treatment Works
* Nonpharmacologic and complementary therapies
* Acute and preventive medications
3. Make “headache trigger reduction” a part
of your everyday life.
4. Work with your healthcare provider to
develop and follow a treatment plan that
works for you