Migraine and You

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Migraine and You

• An Educational Guide for Migraine Headache
  Sufferers

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Who gets migraine?
Migraine Prevalence

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

Females
Males

• 10 20 30 40 50 60 70
  80

Age (years)
Migraine peaks during the most productive
time30-60 years of age Migraine is disabling
some miss work, school or activities many have
reduced productivity during attacks
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How do you know you might have migraine?
Symptoms associated with your headaches
Yes
No

• 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.
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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

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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

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What type of doctor should you see?
Primary Care

• 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
Neurologist
May need referral from primary care
Headaches not responsive to routine care other
existing medical conditions making treatment plan
complex
Headache Specialist
Headaches are severe and disabling may need
referral
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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

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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.

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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

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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 / dont skip meals

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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)

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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

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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
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What can you expect from your preventive headache
treatment?

• Preventive treatments will not cure migraine
  but CAN
• Reduce frequency of attacks by 20 to gt60
• 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
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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

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Taking care of your headachesWhat 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

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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

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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

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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

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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

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Dont be confused by migraine myths
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Where to go for more information

• The American Council for Headache Education
• 19 Mantua RoadMount Royal, NJ 08061Phone
  856-423-0043 / 856-423-0258Fax [phone]
• E-mail achehq_at_talley.com
• Web www.achenet.org

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Supported by

• Ortho-McNeil Pharmaceutical, Inc.