Welcome to the program!

Transcription

1 Calgary Headache Assessment & Management Program (CHAMP) EDUCATION SESSION Welcome to the program!

2 Why is this Session Mandatory? Provide headache management information and orientation to the Champ program Opportunity to hear from other people living with headaches and to ask questions month wait to see the Champ neurologist 2

3 Session Outline Introduction to the program Headache Diagnosis Medical treatment of headaches Behavioral Approaches for headache management CHAMP program components Questions and discussion

4 Calgary Headache Assessment & Management Program (CHAMP) Who we are a multi-disciplinary team of neurologists, nurses, occupational therapists, a psychologist and a kinesiologist working with you toward optimal headache management

5 Neurologist Specialist expertise in headache diagnosis and overall headache management. - Medical treatment options and behavioral strategies.

6 Nurse Nursing interventions provided in the clinic and over the phone: Medication teaching and counselling General headache teaching and support

7 Occupational Therapist Help you to achieve functional goals and to resume roles and activities that may have been disrupted by your headaches

8 Psychologist Short term counselling to address psychological issues that may affect headache condition. mood/anxiety problems relationship stress adjustment to physical or mental health conditions.

9 Kinesiologist Practical education for: safe approaches to exercise and activities. exercise as a pain management tool. postural corrections.

10 CHAMP Research Team Conduct studies to gain more information that may help us to provide better headache management in the future. 10

11 Additional CHAMP Resources Within CHAMP, patients also have access to: Registered Dietician Physical Therapist Psychiatrist *Referral required 11

12 Self-Management Approach Shared Expertise Collaboration Skill Development Building Confidence 12

13 A Multi-Faceted Approach Sleep Quality Exercise Routine Food Choices & Eating Patterns Good Postural Habits Medications -symptomatic -preventative HEADACHE SELF-MANAGEMENT Adequate Hydration Self- Monitoring (Diaries) Stress Management Strategies Pacing & Lifestyle Balance Trigger Management

14 What is Successful Headache Management? Reduced frequency, intensity, and/or duration of headache Improved day-to-day function despite headaches Quality of life improvement/satisfaction Sense of control over headaches

15 Headache: Diagnosis and Use of Medications Calgary Headache Assessment and Management Program (CHAMP) 15

16 Medical Section Outline How are headaches diagnosed? Where does the pain come from? Acute medications to relieve headache attacks. Preventative medications to reduce headache frequency. Medication overuse headache. 16

17 Making a Diagnosis: You are asked to tell your headache story Headache diaries can be very helpful. The doctor will examine you. Blood work, brain scans will be ordered if needed

18 Headache Diagnosis The first decision: Are the headaches: Secondary Headaches? or Primary Headaches?

19 Secondary Headaches: Headaches from an Identifiable Cause Examples: 1. Head/neck injury 2. Medication Overuse 3. Caffeine withdrawal 4. Alcohol Induced 5. Meningitis 6. Brain tumor 7. Brain Hemorrhage 8. Neuralgias 9. Others

20 Primary Headache: Headaches with no Examples: other Underlying Cause 1. Migraine with or without aura 2. Tension-type headache 3. Cluster headache 4. others

21 Chronic Migraine and Chronic Tension-Type Headache Chronic migraine: migraine with headache on more than 14 days a month Chronic tension-type headache: tension-type headache on more than 14 days a month. Some people may have migraine on some days and tension-type headache on other days

22 How do we diagnose primary headaches? Migraine without aura At least 5 attacks, 4-72 hrs 2 of: One-sided Moderate-severe Throbbing Worse with routine activity 1 of: Nausea/vomiting Light and sound sensitivity No other cause Tension-Type Headache At least 10 attacks, 30 min-7 days 2 of: - Mild-moderate intensity - Bilateral - Tight, non-throbbing, band-like headache - No worsening with activity Both of: - No nausea or vomiting - No more than one of light or sound sensitivity No other cause

23 What is an aura? Nervous system symptoms that come on slowly before a migraine and last less than 1 hour Occur in 1/3 of migraine patients Vision changes Numbness/Pins and needles Speech problems Less commonly, weakness, dizziness Resolve completely

24 Examples of visual auras

25 Cortical Spreading Depression and Migraine Aura Lauritzen M. Trends Neurosci 1987;10:

26 What Causes the Pain in a Migraine Attack?

27 Migraine in the population

28 Migraine Treatment Basics Lifestyle issues Specific triggers Treatment for individual headache attacks (acute therapy) Non-medication Medications Preventing headache attacks - Preventative medications - Behavioural strategies

29 Choosing Acute Migraine Medications Mild Attacks: ASA, Acetaminophen (Tylenol), Ibuprofen (Advil) Moderate: NSAIDS (Ibuprofen, Naproxen, Diclofenac, Others) Ergots, Triptans Severe Attacks: Ergotamine, DHE, Triptans

30 Treating Acute Migraine Attacks Treat early in the attack if you can Avoid too frequent use NSAIDS and Triptans can be taken together Codeine-containing medications are not recommended for routine use 30

31 The Triptans: Medications Designed Specifically for Migraine Medication Tablet Wafer Nasal Spray Injection Imitrex x x x Zomig x x x Amerge x Maxalt x x Relpax Axert Frova x x x 31

32 Tension-Type Headaches Attacks are often not severe, so not all attacks require medication. For individual attacks, NSAIDS (Ibuprofen, Naproxen, etc) are best. 32

33 Preventive Medication Consider a daily preventive if: you have significant disability despite the use of acute treatments. you need to use acute medications so frequently that you are at risk for medication-induced headache. Preventive medications need to be taken every day

34 Mean Change Reduction in Monthly Migraine Frequency withtopiramate 0 Month Placebo TPM 50 TPM 100 TPM

35 Migraine preventative medications Certain blood pressure medications propranolol (other bets blockers), verapamil, candesarten Certain antidepressants Amitriptyline, nortriptyline, venlafaxine Certain anti-seizure medications Divalproex sodium, Topiramate, gabapentin Certain vitamins, minerals, herbs Riboflavin, magnesium, butterbur (Petadolex), coenzyme Q10 Others Sandomigran, flunarazine, Botulinum toxin A (Botox) (for chronic migraine)

36 Preventive Medications for Other Headache Types Tension-type headache: Amitriptyline, Nortriptyline, Venlafaxine Cluster headache: Verapamil, Lithium Post-traumatic headaches: Depends on the headache type 36

37 Can medications taken for headache cause more headache? For acute medications, the answer is YES!

38 How much is too much? Triptans, opioids, DHE, ergotamine (e.g. migranal, imitrex, codeine, demerol, 222s, Tylenol#3) 10 or more days/month for more than 3 mo. NSAIDs (ibuprofen, naproxen, diclofenac, etc), ASA, acetaminophen 15 or more days/month for more than 3 mo

39 Medication Overuser 39

40 One Year After Stopping Overuse. 40

41 Treating Medication Overuse Patient Education Stop medication overuse Provide a good acute medication Start a preventative medication 41

42 Key Messages Understand your headaches and diagnosis. Become skillful in using acute medications. Use preventative medications if necessary. Avoid medication overuse. Use diaries if necessary to monitor headaches and medication use. 42

43 Opportunity To Enter Clinical Trials Medication Overuse Study - 3 month study For chronic migraine sufferers (more than 14 days of headache per month) Using pain medications on more than 14 days per month Exercise Study - 6 month study For migraine sufferers ages with less than 25 headache days per month For those interested in an exercise program that are not currently exercising regularly *If interested, please sign up during the break *30 days of diaries are needed to assess eligibility

44 For more information go to 44

45 Behavioural Approach in Headache Treatment interventions intended to change the behaviour of a headache sufferer with the goal of reducing symptoms, improving functional status, or improving health related quality of life. Penzien, Rains & McGrath

46 Why Consider Behavioural Strategies? The individual prefers a non-drug approach. Effective medications cannot be taken or don t work. The patient is pregnant, has plans to become pregnant or is nursing. There is excessive use of acute medication. Significant life stress or deficient stress-coping skills are present.

47 Main Behavioural Strategies Identify and Manage Triggers Lifestyle Adjustments Relaxation Practice Cognitive Behavioural Therapy (Self Talk)

48 Behavioral Strategy #1: Identify and Manage Triggers Become aware of potential triggers Determine your personal headache triggers (Headache diaries can help) Avoid/minimize the triggers you can control Develop a coping plan for times when you cannot control triggers (e.g. travel)

49 Headache Triggers: CHALLENGES triggers can vary from one headache attack to the next identified triggers vary among individuals triggers may affect the brain chemistry quickly or slowly

50 Migraine Trigger Threshold Theory Danger Zone skipped breakfast Trigger Threshold poor sleep Precautionary Zone

51 Migraine Trigger Threshold Theory Chinook Danger Zone Trigger Threshold skipped breakfast poor sleep Precautionary Zone

52 Migraine Trigger Threshold Theory The objective of headache trigger management is to keep your trigger level below your threshold. Reduce your trigger load (minimize/avoid exposure) Raise your threshold (regular aerobic exercise, preventive medication)

53 Trigger Categories Psychological Physical Environmental Dietary Disruption to routines/habits Other (hormonal changes, high blood pressure)

54 Some Common Triggers *Stress/Let down Anxiety/worry and depression Overexertion Caffeine, alcohol MSG, Aspartame, Nitrates Odors/fumes Weather (e.g. Chinooks) Hormones (e.g. menstrual cycle) Changes in eating or sleeping habits

55 Behavioural Strategy #2: Lifestyle Adjustments This involves adjustments in the areas of: hydration and nutrition caffeine intake sleep routine and habits exercise and posture stress management

56 Lifestyle Adjustments eat at regular intervals (every 3-4 hours) glycemic index avoid foods high in simple carbohydrates (sugars), especially eaten alone drink litres of fluid per day limit caffeine intake to 1 cup per day (6-8 oz.); consider stopping caffeine use completely

57 Lifestyle Adjustments Maintain a consistent sleep-wake schedule daily make regular physical activity part of your routine learn about stretching and strengthening exercises to support good postural habits practice a relaxation strategy daily (e.g. diaphragmatic breathing, meditation)

58 Headache Behavioural Strategy #3: Relaxation Relaxation can be used to help prevent headaches or stop headaches in their early stages. Relaxation practice can: counteract the stress response manage negative emotions, enhance sleep help manage pain.

59 Relaxation Research Regular use of relaxation techniques is associated with less frequent and less intense headaches for most individuals with migraine and tension headaches. Progressive Muscle Relaxation Diaphragmatic Breathing Visualization/Imagery Meditation

60 The Physical Stress Response When someone perceives they are under stress, their body reacts with the stress response (fight or flight): -Increased heart rate -Shallow breathing -Release of hormones (Adrenalin) -Muscle Tension The stress response can be a trigger for headaches.

61 Behavioural Strategy #4: Cognitive Behavioural Therapy (Self Talk) Negative/Unhelpful thoughts and behaviour can generate stress and stress-related headaches A coping style of self-talk can help reduce stress and negative emotions The person is less vulnerable to stress-related headache

62 Depression and Anxiety in Headaches - Depression and anxiety occur with greater frequency in people with recurrent headaches than in the general population - A recent Canadian survey (Molgat & Patten 2005) demonstrated the prevalence of major depression: -7.4% of the general population; -7.8% of individuals with chronic medical conditions -17.6% of individuals with migraine

63 Mental Health Resources Crisis Management: The Distress Centre: 266-HELP (4357) Your local hospital emergency room Non-Crisis Support: Access Mental Health:

64 How confident are you that better headache management is within your control?

65 Calgary Headache Assessment & Management Program (CHAMP) Located at 2 sites: 1) South Health Campus 4448 Front Street S.E. (5 th Floor) Phone (403) ) Richmond Road Diagnostic and Treatment Center 1820 Richmond Road S.W. Phone (403)

66 CHAMP Behavioral Programs Lifestyle Assessment individual appointment Workshops/Lectures small group format (max 10 participants) Workshops and Lectures are offered at various sites in Calgary

67 Lifestyle Assessments Focuses on key health domains (sleep habits, hydration/nutrition, exercise and posture, and stress) Guidance given for lifestyle adjustments in these domains that can improve headache management Identify/clarify your goals for headache management Identify program workshops that may help you work towards your goals

68 Self Management Workshop An opportunity to learn and practice coping skills for headache management, including: Relaxation techniques Stress Management Pacing Self-talk strategies A supportive group environment Increase your confidence in your ability to have control over your headaches

69 Bodyworks Workshop Postural Awareness and Adjustments Stretching and Strengthening Exercises

70 Sleep Lecture A single session (1.5 hours) Exploring the relationship between sleep and headache Addressing strategies to promote improved sleep Behavioral Changes Environmental Changes

71 Relaxation Workshop Focus is primarily on relaxation skills Stress management is also addressed For those who prefer a self-study format 8-week program: 3 clinic sessions, 2 phone contacts, self-study at home

72 Lecture Series Three 2-hour sessions, each with a different topic: Nutrition and Headache Headache Medications and Medication Use Coping with Headaches at Work (includes workstation ergonomics) Participants can attend 1, 2 or all 3 sessions

73 Headache Days / Month (N = 85)** *P< **CHAMP self management groups, headache days by patient report at baseline and 3 months post self management.

74 CHAMP Website Workshop & Lecture Schedule Program Overview Headache Diaries and Instructions 74

75 WHAT S NEXT? Participate in a Lifestyle Assessment Enroll in Champ Workshops and Lectures Participate in a Champ Clinical Trial (study) Assessment with a CHAMP neurologist in months from now