Migraine The Problem: Common Symptoms:

Transcription

1 Migraine The Problem: A combination of genetic and environmental factors alter pain mechanisms in your brain Transient changes in brain chemicals such as serotonin and neuropeptides affect the membranes surrounding the brain (meninges) resulting in pain Migraine attacks have numerous triggers such as hormonal fluctuations, light glare, rainy days, too much or too little sleep, hunger, stress, mood disorders and food substances - such as alcohol, nitrates and MSG Common Symptoms: Aura - reversible neurologic symptoms such as flashes of light, vision loss, pins and needles Throbbing pain on one or both sides of the head, often behind the eye Worsening of pain with physical or mental exertion Nausea, loss of appetite, vomiting Sensitivity to light, noise, smells Malaise feeling sick, faint, dizzy usually too sick to work

2 What is Migraine? Migraine is generally thought to be a genetic (inherited) disorder. Many people think migraine is the term for any severe headache, but the word derives from French, meaning half the head, since most people experience throbbing pain centered on one side of the head. It is a lifelong condition that has different symptoms at different ages: colic in babies, carsickness or abdominal pain in children, headache in reproductive years and stroke-like symptoms without headache in old age such as recurrent numbness, visual loss or vertigo. Many people have very mild migraine headaches that are immediately treated with any analgesic but others have severe throbbing pain worsened by physical activity. Nausea and vomiting, sensitivity to light and sound and malaise feeling sick often accompany headache. People having migraine are usually too sick to work and seek a quiet dark place to lie down. Although pain lasts for minutes to hours in kids, adults with migraine may suffer for up to 3 days per attack, sometimes more. Pain often resolves with sleep the body s way of treating migraine. Some individuals have premonitory (warning) symptoms such as yawning, feeling elated, craving a certain food such as chocolate, that may precede headache by days. Aura is a reversible neurologic symptom lasting 20 minutes to 2 hours, often preceding headache. The most common is flashing, shimmering visual lights. Numbness, trouble seeing or trouble talking are examples of less common forms of aura.

3 Women find that migraines often occur in association with their menstrual period as well as other times menstrualassociated-migraine. Less common, only at the time of menses, is menstrual migraine. Their OB-GYN or medical doctor can often prescribe non-hormonal or hormonal treatments that may help. Migraine has numerous triggers including stress, not eating, neck pain, smoke, too little or too much sleep, exercise and substances - alcohol (red wine in particular), nitrites, chocolate and many others. Migraine sufferers are at risk of developing medication overuse headache when triptans or opiates are used 8 or more days per month, or any combinations of over-the-counter meds are used 14 or more days per month. Medication overuse headache must be successfully treated before migraine treatment can be achieved. Both patients and their doctors tend to focus on migraine as an isolated problem, rather than seeing it as the end result of other triggers or co-morbidities (medical conditions associated with migraine) which aggravate the migrainous condition. Treatment of co-morbid conditions and elimination of triggers substantially reduce migraine frequency and duration. Unfortunately, migraine pain is not reduced.

4 Examples of co-morbid problems include: Neck pain Menstrual disorders Anxiety Depression Stress Sleep disorders Other pain syndromes Snoring Obesity GI complaints High caffeine consumption

5 What Can I Do? Eliminate triggers Stress reduction (see a counselor if useful) Hunger eat regular meals; don t skip eat by the clock, not by your stomach Neck pain use a neck splint to treat cervicogenic headache, female posture related headache and occipital neuralgia. Make appropriate ergonomic changes. Sleep ensure 7-8 hours sleep nightly. Headache relief is impossible if sleep deprived. Go to bed and wake up the same time every day even on weekends Lack of exercise walk! 30 minutes or more at least 4 times per week. Food and medication triggers avoid common triggers: chocolate, MSG, perfume, oranges, nitrites, alcohol, red wine, female hormone therapy Glare wear hat with visor and sunglasses in bright light Caffeine limit caffeine to 2 regular cups of coffee per day. Mix caffeinated and decaffeinated coffee if you drink more. No energy drinks or caffeinated beverages Identify and Treat Co-Morbidities Medical disorders - work with your physician to optimize management of any medical problems such as hypertension, diabetes, arthritis to reduce the stress that uncontrolled symptoms put on your body Psychiatric disorders work with your physician to optimize treatment of mood disorder, anxiety, excessive worry Sleep disorders obstructive sleep apnea, restless leg syndrome, insomnia. If you have these problems, work with your doctor or sleep specialist to treat them. You will find that Migraine, sleep and mood all travel together. All are better when feeling well, all are worse well feeling unwell

6 Acute Treatment (taken when headache occurs) Treat early - as soon as you realize you are getting a headache. Avoid escalating doses. Use effective dose upon first administration. Do NOT use Fioricet or Fiorinal due to risk of Medication Overuse Headache Medication Dose Side Effects Contraindication Acetaminophen mg Liver damage Liver disease Alcoholism Aspirin mg GI upset Bleeding Ibuprofen mg Bleeding GI upset Edema Renal damage Naproxen mg GI upset Bleeding Edema Renal damage GI bleeding Ulcers Gastritis GI bleeding Gastritis Renal disease Ulcers GI bleeding Gastritis Renal disease Ulcers Preventative Treatment of Migraine taken daily to prevent Migraine occurring. Preventative treatment should be considered if you are having more than 8 migraine days per month. Evidence-based, non pharmacologic therapies are listed on next page. Trial and error is the only method to see if you benefit from their use. Health food and natural product stores usually have these substances. Any substance can have possible side effects or toxicities so make sure you review their use with the seller when purchasing them.

7 Feverfew - Capsule 6.25 mg three times per day - Leaves 2-3 medium sized leaves chewed per day - Do not use in pregnancy and lactation - May cause rapid pulse, nausea- GI complaints, eczema Magnesium mg per day to slowly increase up to 1200 mg per day - Use smallest dose that is effective - Do not use in renal disease - Monitor for GI upset, diarrhea - Possibly effective in Migraine patients if magnesium deficient CoQ mg per day Riboflavin mg per day - Up to 3 months may elapse before benefit occurs - Urine may turn a yellow orange color

8 What My Healthcare Provider Can Do Help to identify and eliminate triggers Help to identify and treat co-morbidities Help manage menstrual headache Non-narcotic Prescription Acute Treatment If simple analgesics have failed, additional treatments can be offered. Oral Triptans highly effective, specific migraine treatment Subcutaneus triptan injections or nasal triptans if severe nausea and vomiting develops at onset of headache Nausea medications such as metoclopramide or Prochlorperazine Ergotamines require careful patient selection and monitoring Corticosteroids require careful patient selection and monitoring Other choices based on physician judgment Prescription Preventative Treatment (from evidence based guidelines) Tricyclic antidepressants Beta blockers Anticonvulsants Calcium channel blockers Botulinum toxin A (Botox) Natural substances Other choices based on physician judgment