Migraine and YouMigraine 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

1 10 20 30 40 50 60 70 80

How do you know you might have 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. 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?

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

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 / 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– Acute:

• Triptans• Analgesics

– Preventives• Antiepileptics• Beta-blockers• Antidepressants (TCAs)

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

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)

# attacksJanuary 7

February 6

March 4

x x

x x

x x x xx 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– Record medications – Monitor response

• 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– Hormone fluctuations

• Menstruation– 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– More severe– More frequent

Don’t be confused by migraine Don’t be confused by migraine myths…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.

Where to go for more information

• The American Headache Society® Committee for Headache Education (ACHE)

19 Mantua RoadMount Royal, NJ 08061Phone: 856-423-0043Fax: 856-423-0082

E-mail: achehq@talley.com

Web: www.achenet.org

Supported by:

• Ortho-McNeil Pharmaceutical, Inc.