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Understanding Chronic Migraine

L e a r n a b o u t d i a g n o s i s , m a n a g e m e n t , a n d

t r e a t m e n t o p t i o n s f o r t h i s m i g r a i n e d i s e a s e

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What We’re Going to Cover Today

• The symptoms and phases of migraine

• Differences between episodic migraine and Chronic Migraine

• Understanding the stigma of Chronic Migraine

• Tips for discussing Chronic Migraine with your doctor

• Ways to manage Chronic Migraine, including types of treatment options

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What Is Chronic Migraine?

• T h e b a s i c s o n a d i f f i c u l t a n d

o f t e n d e b i l i t a t i n g d i s e a s e

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First, What Is Migraine Disease?

• Migraine disease is identified by headache with pain that can last from 4 hours to 3 days

‒ Pain is:

> Usually moderately to severely intense

> Pulsating

> Often occurring on 1 side of the head

> Made worse by physical activity

‒ Telltale signs may be:

> Nausea and/or vomiting

> Sensitivity to light and sound

‒ Vision or sensory changes (aura) may come just before or just as a migraine begins

• Triggers or certain things from your everyday life can cause a headache/migraine attack (eg, stress or hormonal changes)

• Migraine is a common disease, yet often goes undiagnosed

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Medical names for phases

ProdromeBefore headache

pain begins

AuraBefore headache

pain begins

Headache PostdromeAfter most headache

pain ends

Each phase has its own symptoms and time frame

End of attackBeginning of attack

What Are the Phases andSymptoms of Migraine Disease?

• Migraine symptoms and phases may vary from person to person and from attack to attack

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Prodrome Phase: Before Headache Pain Begins

Tiredness

Difficulty concentrating

Sensitivity to light and sound

Elated mood

Depression

Unusual hunger or food cravings

A few hours to a couple of days

Typical

symptoms

Duration

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Aura Phase: Before Headache Pain Begins

Changes in vision,

sensation, or speech

Each symptom may last 5 to 60 minutes

Typical

symptoms

Duration

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Headache Phase

Moderate to severely intense pain

Nausea and/or vomiting

Sensitivity to light and sound

Neck pain and stiffness

4 to 72 hours

Typical

symptoms

Duration

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Continued headache

Tiredness

Depression

Euphoria

Sensitivity to light and sound

0 to 24+ hours

Typical

symptoms

Duration

Postdrome Phase: After Most Headache Pain Subsides

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Voices on Living With Chronic Migraine

“My headaches first started years ago.

I first noticed flashes of light. After a few minutes, the

flashes stopped and an intense headache started, along

with vomiting. The headaches now seem to last longer

and have increased in frequency over the years.”

“When you live with Chronic Migraine, you’re always

worried about the next step.”

Real patient quotes.

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The Impact ofChronic Migraine

• Y o u m i g h t h a v e a h e a d a c h e / m i g r a i n e a t t a c k

o r w o r r y w h e n t h e n e x t o n e w i l l s t a r t

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Based on findings from a 2010 publication summarizing global Chronic Migraine prevalence rates.

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Episodic Migraine

Headaches on fewer than 15 days per

month, some of them migraine

Chronic Migraine

Headaches lasting 4 hours or longer,

at least 15 days per month

―On at least 8 days, headache has migraine features

Two Types of Migraine Disease(Defined by Headache Frequency)

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Chronic Migraine Has More Negative Impact on People’s Lives Than Episodic Migraine

Compared to those with episodic migraine, people with Chronic Migraine:

• Report longer-lasting headaches with more intense pain

• Have greater headache-related disability

• Are more likely to miss:

‒ Work or school

‒ Family activities

‒ Household work

• Experience the following conditions more often:

‒ Allergies/Hay fever

‒ Sinusitis

‒ Depression

‒ High cholesterol

‒ High blood pressure

‒ Arthritis

‒ Chronic pain

‒ Anxiety

‒ Obesity

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Voices on Living With Chronic Migraine

“It’s discouraging when you feel one coming on. It’s

disruptive not to be able to plan your day every day. It

doesn’t matter if you have theater tickets or plane tickets.

If you can’t go, you can’t go.”

“You can’t schedule anything. You can’t plan anything.

It is a constant fear or hesitation. It’s like living a

maybe life.”

Real patient quotes.

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Chronic Migraine Leads to Changes in the Brain

• In people with frequent migraine attacks, studies have shown:

‒ Higher amounts of iron in certain parts of the brain

> This may lower the brain’s ability to control specific signals

‒ Increased activity in the areas of the brain that regulate pain

> These areas remain overactive between attacks

‒ The more your brain is exposed to migraine, the more likely

you’ll experience another attack

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“It’s so frustrating when no one takes my migraines

seriously. It’s not just in my head, but sometimes I do

wonder if I’m making it into a bigger deal than it really is.”

“No one gets the pain I’m in or how tired I feel. I find

myself just powering through it. There doesn’t seem to

be any other option.”

Quotes written based on real patient experiences.

Voices on Living With Chronic Migraine

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Myths About Migraine Disease

• Migraine disease…

‒ Affects women only

‒ Is a headache (as opposed to a neurological disease)

• People living with migraine disease…

‒ Are emotionally fragile or weak

‒ Cannot handle stressful situations or high-stress jobs

‒ Are unreliable

‒ Exaggerate or fake their symptoms

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Migraine disease misconceptionsNegative ideas about migraine impact your

access to care and disease education

The cycle continuesLack of treatment means your condition is not managed

and misconceptions of migraine continue or worsen

Feelings of doubtThe seriousness of the disease isn’t fully realized and

you start to doubt the legitimacy of your condition

Reluctance to speak upYou may decide to “power through,” putting off

treatment or not sharing the full range of symptoms

How Stigma Impacts People With Migraine Disease

You feel frustrated and

hesitate to seek treatment

Lack of treatment

continues the cycle

Negative ideas about

migraine by society

Friends, family, coworkers,

etc don’t take you seriously

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Shedding the Stigma of Migraine Disease

• Help alleviate the stigma of Chronic Migraine by speaking up

‒ Be vocal about how the disease affects your everyday life

‒ Don’t be afraid to tell others when you’re not feeling supported

• Choosing the right words may help you to better explain your disease to others

• Open communication with your doctor is especially important

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Talking to Your Doctor About Chronic Migraine

• B e i n g p r e p a r e d f o r y o u r

a p p o i n t m e n t c a n h e l p

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The Right Information Is Very Important

• Share as much as possible about your migraine disease

• Track your symptoms for several months so you can give

your doctor a complete picture of your headache/migraine days

• Tracking headache/migraine attacks is important:

‒ To help get the right diagnosis

‒ To help guide a discussion with your doctor

‒ To help provide information that may be required by your insurer

‒ To help monitor progress and see if a treatment is working

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Tell Your Doctor About Headache/Migraine FREQUENCY

• On average, how many days each month do you experience headache/migraine of any kind?

‒ 15 days or more each month?

‒ Fewer than 15 days each month?

• On average, how many days per month are you completely headache-free?

• Do you have headaches that last 4 hours or more each day if you don’t take any medicine?

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Tell Your Doctor About Headache/Migraine SYMPTOMS

• Do you experience any of the following with your headache/migraine?

‒ Moderate to severe pain

‒ Throbbing pain

‒ Nausea and/or vomiting

‒ Sensitivity to light

‒ Sensitivity to sound

• Do you experience any other symptoms with your headache/migraine?

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Tell Your Doctor About These CONDITIONSThat May Be Associated With Chronic Migraine

• Do you experience any other conditions?

‒ Allergies/Hay fever

‒ Sinusitis

‒ Depression

‒ High cholesterol

‒ High blood pressure

‒ Arthritis

‒ Chronic pain

‒ Anxiety

‒ Obesity

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Tell Your Doctor How Headache/Migraine AFFECTS YOUR LIFE

• Does headache/migraine interfere with work or school?

• How does headache/migraine impact the activities you do during the day?

• Finally, talk about medicines

‒ What do you take now for your headache/migraine?

‒ What have you taken in the past (including over-the-counter medicines and prescriptions)?

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Two Ways to Prepare for Your Doctor’s Appointment

• Complete the ID-Chronic

Migraine (ID-CM) screening tool

• Fill out a headache tracker prior to

your visit

Visit hcp.mychronicmigraine.com/#documentation to download these resources

before your appointment or ask your doctor about them at your appointment.

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Chronic Migraine Management

• L e a r n w h a t y o u c a n d o f o r y o u r s e l f

a n d y o u r h e a l t h

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Triggers can be managed:

Avoiding your triggers when possible and creating healthy habits

may help you reduce the frequency of your headaches/migraines

Stress

Know the Common Triggers That May Cause an Attack

• Not eating

• Weather

• Sleep disturbance

• Strong odors/smells

• Neck pain

• Bright or flashing lights

• Alcohol

• Smoke

• Food or food additives

(such as MSG or nitrates)

• Caffeine

• Overusing certain

migraine medication

Other triggers include:

Hormonal changes

2 most common triggers:

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Day 1 2 3 4

None, or headache that lasted less than 4 hours (N)

Mild headache (H)/migraine (M) M

Moderate headache (H)/migraine (M) H

Severe headache (H)/ migraine (M) M H

Family event

Social event

Work/school

Housework

Medication 1:

Medication 2

Medication 3:

Medication 4:

Sa

mp

le H

ea

da

ch

e T

racke

r

Keep a Headache Tracker

• Good way to track your

headaches/migraine attacks

‒ When headaches happened

‒ How long they lasted

‒ How severe they were

‒ Other symptoms you may

have experienced

‒ Triggers identified

‒ Medicines used

• Find additional resources at

MyChronicMigraine.com

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Work Social settingsHome

Avoid Triggers and Make Positive, Healthy Changes

• Exercise/weight

management

• Stop smoking

• Eat regularly

• Get enough sleep

• Set boundaries and

be assertive

• Find healthy ways to

manage stress

• Avoid smoking areas

• Avoid food and drinks

that may trigger

headaches/migraines

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• Biofeedback therapy

• Cognitive behavioral therapy

Behavioral

treatment

Practice Self-Care

• Use headache/migraine trackers

• Understandtreatment options

• Explore websites for education and tools:– Headaches.org

– AmericanHeadacheSociety.org

– MyChronicMigraine.com

Education and

empowerment

• Exercise

• Weight reduction

• Regular andhealthy diet

• Regular sleeppattern

• Stress management

Maintain a

healthy lifestyle

• Deep breathing

• Meditation and yoga

• Progressive muscle relaxation

• Guided visualimagery

Relaxation training/

Stress management

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Acute and Preventive Treatment Options

• T a l k t o y o u r d o c t o r a b o u t w h a t

m i g h t b e r i g h t f o r y o u

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Preventive

Help prevent headache/migraine

before they even start

There Are Medicines That May Help

• Treatments may help manage Chronic Migraine and possibly reduce headache/

migraine frequency

• Talking to a Headache Specialist about your headaches/migraines and goals will help

determine your treatment and management plans

• Ways to manage Chronic Migraine include non-drug treatments, devices, and medicine

‒ Two types of medicine to help manage headaches/migraines are:

Help stop headache/migraine

pain during an attack

Acute

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Learn more about migraine, find out about the latest research, get information on clinical trials,

find Headache Specialists, and receive regular newsletters.

• American Headache Society (AHS)

americanheadachesociety.org

• American Migraine Foundation

americanmigrainefoundation.org

• The Coalition For Headache and Migraine Patients (CHAMP)

headachemigraine.org

• Migraine Research Foundation

migraineresearchfoundation.org

• National Headache Foundation (NHF)

headaches.org

Many Organizations Have Information for People With Chronic Migraine

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Summary of Topics Covered Today

• Chronic Migraine is a complex disease

‒ 15 or more headache days per month, with headache lasting 4 hours a day or longer,

with 8 or more headache days per month linked to migraine

• Good communication with your physician is important

‒ Sharing the right information can help lead to an accurate diagnosis and better

treatment plan

• Empowerment can improve your Chronic Migraine

‒ Keep a headache tracker, avoid triggers, and practice a healthy lifestyle

• Talk to your doctor about treatment options

‒ Acute and preventive medicine options are available

• Learn more and find a Headache Specialist at MyChronicMigraine.com

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References

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• Hildreth CJ, Lynm C, Glass RM. JAMA patient page. Migraine headache. JAMA. 2009;301(24):2608.

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• Kelman L. The postdrome of the acute migraine attack. Cephalalgia. 2006;26(2):214-220.

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• National Institute of Neurological Disorders and Stroke, National Institutes of Health, US Department of Health and Human Services. NINDS headache: hope through research page.

National Institute of Neurological Disorders and Stroke website. https://catalog.ninds.nih.gov/pubstatic//16-158-Z/16-158-Z.pdf. Updated May 2016. Accessed June 26, 2019.

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Neurol. 2011;13(1):28-40.

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