Migraine and You An Educational Guide for Migraine Headache Sufferers Who gets migraine? Migraine Prevalence % About 20% of women get migraine at one time or another in their life Females Males 1 10 20 30 40 50 60 Age (years) 70 80 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 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. 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? Family physician, internal medicine specialist May need referral from primary care Headaches are severe and disabling; may need referral Primary Care Ask for a specific headache appointment and get a specific diagnosis Neurologist Headaches frequent and difficult to manage or if there are other medical conditions to manage simultaneously Headache Specialist Headaches not responsive to routine care; other existing medical conditions making treatment plan complex 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 High pain No pain Time • 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 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) January # attacks 7 February 6 March 4 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 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 Road Mount Royal, NJ 08061 Phone: 856-423-0043 Fax: 856-423-0082 E-mail: [email protected] Web: www.achenet.org Supported by: • Ortho-McNeil Pharmaceutical, Inc.