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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
50 60
Age (years)
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
• 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
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
Headaches frequent and
difficult to manage or if there
are other medical conditions
to manage simultaneously
Headaches not responsive
to routine care; other
existing medical conditions
making treatment plan
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
• 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?
• Acute
– Taken when a migraine is
– 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
– Reduce stress
– Exercise
– Regular sleep
– Counseling or
– Biofeedback / relaxation
– Eat regularly / don’t skip
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
– Overuse of acute medications ( 2 times per week)
– Acute medications are not effective, well tolerated or are
• 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
• Improve response if you take medicines
– Decreased pain, nausea, photophobia and
• 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)
# attacks
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
– 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
– 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
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
• 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
Myth: Migraine is all in your head… like a psychological
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
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]
Supported by:
• Ortho-McNeil Pharmaceutical, Inc.
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