Migraine Management

I recently attended a presentation on Migraine by Associate Professor and neurologist David Williams from Monash University.  It was a worthwhile update hosted by Headache Australia at the Alfred Hospital.  This blog does not replace information provided by your GP or specialist. The following is a summary of the information that was presented.

WHO SUFFERS FROM MIGRAINE?

About 15% of the population suffers from migraine at some stage in their lives.

WHAT IS MIGRAINE?

The most recent theory is that migraine is on the normal physiological spectrum i.e. all humans can suffer a seizure but not all have epilepsy.

The PROCESS of migraine is a complex and temporary chemical and electrical change in the brain that results in symptoms.  It tends to start at the base of the brain (the brainstem) and moves like a tide involving the rest of the brain.

https://www.youtube.com/watch?v=pUbXB8vT8fY

http://makethislookawesome.blogspot.com.au/2011/11/what-is-migraine.html

 

HOW DO YOU KNOW IF IT'S MIGRAINE?

Simple test: If you have a headache and you shake your head and it gets worse then it's a migraine type headache.

TRIGGERS

They are different for everyone. 

Commonly reported FOOD Triggers = chocolate, cheese, coffee, nuts, citrus, processed meats, MSG and aspartame, alcohol.

Commonly reported OTHER triggers: bright or flickering light, motion, loud sounds, strong odours, changes in atmospheric pressure, fatigue, lack of sleep, stress, hormones, skipping meals, some medication.

 

THE FOUR PHASES OF MIGRAINE

1.      PRODROME/PREMONITORY: pre-symptomatic stage, e.g. not feeling right, brain fog, frequent and severe yawning, short tempered

2.      AURA*: temporary spread of chemical changes to 50-60% of the brain

3.      HEADACHE/PAIN 

4.      POSTDROMAL/RESOLUTION: the pain has passed, but you are left feeling fatigued and washed out

* Only 20-30% of people experience AURA symptoms e.g. visual scotoma (blind spots), blindness, speech disturbance, tingling, weakness, nausea, unsteadiness

PROGNOSIS

Migraines usually last a few days.

 

WHY? WHY? WHY?

Most people have a genetic vulnerability. In other words, it's how you're wired.

Nerves and blood vessels become sensitised to pain

Pain breeds pain

And the tissues are not as good at resetting after the pain has past

 

RESEARCH

Pain threshold is lower in people with migraines (pin pricks)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268359/

The same process occurs in low back pain:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598908/

 

MEDICATION

There is NO evidence for pain medication which means NO panadeine NO paracetamol

WHY NO MEDICATION?

Rebound Headaches can occur with migraine

These can be caused by high rates of codeine overuse (Australia one of the only places it is available over the counter)

Triptans can be overused and this prevents the brain to allow the tide of pain to recede on its own

STOP the spread of chemical changes in the brain with NSAID and TRIPTANS

Preventers* = Endep, Topamax, Epilin

*Pharmaceutical preventers have multiple side effects as they change brain chemistry e.g. sedation, confusion, unsteadiness, nausea 

* Nutritional preventers e.g. Vit B2, Mg, B2 Folate, Coenzyme Q10 - very individual. 

 

YOU MUST HAVE A PLAN

1) Know YOUR migraine (at some point you must keep a migraine diary to plot evolution of symptoms)

2) Avoid triggers (PERSONAL) 

3) Have an ACUTE MIGRAINE PLAN and HIT IT HARD (escalation of treatment) MUST catch it early, once headache is there (Phase 3) the chemical spread through the brain is TOO big

Step 1) HYDRATE (sleep/eat)

If this fails:

Step 2) NSAIDS e.g. voltaren, aspirin, ibuprofen

If this fails:

Step 3) Second dose NSAIDS (within shortened time period)

If this fails:

Step 4) TRIPTANS* maxalt, immigrin, naramig

If this fails after 2-3 days of headache/vomiting:

Step 5) HOSPITAL fluid infusions, stematol (anti-nausea) morphine

*Triptans can cause rebound headache

 

THERE IS NO ‘OFF THE SHELF’ TREATMENT

Be healthy - eat well, rest

Acceptance

Often natural fluctuations

Exercise

Good sleep hygiene (http://www.fairfieldosteo.com.au/reconstructinghealth/2015/7/2/five-tips-for-a-better-nights-sleep ) 

Intellectual stimulation

Good social network

 

Order of Important people

YOU

Family 

Employer

GP

Nurse

Pharmacist

Specialist

Allied Health (combination of treatment that makes sense and is financially viable)

 

What is CHRONIC MIGRAINE?

CHRONIC MIGRAINE is an escalating episodic migraine and is vaguely classified as suffering with symptoms for more than 14 days per month.10% of sufferers fluctuate into chronic migraine at any given time2-3% of migraine sufferers find their pain becomes disabling.

Tell me about BOTOX?

Clinical trials suggest that BOTOX injections over seven key areas of the head and neck (31 total injection sites) can reduce the sensitisation process in people with CHRONIC MIGRAINE and return people to episodic migraine.