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What You Can Do For Your Migraine Headaches

What You Can Do For Your Migraine Headaches. What is Migraine?. Repeated attacks of headache Moderately or severely painful Frequent or infrequent Last a few hours to a couple of days Often only one side of the head hurts Often experience loss of appetite, nausea, and vomiting.

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What You Can Do For Your Migraine Headaches

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  1. What You Can Do For Your Migraine Headaches

  2. What is Migraine? • Repeated attacks of headache • Moderately or severely painful • Frequent or infrequent • Last a few hours to a couple of days • Often only one side of the head hurts • Often experience loss of appetite, nausea, and vomiting World Federation of Neurology

  3. Feeling of well-being Talkativeness Surge of energy Hunger Decreased appetite Drowsiness Depression Irritability Tension Restlessness What You Might Feel Before or During an Attack

  4. Nausea Vomiting Diarrhea Sweating Cold hands Sensitivity to light Sensitivity to sound Scalp tenderness Pale color Pulsing temple Pressure pain What You Might Experience During an Attack

  5. Triggers and Risk Factors Migraine headaches are often triggered by specific things

  6. Triggers: Changes in Daily Cycles

  7. Triggers: Environment or Diet

  8. Triggers: Mental

  9. Mild 1.2% Moderately severe 18.4% 33.2% Extremely severe 47.2% Severe Most Patients’ Headaches Are Severe or Extremely Severe National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment

  10. Can work as normal 9% 52% 39% Need bed rest Can work with some difficulty Migraine Takes Quality Time Out From Your Life National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment

  11. 9 million 14 million 21 million 18 million 16 million Migraine Takes Time Out From Your Life In the past 3 months... Missed Work or School Functioned less than half as well at work/school Were unable to do chores/household work Functioned less than half as well at household chores Missed family or leisure activity

  12. Unnecessary Suffering • More than half of people with migraine suffer for at least a year before they are diagnosed with migraine • 38% suffer for 3 or more years National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment

  13. 12% Affected Americans: 7% 6% 5% 1% Rheumatoid arthritis Asthma Diabetes Osteoarthritis Migraine How Migraine Stacks Up Against Other Common Diseases From the Centers for Disease Control and Prevention, the US Census Bureau, and the Arthritis Foundation.

  14. Migraine Major Forms: • Migraine without aura (common) 70% • Migraine with aura (classical) 25% • Migraine variants and complicated migraine 5%

  15. What is a Migraine Aura?

  16. The Stages of a Migraine Attack

  17. When Should You Take Your Migraine Medicine? • Triptans need to be taken as soon as you recognize an attack • Most patients wait too long • No need to suffer • Triptans work best in the first couple of hours of an attack • Dihydroergotamine works at any time during an attack

  18. How Migraine Works 3 Changes in nerve cell activity and blood flow may result in visual disturbance, numbness or tingling, and dizziness. 4 Chemicals in the brain cause blood vessel dilation and inflammation ofthe surrounding tissue 5 The inflammation irritates the trigeminal nerve, resulting in severe or throbbing pain 2 Electrical impulses spread to other regions of the brain. 1 Migraine originates deep within the brain

  19. Protective Factors • Regular sleep • Regular meals • Regular exercise • Biofeedback • Healthy lifestyle

  20. Medicines to Stop a Migraine Attack • Non-prescription medications – use with care and tell your doctor • NSAIDs (eg, ibuprofen, naproxen) • Aspirin, acetaminophen, caffeine combination (avoid using more often than twice a week, especially if using several agents or if you drink a lot of coffee, tea, or caffeinated soda) • Prescription medications • Triptans • Dihydroergotamine (DHE) • Others

  21. Almotriptan (AxertTM) Tablets Eletriptan (Relpax®) Tablets Rizatriptan (Maxalt®) Tablets Orally disintegrating tablets (MLT) Naratriptan (Amerge) Tablets Frovatriptan (Frova®) Tablets Sumatriptan (Imitrex®) Subcutaneous Nasal spray Tablets Zolmitriptan (Zomig®) Tablets Orally disintegrating tablets (ZMT) Nasal Spray Triptans

  22. DHE • Dihydroergotamine • Nasal Spray (Migranal®) • Injectable (D.H.E. 45®)

  23. Others • Isometheptene Mucate Combination • Used in untreated migraine that is usually mild to moderate

  24. Your Symptoms May Affect The Choice of Medication

  25. Other Factors Involved in the Choice of Medication • How fast it works • Nasal spray allows for fast onset of migraine relief • How long it keeps working • Presence of migraine symptoms you may have • Other medications you may be taking

  26. Fast Relief vs. Long-lasting Relief • Injections yield the fastest relief • A scientific study compared DHE injection with an injectable triptan • The triptan worked slightly faster • DHE worked longer, so fewer patients had a return of their headaches Winner P, et al. Arch Neurol. 1996;53:180-184.

  27. Non-oral Alternatives • Nasal Sprays • Dihydroergotamine (Migranal®) • Sumatriptan (Imitrex®) • Zolmitriptan (Zomig®) • Injections • Dihydroergotamine (D.H.E. 45®) • Sumatriptan (Imitrex®) • Nasal sprays are safe, effective alternatives to oral medications

  28. Options for Preventive Treatment • Divalproex sodium/sodium valproate (anticonvulsant) • Propranolol (beta-blocker) • Timolol (beta-blocker) • Methysergide (serotonin antagonist) • Other anticonvulsants • Other beta-blockers • Antidepressants • NSAIDs (eg, aspirin) • Other serotonin antagonists These are medicines you take every day to prevent headaches

  29. Chronic Daily Headache • About 4% of Americans have this condition • 20% to 40% of primary care headache patients are affected • Defined as 15 or more headache days each month

  30. Chronic Daily Headache Some contributing factors: • Frequency and duration of migraine attacks • Overuse or misuse of certain medicines • Other diseases (for example, depression or anxiety) • Life style or life events

  31. May cause chronic headaches: Opiates Combination analgesics Caffeine Barbiturate-containing medications Ergotamine tartrate, isometheptene Triptans Others Not clearly associated with chronic headaches: Acetaminophen Aspirin Dihydroergotamine Others Some Medications May Cause Migraine to Become Chronic

  32. Rest Biofeedback Ice/heat Massage Exercise Avoid triggers Seek treatment early Keep a headache diary Take medications as directed by your doctor Self Treatment Efforts:What You Can Do For Your Migraines Many options are available for migraine relief – ask your doctor what’s right for you

  33. The National Headache Foundation • For more information on headache causes and treatments visit the National Headache Foundation (NHF) Web site at: www.headaches.org • A list of NHF physician members by state is available on request by calling toll-free: 1-888-NHF-5552

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