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 / dont 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

March

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

Dont 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: achehq@talley.com
Web: www.achenet.org

Supported by:
Ortho-McNeil Pharmaceutical, Inc.