migraine%20headache
MIGRAINE HEADACHE
Migraine headache without aura has at least 5 attacks of any 2 symptoms of unilateral headache that is throbbing or pulsating in nature, moderate to severe in pain and activity aggravates pain. It is accompanied with either nausea and vomiting or photophobia and/or phonophobia. The symptoms last for 4-72 hours without signs of secondary headache.
Migraine headache with aura has at least 2 attacks with any of the fully reversible symptoms of flickering lights, spots or lines and/or vision loss, sensory symptoms of pins and needles and/or numbness and dysphasic speech disturbance but without motor weakness. Accompanied by at least 2 of the following symptoms of homonymous visual symptoms and/or unilateral sensory symptoms or at least 1 aura symptom develops gradually over ≥5 minutes and/or different aura symptoms that occur in succession over ≥5 minutes.

Migraine%20headache Patient Education

Lifestyle Modification

Predisposing Factors Recognition and Trigger Avoidance

  • Patient should be educated about the many influences that can lead to a migraine attack
  • Identify and differentiate between predisposing and precipitating or trigger factors
    • Some predisposing factors cannot always be avoided but can be treated
    • Factors triggering an acute attack in one patient may not trigger an attack in another patient
  • Predisposing factors: Stress, depression, anxiety, menstruation, menopause, head or neck trauma
  • Trigger factors:
    • Environmental triggers: Weather changes, bright lights, loud noise, motion, high altitude, odors (eg fumes or perfumes)
    • Lifestyle triggers: Disturbance in sleep patterns, long distance travel, poor diet, skipping meals, smoking, stress, physical strain, fatigue
    • Hormonal triggers: Menopause, puberty, menstruation
    • Medication triggers: Glyceryl trinitrate, oral contraceptives, hormone therapy
    • Dietary triggers: Caffeine, chocolate, aspartame, alcohol, monosodium glutamate, tyramine-containing food and nitrate-containing food
  • Most patients benefit from adequate hydration, regular eating patterns and sleep schedules, regular aerobic exercise and stress reduction
  • Patients also prefer to stay in a dark and quiet room during the attacks 

Patient Education

  • Individuals need to understand that migraine headache is a physiological disorder with genetic predisposition or a primary brain disorder with no structural lesion in the brain
    • Patients are predisposed to blood vessel and inflammatory responses in the brain which cause pain
  • Patients need to be educated about controlling acute attacks and preventive therapy
  • Patients should be made aware of the potential for medication-induced headache (manifested as chronic daily headache) which can be caused by the overuse of analgesics and acute migraine drugs
    • If treating acute headache >2x/week, the patient should consider prophylaxis treatment to prevent medication-induced headache
  • When creating a management plan, involve the patient in the decision-making process
  • Discuss therapeutic options including risks versus benefits and medication-induced headache
  • Patient should be encouraged to keep a headache diary
    • Record frequency, duration and severity of each headache attack
    • Take note of any resulting disability
    • Treatment used for headache and its effects (include adverse reactions to the medication)

Rescue Medication

  • Clinical consideration: Self-administered rescue medication for patients who have severe migraine which do not respond to other treatments
  • May consist of opioid or Butalbital-containing combination that patient may use at home
    • Enables the patient to administer pain relief without the need for physician clinic or emergency department visit
  • Patient must be educated on the appropriate use of rescue medication
  • There should be an adequate trial of preventive therapy because clinical benefit manifests after 2-3 months


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