Migraine%20headache Patient Education

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 

• 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 or calendar
  
  • 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