1. Anne Grover CNM2 Neurology Bon Secours Hospital
Migraine Matters
Anne Grover
CNM2 Neurology
Bon Secours Hospital
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2. Practice Nurse Conference. 1st October 16
Migraine
Primary headache disorder
Episodic
Most often begins at puberty but can affect children
3x more common in women1.
Age most disabling for
women, more constant for men2.
1.Moloney, M.F. , Johnson, C.J. (2011) .
2. Frith, A., (2016).
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Burden
Sixth highest cause of disability worldwide 4.
500,000 people in Ireland 5.
Estimated cost to Irish economy €252 million annually 6.
4. World Health Organization.
5. Tomkins, E. (2013).
6. Migraine Association of Ireland.
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4. Many Migraineurs Remain Undiagnosed
56%
Diagnosed Migraine
44%
Undiagnosed Migraine
Diamond S et al. (2007).
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Diagnosis
Primarily by history
Medical history and medication
Description of headache
Different types of headache
Family history
MRI to rule out secondary cause
Frith, A. (2016).
The Migraine Association of Ireland.
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6. Practice Nurse Conference. 1st October 16
The I-D Migraine Test
In the last three months did you have any of the following three symptoms with a headache?
You felt nauseous?
Light bothered you?
Your headache limited your ability to work/study/play for at least one day?
Lipton et al. (2003).
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7. Practice Nurse Conference. 1st October 16
National Headache Foundation (2007).
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8. Phases of a Migraine Attack
Treatment Phase
Pre-headache
Headache
Post-headache
Resolution
Premonitory/
Prodrome
Aura
Recovery/
Postdrome
Moderate to Severe
Mild
Focal neurological symptoms preceding headache
(<1 hour)
Symptoms
occurring hours/days after headache resolution
Warning symptoms
occurring up to 48 hours prior
to headache
Unilateral pulsing pain worse with movement
4-72 hours
Migraine Intensity
Symptoms:
Sensitivity to light, sound, smells
Nausea/vomiting
Pain head and neck
Scalp tenderness
Pallor
Depression
No energy
Difficulty concentrating
Symptoms:
Tiredness
Confusion
Decreased appetite
Stiff or sore muscles
Low mood/Euphoria
Symptoms :
Food cravings
Mood changes
Yawning
Fatigue
Nausea
Sensitivity
Symptoms:
Visual
Sensory
Speech disturbance
Time
Frith, A., (2016).
International Headache Society. (2013).
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9. Migraineurs ‘I have headaches that make me go lie down in a dark room’
‘I thought I’d had a stroke, my face and arm felt funny‘
‘I always think I am going to be ok. Never expect them when they happen. Then miss the moment. Can be 3-4 days if you miss it.’
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Migraine Tool Kit
Empowers person towards self-care
Education on migraine and medications
Awareness of unique triggers
Lifestyle review
Stress Management
Migraine diary
Frith, A. (2016).
The Migraine Association of Ireland.
Tomkins, E. (2016).
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Triggers
Alteration in sleep cycle
Changes in routine
Missed/delayed meals, dehydration
Foods. Alcohol.
Emotion
Hormonal changes, oral contraceptives
Environmental
Meteorological
Frith, A. (2016).
Tomkins, E. (2016).
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Assessment Tools
Headache Impact Test (HIT) , (HIT6).
Migraine Disability Assessment Questionnaire (MIDAS).
24-hour Migraine Quality of Life Questionnaire (24-hr-MQOLQ)
World Headache Alliance (2016). .
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13. Education on Medications
Over the counter
Abortive
Preventative
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14. Medication Overuse Headache
Most common cause chronic migraine
174,000 Republic of Ireland
Affects more women than men
Frith, A. (2016).
The Migraine Association Ireland.
Tomkins, E. (2013).
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New Treatment Options
Greater Occipital Nerve Block Injection
Botulinium toxin type A Injection
CGRP (Calcitonin Gene Related Peptide) entering phase 3 late stage clinical trials.
Neurostimulation devices being tested
Frith, A.(2016).
The Migraine Association Ireland.
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16. Non-Prescription Supplements
Riboflavin (Vitamin B2) 400mg/day
Magnesium mg/day
Co-enzyme Q10 150mg/day
Feverfew 50-83mg/day
Butterbur 150mg/day
Frith, A. (2016).
Moloney, M.F., Johnston,C.J. (2011).
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17. Non-Medical Management
Acupuncture
Yoga
Massage
Mindfulness
Biofeedback
Relaxation
Frith, A. (2016).
Moloney, M.F., Johnston,C.J. (2011).
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Red flags
Headache onset after 50
Sudden onset of new severe headache
Change in headache from previous history
Progressively worsening headaches
Moloney, M.F. , Johnson, C.J. (2011). .
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Red flags
Decreased level of consciousness
New onset in patient with cancer, HIV
Focal neurological symptoms
Headache with systemic illness- fever, stiff neck, rash Moloney, M.F., Johnson, C.J. (2011).
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‘With proper measures, the fear of migraines need no longer overshadow your life’ Alison Frith (2016).
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21. Information and Support
The Migraine Association of Ireland Helpline (ROI) The Migraine Trust Migraine Action
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References
Diamond, S., Bigal, M.E., Silberstein, S., Loder, E., Reed, M., Lipton, R.B. (2007). Patterns of diagnosis, acute and preventative treatment for Migraine. Headache; 47(3): Frith, A. (2016). Coping with Headaches and Migraine. London: Sheldon. International Headache Society. (2013). Cephalalgia. The International Classification of Headache Disorders, 3rd edition (beta version), 33(9): 629–808. Kurth, T., Winter, A.C., Eliassen, A.H., Dushkes, R., Mukamai, K.J., Rimm, E., Willett, W.C. Manson, J.E. Rexrode, K.M. (2016). Migraine and risk of cardiovascular disease in women: prospective cohort study. The bmj 353;i2610. Lipton , R. B., Dodick, D., Sadovsky, R., (2003). A self-administered screener for migraine in primary care: the ID Migraine validation study. Neurology; 61, (3): Moloney, M.F. , Johnson, C.J. (2011). Migraine Headaches: Diagnosis and Management. Journal of Midwifery and Women’s Health. 56:(3). p Moriarty, M., Mallick-Searle, T. (2016). Diagnosis and treatment of chronic migraine. Nurse Practitioner: 41:(6). P National Headache Foundation. (2014). The pathways of migraine. Accessed September 17th The Migraine Association of Ireland. Managing Migraine. The Migraine Association of Ireland. What kind of headache? The Migraine Association of Ireland. CGRP antibodies & migraine – findings so far. Tomkins, E. (2013). Migraine Clinical Overview, Medication Overuse and Treatment Options. Accessed September 16th, Tomkins, E. (2016). Migraine: The Facts. The Irish Times. 22 March World Headache Alliance. (2016). . Accessed September 16th, World Health Organization. Headache disorders. Accessed September 16th , 2016.
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