1. Migraine and You An Educational Guide for Migraine Headache Sufferers

2. Who gets migraine? About 20% of women get migraine at one time or another in their life Migraine Prevalence % Age (years) Males Females 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 110 20 30 40 50 60 70 80

3. How do you know you might have migraine? 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. YesNo Symptoms associated with your headaches

4. 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

5. 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

6. What type of doctor should you see? Ask for a specific headache appointment and get a specific diagnosis Primary Care Neurologist Headache Specialist Family physician, internal medicine specialist Headaches frequent and difficult to manage or if there are other medical conditions to manage simultaneously May need referral from primary care Headaches not responsive to routine care; other existing medical conditions making treatment plan complex Headaches are severe and disabling; may need referral

7. 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

8. 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.

9. 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

10. 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 / don’t skip meals

11. 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)

12. 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

13. What can you expect from your acute headache treatment? Acute medications should work within 2 hours 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 High pain No pain Time

14. 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) # attacks January7 February6 March4 x x x x x x

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. Don’t 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.

22. 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

23. Supported by: Ortho-McNeil Pharmaceutical, Inc.