Migraine ManagementLifestyle and Alternative
TreatmentsDr David PB WatsonHamilton Medical Group AberdeenDepartment of Neurology ARI
SummaryThe sensitive brainTriggersLifestyleAlternative treatments
Triggers suggest that migraine is a disorder of the brain
The case for the sensitive migraine brain
Normal life events trigger or are associated with attacks in those predisposed
Coppola G et al. Cephalalgia. 2007;27:1429–1439; Kelman L. Cephalalgia. 2007; 27:394–402; Pietrobon D et al. Nat Rev Neurosci. 2003;4:386–398.
Dehydration
Diet
Environmentalstimuli
Changes in oestrogenlevel in womenStress
Hunger
Sleep
disturbance
RoutineThe migraine brain likes routine
Regular meals
Regular sleep
Regular exercise
Regular hormones
1. Kelman L. Cephalalgia 2007;27:394–402.
0102030405060708090
Perc
enta
ge o
f pati
ents
Triggers
Migraine Triggers
• A high percentage of migraine patients report triggers• The mean number of triggers in one study was 6.7 per patient
Kelman L. Cephalalgia 2007;27:394–402.
Trigger 1 - Stress StressTension
Can increase migraine frequency and severity
Relaxation Can reduce migraine frequency and severity
Stress and Pressure
Symptoms of Stressheadachepalpitationsabdominal crampssleep disturbanceindecisiveness anxiety impatience difficulty relaxing difficulty
concentrating recurrent fatigue
irritabilitydepression increase in eating,
drinking or smoking increased caffeine
consumption pacing fidgeting nervous habits (nail-
biting, foot-tapping)
Stress Management Tipsif you're stressed the
first step to feeling better is to identify the cause.
be physically activetake control connect with peoplehave some ‘me time’challenge yourself
avoid unhealthy habitstry volunteer workwork smarter, not
harderbe positiveaccept the things you
cannot changemassage – good for
relaxation
Trigger 2- Hormones
Mainly migraine without aura
Menstrual migraine and oestrogen withdrawal
Perimenopausal headache oestrogen fluxes
Pregnancy generally good for migraine
Trigger 3- Missing mealsMain food trigger is missing meals and hunger
Caffeine withdrawal and dehydration can cause headache
Food Trigger Myths A review of clinical studies suggests there is
poor evidence that foods trigger migraine. Crawford P, Simmons M. Journal of Family Practice 2006;55(1):62-6.
There is no evidence to support avoidance of cheese or chocolate, or exclusion diets eadachin2006;7(4):188-95.Wober C et al: Cephalalg07;27(4):304-14
Omega-3 fatty acids do not reduce the incidence of migraine. Pradalie001;21(8):818-22
Case Study slide a 28 year old female nurse
Normal migraine frequency one every 1-2 weeks
Last 6 months full migraine every 4 days and back ground headache most other days
Taking lots of painkillers to get through
What changed?
Case study slide b
Promoted to nurse practitioner in hospital
Working 12 hour shifts 2 day , 2 night, 3 off
Studying for prescribing degree
Caring for gran
Long distance relationship
Case study slide c
Solution = breaking arm!!
Return to work 4 days, 3 days off, 4 nights, 4 days off
Partner moved to Aberdeen
Gran died
Given study leave
Alternative therapies
AcupunctureA well conducted study compared acupuncture and
sham procedures and compared them to a controls on a waiting list.
Patients receiving acupuncture or sham acupuncture fared significantly better for most outcome measures.
But there were no significant differences between the acupuncture group and the sham acupuncture group.
There are obvious problems in this study with the control group being on a waiting list, any intervention will have a powerful placebo effect.
Herbal RemediesFeverfew, butterbur, coenzyme Q & oral
niacin may have a role in migraine prevention
Riboflavin in a dose of 200 mg per day has been compared to placebo and found to have a responder rate of 59% versus 15% for the number of migraine days
Schoenen J, Jacquy J, Lenaerts M.; Neurology 1998;50(2):466-70.
Physical TherapiesWeak Evidence
for TENS (Transcutaneous electrical nerve stimulation)
No Evidence that spinal
manipulation, osteopathy or chiropractic treatment have any role in the preventive treatment of migraine.
SummaryMigraine brain does not like changeLifestyle changes can make a significant
differenceAlterative therapies can help some patients
Any Questions?