Migraine Management Lifestyle and Alternative Treatments

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Migraine ManagementLifestyle and Alternative
Treatments

• Dr David PB Watson
• Hamilton Medical Group Aberdeen
• Department of Neurology ARI

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Summary

• The sensitive brain
• Triggers
• Lifestyle
• Alternative treatments

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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

Dehydration
Sleep disturbance
Diet
Environmental stimuli
Hunger
Changes in oestrogen level in women
Stress
Coppola G et al. Cephalalgia. 20072714291439
Kelman L. Cephalalgia. 2007 27394402
Pietrobon D et al. Nat Rev Neurosci.
20034386398.
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Routine

• The migraine brain likes routine
• Regular meals
• Regular sleep
• Regular exercise
• Regular hormones

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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 200727394402.
1. Kelman L. Cephalalgia 200727394402.
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Trigger 1 - Stress

Stress Tension
Can increase migraine frequency and severity
Relaxation
Can reduce migraine frequency and severity
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Stress and Pressure
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Symptoms of Stress

• headache
• palpitations
• abdominal cramps
• sleep disturbance
• indecisiveness
• anxiety
• impatience
• difficulty relaxing
• difficulty concentrating
• recurrent fatigue

• irritability
• depression
• increase in eating, drinking or smoking
• increased caffeine consumption
• pacing
• fidgeting
• nervous habits (nail-biting, foot-tapping)

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Stress Management Tips

• if you're stressed the first step to feeling
  better is to identify the cause.
• be physically active
• take control
• connect with people
• have some me time
• challenge yourself

• avoid unhealthy habits
• try volunteer work
• work smarter, not harder
• be positive
• accept the things you cannot change
• massage good for relaxation

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Trigger 2- Hormones

• Mainly migraine without aura
• Menstrual migraine and oestrogen withdrawal
• Perimenopausal headache oestrogen fluxes
• Pregnancy generally good for migraine

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Trigger 3- Missing meals

• Main 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 no evidence that foods trigger migraine.
  Crawford P, Simmons M. Journal of Family Practice
  200655(1)62-6.
• There is no evidence to support avoidance of
  cheese or chocolate, or exclusion diets
  eadachin20067(4)188-95.Wober C et al
  Cephalalg0727(4)304-14
• Omega-3 fatty acids do not reduce the
  incidence of migraine. Pradalie00121(8)818-22

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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?

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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

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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

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Alternative therapies
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Acupuncture

• A 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.

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Herbal Remedies

• Feverfew, 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
  199850(2)466-70.

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Physical Therapies

• No Evidence
• that spinal manipulation, osteopathy or
  chiropractic treatment have any role in the
  preventive treatment of migraine.

• Weak Evidence
• for TENS (Transcutaneous electrical nerve
  stimulation)

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Summary

• Migraine brain does not like change
• Lifestyle changes can make a significant
  difference
• Alterative therapies can help some patients

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Any Questions?