by dr. david greene, ceo nevada pain network nevadapainnetwork.com the basics of migraines

By Dr. David Greene, CEO

Nevada Pain Network

NevadaPainNetwork.com

THE BASICS OF MIGRAINES

• Chronic headaches that affect people from a few hours up to 72 hours straight.

• Complicated, recurrent headache disorder.

• Most common in women and those between 15 and 55.

• Most become less severe and less frequent with age.

WHAT IS A MIGRAINE?

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• Affects 18% of women, 8% of men.

• 30 million in US have at least one migraine per year.

• Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine.

• 70% have a 1st degree relative who suffers.

• If one parent suffers from migraine, there is a 40% chance a child will suffer. If both parents suffer, the chance rises to 90%.

• More than 90% of sufferers are unable to work or function normally during their migraine.

HOW COMMON ARE MIGRAINES?



• There’s a LOT we don’t know.

• Genetics and Environment

• Imbalances in brain chemicals – serotonin levels drop during migraines.

• Low serotonin, a pain management chemical, levels can trigger a migraine by letting too much blood flow through vessels that should be constricted—inducing a throbbing sensation.

WHAT CAUSES MIGRAINES?



• Foods – aged cheese, red wine (tyramine), beer, whisky, food additives (nitrates), cold foods, citrus fruits, MSG, caffeine.

• Elevated Stress

• Weather changes – barometric

• Strong scents – perfume, paint

• Hair accessories – ponytail

• Exercise – e.g. sex

• Poor Posture

• Skipping Meals

• Smoking

WHAT ARE TYPICAL MIGRAINE TRIGGERS?



CHOCOLATE

Small silver lining – NO evidence to clearly substantiate that chocolate is a trigger of

migraine headaches. It’s a myth!



• Often unilateral head pain that is throbbing and aggravated by activity.

• Aura – visual or sensory symptoms prior to the onset of the headache (photophobia, visual scintillations).

• 80% of migraines have no aura.

SYMPTOMS OF MIGRAINES



• No objective testing available.

• CT or MRI can rule out badness causing similar symptoms.

• Diagnosed on patient history and pattern of symptoms.

• Migraine diary can be very helpful.

DIAGNOSING MIGRAINES



• International Headache Society requires pt to have at least 5 attacks fulfilling 3 criteria:

1. 4-72 hour duration

2. At least 2 of these:

1. Unilateral

2. Pulsating

3. Moderate to severe pain intensity

4. Aggravation by or causing avoidance of routine physical activity

3. At least one of these:

1. Nausea +/- Vomiting

2. Photophobia and phonophobia

MAKING THE DIAGNOSIS OF MIGRAINE



• Triptans – target Serotonin

• Almotriptan (Axert)

• Eletriptan (Relpax)

• Frovatriptan (Frova)

• Naratriptan (Amerge, Naramig)

• Rizatriptan (Maxalt)

• Sumatriptan (Alsuma, Dosepro, Imitrex, Sumavel, Treximet, Zecuity)

• Zolmitriptan (Zomig)

ABORTIVE TREATMENT OPTIONS



• Acetaminophen-isometheptene-dichloralphenazone (Midrin)

• Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)

• Ergotamine tartrate (Cafergot)

• Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)




• Narcotics

• Barbiturates

• Nausea

• Metoclopramide (Reglan)

• Prochlorperazine (Compazine)

• Promethazine (Phenergan)




• Goal is to lessen the frequency and severity of migraines.

• High blood pressure medications

• Beta blockers

• Calcium Channel Blockers

• Antidepressants

• Amitriptyline (Elavil)

• Nortriptyline (Pamelor)

• Antiseizure medications

• Gabapentin

• Topamax

• Depakote

• Pizotifen (Sanomigran)

• Serotonin antagonist

PREVENTIVE TREATMENT OPTIONS



INTERVENTIONAL TREATMENTS

• FDA has approved Botox injections for chronic migraines.

• 3 month intervals

• Injected into 32 sites in a 10 minute procedure.

• Covered if certain medications have been tried and failed.

• For chronic migraines = “distinct and severe neurological disorder characterized by patients who have a history of migraine and suffer from headaches on 15 or more days per month with headaches lasting four hours a day or longer.”

• Patients treated with BOTOX® (onabotulinumtoxinA) averaged 8 to 9 fewer headache days per month compared to baseline (vs 6 to 7 days with placebo) as demonstrated in the Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) study.1



• Occipital Nerve Blocks

• Cervical Facet Injections

• Cervical Epidural Injection

• Sphenopalatine Ganglion Blocks

• Supratrochlear Nerve Blocks

• Supra/ Infraorbital Nerve Blocks

• Pulsed radiofrequency energy of Occipital Nerves

INTERVENTIONAL TREATMENTS



NERVE BLOCKS• Study of 100 pts.receiving GON blocks (Migrainetrust.org) - 53% achieved pain

relief averaging 3 weeks.

• Retrospective study on the efficacy of GON block in refractory migraine patients. [5] A mixture of lidocaine and methylprednisolone was used for nerve blockade. Fifty-four percent of migraine patients reported on being "significantly better" after the blocks, and the duration of response lasted up to 6 months. (Gawel and Rothbart 1992, Cephalalgia)

• Caputi and Firetto examined the benefit of PNBs in the treatment of migraine. [6] They assessed 27 migraine patients before and after GON and supraorbital nerve (SON) blocks. Maximum of 10 injections with 85% effectiveness rate for 6 months.



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by dr. david greene, ceo nevada pain network nevadapainnetwork.com the basics of migraines

Documents

ceo nevada pain network

migraine diary

severe pain intensity

unilateral head pain

pain management chemical

trigger of migraine

basics of migraines

typical migraine triggers