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 no

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?