3Triggers suggest that migraine is a disorder of the brain The case for the sensitive migraine brainNormal life events trigger or are associated with attacks in those predisposedDehydrationKelman, p 396, Fig 2Kelman, p 394, C1,Par 1, L 1-15Sleep disturbanceDietEnvironmental stimuliHungerThe triggers (with their frequencies) in this study were stress (79.7%), hormones (eg, estrogen levels in women) (65.1%), hunger (57.3%), sleep disturbance (49.8%),StressChanges in oestrogen level in womenR1, p 1434, C2,Par 2, L 1-4R1, p 1434, C2,Par 3, L 1-2, 14-16R1, p 1434, C2,Par 3, L 4-13Coppola 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.R2, p 391, C1,Par 2, L 6-9R2, p 390,Legend to Fig. 3R3, p 1, Abs,Par 1, L 1-2R3, p 1, Abs,Par 1, L 7-8R3, p 1, Abs,Par 1, L 8-12References:1. Coppola G, Pierelli F, Schoenen J. Is the cerebral cortex hyperexcitable or hyperresponsive in migraine? Cephalalgia. 2007;27(12):1429–1439.2. Pietrobon D, Striessnig J. Neurobiology of migraine. Nat Rev Neurosci. 2003;4(5):386–398.3. Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27(5):394–402.
5Migraine TriggersA high percentage of migraine patients report triggersThe mean number of triggers in one study was 6.7 per patientKelman L. Cephalalgia 2007;27:394–402.1. Kelman L. Cephalalgia 2007;27:394–402.5
6Trigger 1 - Stress Stress Tension Can increase migraine frequency and severityRelaxationCan reduce migraine frequency and severity
8Symptoms of Stress headache palpitations abdominal cramps sleep disturbanceindecisivenessanxietyimpatiencedifficulty relaxingdifficulty concentratingrecurrent fatigueirritabilitydepressionincrease in eating, drinking or smokingincreased caffeine consumptionpacingfidgetingnervous habits (nail-biting, foot-tapping)
9Stress Management Tips if you're stressed the first step to feeling better is to identify the cause.be physically activetake controlconnect with peoplehave some ‘me time’challenge yourselfavoid unhealthy habitstry volunteer workwork smarter, not harderbe positiveaccept the things you cannot changemassage – good for relaxation
10Trigger 2- Hormones Mainly migraine without aura Menstrual migraine and oestrogen withdrawalPerimenopausal headache oestrogen fluxesPregnancy generally good for migraine
11Trigger 3- Missing meals Main food trigger is missing meals and hungerCaffeine withdrawal and dehydration can cause headacheFood Trigger MythsA 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): Wober C et al: Cephalalg07;27(4):304-14Omega-3 fatty acids do not reduce the incidence of migraine. Pradalie001;21(8):818-22
12Case Study slide a 28 year old female nurse Normal migraine frequency one every 1-2 weeksLast 6 months full migraine every 4 days and back ground headache most other daysTaking lots of painkillers to get throughWhat changed?
13Case study slide b Promoted to nurse practitioner in hospital Working 12 hour shifts 2 day , 2 night, 3 offStudying for prescribing degreeCaring for granLong distance relationship
14Case study slide c Solution = breaking arm!! Return to work 4 days, 3 days off, 4 nights, 4 days offPartner moved to AberdeenGran diedGiven study leave
16AcupunctureA 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.
17Herbal RemediesFeverfew, butterbur, coenzyme Q & oral niacin may have a role in migraine preventionRiboflavin 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 daysSchoenen J, Jacquy J, Lenaerts M.; Neurology 1998;50(2):some studies that seem to suggest that feverfew, butterbur and coenzyme Q may have a role in migraine prevention as may riboflavin which has a reasonable trial to support its use.
18Physical Therapies No Evidence Weak Evidence that spinal manipulation, osteopathy or chiropractic treatment have any role in the preventive treatment of migraine.Weak Evidencefor TENS (Transcutaneous electrical nerve stimulation)
19Summary Migraine brain does not like change Lifestyle changes can make a significant differenceAlterative therapies can help some patients