Migraine Matters Anne Grover CNM 2 Neurology Bon

Migraine Matters Anne Grover CNM 2 Neurology Bon Secours Hospital Practice Nurse Conference. 1 st October 16

Migraine • Primary headache disorder • Episodic • Most often begins at puberty but can affect children • 3 x more common in women • Age 30 -40 most disabling for women, more constant for men 1. 2. 1. Moloney, M. F. , Johnson, C. J. (2011). 2. Frith, A. , (2016). Practice Nurse Conference. 1 st October 16

Burden • Sixth highest cause of disability worldwide 4. • 500, 000 people in Ireland 5. • Estimated cost to Irish economy € 252 million annually 6. 4. World Health Organization. 5. Tomkins, E. (2013). 6. Migraine Association of Ireland. Practice Nurse Conference. 1 st October 16

Many Migraineurs Remain Undiagnosed 56% Diagnosed Migraine 44% Undiagnosed Migraine Diamond S et al. (2007). Practice Nurse Conference. 1 st October 16

Diagnosis ü Primarily by history ü Medical history and medication ü Description of headache ü Different types of headache ü Family history ü MRI to rule out secondary cause Frith, A. (2016). The Migraine Association of Ireland. Practice Nurse Conference. 1 st October 16

The I-D Migraine Test In the last three months did you have any of the following three symptoms with a headache? You felt nauseous? Light bothered you? Your headache limited your ability to work/study/play for at least one day? Lipton et al. (2003). Practice Nurse Conference. 1 st October 16

National Headache Foundation (2007). Practice Nurse Conference. 1 st October 16

Phases of a Migraine Attack Treatment Phase Pre-headache Premonitory/ Prodrome Resolution Aura Moderate to Severe Migraine Intensity Mild Focal Warning neurological symptoms occurring up to 48 preceding hours prior headache to headache (<1 hour) Symptoms : • Food cravings • Mood changes • Yawning • Fatigue • Nausea • Sensitivity Post-headache Headache Symptoms: • Visual • Sensory • Speech disturbance Unilateral pulsing pain worse with movement 4 -72 hours Symptoms: • Sensitivity to light, sound, smells • Nausea/vomiting • Pain head and neck • Scalp tenderness • Pallor • Depression • No energy • Difficulty concentrating Time Frith, A. , (2016). International Headache Society. (2013). Practice Nurse Conference. 1 st October 16 Recovery/ Postdrome Symptoms occurring hours/days after headache resolution Symptoms: • Tiredness • Confusion • Decreased appetite • Stiff or sore muscles • Low mood/Euphoria

Migraineurs ‘I thought I’d had a stroke, my face and arm felt funny‘ ‘I have headaches that make me go lie down in a dark room’ ‘I always think I am going to be ok. Never expect them when they happen. Then miss the moment. Can be 3 -4 days if you miss it. ’ Practice Nurse Conference. 1 st October 16

Migraine Tool Kit Empowers person towards self-care • Education on migraine and medications • Awareness of unique triggers • Lifestyle review • Stress Management • Migraine diary Frith, A. (2016). The Migraine Association of Ireland. Tomkins, E. (2016). Practice Nurse Conference. 1 st October 16

Triggers • • Alteration in sleep cycle Changes in routine Missed/delayed meals, dehydration Foods. Alcohol. Emotion Hormonal changes, oral contraceptives Environmental Meteorological Frith, A. (2016). Tomkins, E. (2016). Practice Nurse Conference. 1 st October 16

Assessment Tools • Headache Impact Test (HIT) , (HIT 6). • Migraine Disability Assessment Questionnaire (MIDAS). • 24 -hour Migraine Quality of Life Questionnaire (24 -hr-MQOLQ) World Headache Alliance (2016). Practice Nurse Conference. 1 st October 16

Education on Medications Over the counter Abortive Preventative Practice Nurse Conference. 1 st October 16

Medication Overuse Headache • Most common cause chronic migraine • 174, 000 Republic of Ireland • Affects more women than men Pain relief Frith, A. (2016). The Migraine Association Ireland. Tomkins, E. (2013). Medication Headache Practice Nurse Conference. 1 st October 16

New Treatment Options • Greater Occipital Nerve Block Injection • Botulinium toxin type A Injection • CGRP (Calcitonin Gene Related Peptide) entering phase 3 late stage clinical trials. • Neurostimulation devices being tested Frith, A. (2016). The Migraine Association Ireland. Practice Nurse Conference. 1 st October 16

Non-Prescription Supplements • • • Riboflavin (Vitamin B 2) 400 mg/day Magnesium 300 -400 mg/day Co-enzyme Q 10 150 mg/day Feverfew 50 -83 mg/day Butterbur 150 mg/day Frith, A. (2016). Moloney, M. F. , Johnston, C. J. (2011). Practice Nurse Conference. 1 st October 16

Non-Medical Management • • • Acupuncture Yoga Massage Mindfulness Biofeedback Relaxation Frith, A. (2016). Moloney, M. F. , Johnston, C. J. (2011). Practice Nurse Conference. 1 st October 16

Red flags • Headache onset after 50 • Sudden onset of new severe headache • Change in headache from previous history • Progressively worsening headaches Moloney, M. F. , Johnson, C. J. (2011). . Practice Nurse Conference. 1 st October 16

Red flags • Decreased level of consciousness • New onset in patient with cancer, HIV • Focal neurological symptoms • Headache with systemic illness- fever, stiff neck, rash. Moloney, M. F. , Johnson, C. J. (2011). Practice Nurse Conference. 1 st October 16

‘With proper measures, the fear of migraines need no longer overshadow your life’. Alison Frith (2016). Practice Nurse Conference. 1 st October 16

Information and Support The Migraine Association of Ireland Helpline 1850 200 378 (ROI) www. migraine. ie info@migraine. ie The Migraine Trust www. migrainetrust. org Migraine Action www. migraine. org. uk Practice Nurse Conference. 1 st October 16

References Diamond, S. , Bigal, M. E. , Silberstein, S. , Loder, E. , Reed, M. , Lipton, R. B. (2007). Patterns of diagnosis, acute and preventative treatment for Migraine. Headache; 47(3): 355 -363. Frith, A. (2016). Coping with Headaches and Migraine. London: Sheldon. International Headache Society. (2013). Cephalalgia. The International Classification of Headache Disorders, 3 rd edition (beta version), 33(9): 629– 808. Kurth, T. , Winter, A. C. , Eliassen, A. H. , Dushkes, R. , Mukamai, K. J. , Rimm, E. , Willett, W. C. Manson, J. E. Rexrode, K. M. (2016). Migraine and risk of cardiovascular disease in women: prospective cohort study. The bmj 353; i 2610. Lipton , R. B. , Dodick, D. , Sadovsky, R. , (2003). A self-administered screener for migraine in primary care: the ID Migraine validation study. Neurology; 61, (3): 375 -382. Moloney, M. F. , Johnson, C. J. (2011). Migraine Headaches: Diagnosis and Management. Journal of Midwifery and Women’s Health. 56: (3). p. 282 -292. Moriarty, M. , Mallick-Searle, T. (2016). Diagnosis and treatment of chronic migraine. Nurse Practitioner: 41: (6). P. 18 -32. National Headache Foundation. (2014). The pathways of migraine. http: //www. headaches. org/education. Accessed September 17 th 2016. The Migraine Association of Ireland. Managing Migraine. The Migraine Association of Ireland. What kind of headache? The Migraine Association of Ireland. CGRP antibodies & migraine – findings so far. Tomkins, E. (2013). Migraine Clinical Overview, Medication Overuse and Treatment Options. Accessed September 16 th, 2016. Tomkins, E. (2016). Migraine: The Facts. The Irish Times. 22 March 2016. World Headache Alliance. (2016). http: //www. w-h-a. org. Accessed September 16 th, 2016. Practice Nurse Conference. 1 st October 16 World Health Organization. Headache disorders. http: //www. who. int. Accessed September 16 th , 2016.