MI MIGRAI AINES A A b r i e f o v e r v i e w f o r p h p h - PowerPoint PPT Presentation

MI MIGRAI AINES A A b r i e f o v e r v i e w f o r p h p h y s i c i c i a i a n s a n d s c i e i e n t i s i s t s

MI MIGR GRAINES S VS. S. HE HEADACHE HES Migraines should not be considered to be “strong” headaches They are different in their genesis and symptoms

MI MIGR GRAINES S VS. S. HEADACHES ION 1 DU DURATIO Last between 4 and 72 hours E OF ADDITIONAL SYMPTOMS 1 PRESEN PRE ENCE Nausea, vomiting, photophobia, phonophobia o Visual, sensory, or motor symptoms o Pulsating quality o Unilateral Location (generally) o Aggravated by physical activity o RRENCE 1 RECURREN REC At least five attacks fulfilling the above criteria IM IMPAC ACT 2 Migraines are considered incapacitating to the individual 1 International Headache Society. “The International Classification of Headache Disorders, 3 rd Edition.” (2018). 2 Migraine Research Foundation. https://migraineresearchfoundation.org/about-migraine/what-is-migraine/. Accessed 2018.

PR PREVALE LENCE CE UN UNITE TED STATE TES 39 39 million on (1 (12% of the e population) 1 1 Migraine Research Foundation. http://migraineresearchfoundation.org/about-migraine/migraine-facts. Accessed 2018.

PR PREVALE LENCE CE ( (CON ONT’D) CH CHILDREN WO WOMEN CHRONIC CH C MIGRAINES 10% of children suffer Migraines impact three times More than 4 million adults experience from migraines 1 more women than men chronic daily migraines (at least 15 (18% vs. 6%) 1 migraine days monthly) 1 1 Migraine Research Foundation. http://migraineresearchfoundation.org/about-migraine/migraine-facts. Accessed 2018.

CO COSTS TO SOCIETY 6 th highest cause of disability worldwide 1 $5.4 billion was spent in 2015 to treat chronic migraine 2 13 billion is lost by employers yearly due to lost 20% of chronic migraine sufferers are disabled 2 workdays Anxiety and depression are more common in $36 billion annually are lost in health care and those with chronic migraines 1,2 lost productivity costs in the U.S. 2 1 World Health Organization. Headache Disorders: Key Facts. www.who.int/news-room/fact-sheets/detail/headache-disorders. Accessed 2018. 2 Migraine Research Foundation. http://migraineresearchfoundation.org/about-migraine/migraine-facts. Accessed 2018.

MI MIGR GRAINE PHASE SES MIGRAINE NES CAN N HAVE FOUR PHASES, ALTHOUGH A PATIENT NT MAY NO NOT EXPERI EX PERIEN ENCE E EV EVER ERY ONE E OF THEM EM WHEN EN HAVING G A MIGR GRAINE 1 PRODOME PR Early signs and symptoms include food cravings, unexplained mood changes, uncontrollable yawning, fluid retention, and increased urination. Begins up to 24 hours before a migraine. 1 2 AU AURA Visual, motor, or sensory motor symptoms including flashing or bright lights, zig-zag lines, muscle weakness, tingling in one side of the body, and inability to speak clearly. Usually lasts 20 to 60 minutes. 1,2 1 MedlinePlus. Migraine. https://medlineplus.gov/migraine.html. Accessed 2018. 2 American Migraine Foundation. “Understanding Migraine with Aura.” https://americanmigrainefoundation.org/understanding-migraine/understanding-migraine-aura. Accessed 2018. 3 American Migraine Foundation. “The Timeline of a Migraine Attack.” https://americanmigrainefoundation.org/understanding-migraine/timeline-migraine-attack Accessed 2018. 4 American Migraine Foundation. “Migraine and Aura.” https://americanmigrainefoundation.org/understanding- migraine/migraine-and-aura. Accessed 2018.

MI MIGR GRAINE PHASE SES S (CONT’D) 3 HEADACHE HE HE Characterized by throbbing, drilling, or pulsating pain usually on one side of the head (although both sides can be affected). Can be accompanied by photophobia, phonophobia, osmophobia, nausea, and vomiting. Pain is worsened by physical activity. Lasts 4 to 72 hours. 1,3,4 4 PO POSTDROME Fatigue, body aches, depression/euphoria, inability to concentrate. Follows the headache phase. Length varies (24-48 hours). 1,3 1 MedlinePlus. Migraine. https://medlineplus.gov/migraine.html. Accessed 2018. 2 American Migraine Foundation. “Understanding Migraine with Aura.” https://americanmigrainefoundation.org/understanding-migraine/understanding-migraine-aura. Accessed 2018. 3 American Migraine Foundation. “The Timeline of a Migraine Attack.” https://americanmigrainefoundation.org/understanding-migraine/timeline-migraine-attack Accessed 2018. 4 American Migraine Foundation. “Migraine and Aura.” https://americanmigrainefoundation.org/understanding- migraine/migraine-and-aura. Accessed 2018.

TR TRIG IGGERS WH WHIL ILE THERE AR ARE NO UNIV IVERSAL AL TRIG IGGERS, MIG IGRAIN AINE ATTAC ACKS CAN AN BE TR TRIGGERED IN SOME PEOPLE BY : Loud noises Stress Strong smells Anxiety Skipped meals Lack of sleep Hormonal changes Weather changes Bright or flashing lights Certain medications 1 Migraine Research Foundation. https://migraineresearchfoundation.org/about-migraine/migraine-triggers. Accessed 2018. 2 MedlinePlus. Migraine. https://medlineplus.gov/migraine.html. Accessed 2018.

GEN GENET ETIC PRED EDISPOSITION A A GENETIC PREDISPOSITION TO TO MIGRAINES EXISTS 1 FA FAMILY HISTORY Approximately 80% of migraine patients have a family history of migraines 1 CH CHROMOSOME ABNORMALITIES A genetic anomaly on chromosome 19 for Familial Hemiplegic Migraine has been determined 1 1 American Headache Society. Ten Things That You and Your Patients with Migraine Should Know Factsheet. https://americanheadachesociety.org/resources/headache-fact-sheets. Accessed 2018.

MI MIGR GRAINE TYPES MIGRAINE NES PRIMARILY PRESENT NT IN N ONE NE OF TWO FORMS 1 MIGRAINES WITH AURA MIGRAINES WITHOUT AURA Characterized by transient focal neurological A clinical syndrome characterized by headache symptoms preceding or accompanying the with specific features and associated symptoms, headache. Some patients also experience a but no aura. 1 prodomal and/or postdomal phase. 1 1 International Headache Society. “The International Classification of Headache Disorders, 3 rd Edition.” (2018)

DIAGNOSTIC CRITERIA DI A FOR MIGRAI AINE WITHOUT UT AUR URA AT AT LEAST FIV FIVE AT ATTACKS FULFILLING THE 4): 1 CRITERIA BELOW (1-4) CR Headache a He attacks t that l last 4 4–72 72 hour hours (whe hen n 1 untreated or unt or uns unsucce uccessful fully treated) 2 He Headache h has a at l least t two o of t the f following f four r charact cha cteristics cs: 1 Unilateral location o Pulsating quality o Moderate or severe pain intensity, and/or o Aggravation by or causing avoidance of routine physical o activity (e.g. walking or climbing stairs) 3 During Dur ng he head adache ache at at leas ast one one of of the he fol ollowi owing ng occur occurs: Nausea and/or vomiting o Photophobia and phonophobia o 4 No Not a accounted f for b r by a another d r diagnosis 1 International Headache Society. “The International Classification of Headache Disorders, 3 rd Edition.” (2018)

DI DIAGNOSTIC CRITERIA A FOR MIGRAI AINE WITH AUR URA AT LEAST TW AT TWO AT ATTACKS FULFILLING THE CRITERIA BELOW (1-3) CR 3): 1 1 On One or more of the following fully reversible aura sy symptoms: s: Visual Brainstem o o Sensory Retinal o o Motor Speech and/or language o o 2 At least three of the following six characteristics: At At least one aura symptom spreads gradually over 5 mins o Two or more aura symptoms occur in succession o Each individual aura symptom lasts 5–60 minutes o At least one aura symptom is unilateral o At least one aura symptom is positive o Thee aura is accompanied, or followed within 60 minutes, o by headache 3 Not a No accounted f for b r by a another d r diagnosis 1 International Headache Society. “The International Classification of Headache Disorders, 3 rd Edition.” (2018)

DI DIAGNOSTIC CRITERIA A FOR CHRONIC MIGRAI AINE CH CHRONIC C MIGRAINES ARE DEFINED AS: 1 A headache occurring on 15 or more days/month for more than three months, which on at least eight days/month has the features of migraine headaches 1 International Headache Society. “The International Classification of Headache Disorders, 3 rd Edition.” (2018)

TR TREATM TMENTS No absolute cure exists, sine the pathophysiology remains to be fully understood 1 Treatments include pharmacotherapy and behavioral therapies 1 1 National Institute of Neurological Disorders and Stroke. Migraine Information Page. www.ninds.nih.gov/disorders/all-disorders/migraine-information-page. Accessed 2018.

BE BEHAVIORAL THERAPI PIES Used in conjunction with pharmacotherapy 1 Therapies include relaxation training, biofeedback, stress management, trigger management 1,2 1 American Headache Society. Behavioral Treatments for Headache Factsheet. https://americanheadachesociety.org/resources/headache-fact-sheets. Accessed 2018. 2 National Institute of Neurological Disorders and Stroke. Migraine Information Page. www.ninds.nih.gov/disorders/all-disorders/migraine-information-page. Accessed 2018.