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Migraine Matters

Migraine Matters. Anne Grover CNM2 Neurology Bon Secours Hospital. Practice Nurse Conference. 1st October 16. Migraine. Primary headache disorder Episodic Most often begins at puberty but can affect children 3x more common in women 1. Age 30-40 most disabling for

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Migraine Matters

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  1. Migraine Matters Anne Grover CNM2 Neurology Bon Secours Hospital Practice Nurse Conference. 1st October 16

  2. Migraine Primary headache disorder Episodic Most often begins at puberty but can affect children 3x more common in women1. Age 30-40 most disabling for women, more constant for men2. 1.Moloney, M.F. , Johnson, C.J. (2011) . 2. Frith, A., (2016). Practice Nurse Conference. 1st October 16

  3. 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. 1st October 16

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

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

  6. 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. 1st October 16

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

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

  9. Migraineurs ‘I have headaches that make me go lie down in a dark room’ ‘I thought I’d had a stroke, my face and arm felt funny‘ ‘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. 1st October 16

  10. 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. 1st October 16

  11. 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. 1st October 16

  12. Assessment Tools • Headache Impact Test (HIT) , (HIT6). • Migraine Disability Assessment Questionnaire (MIDAS). • 24-hour Migraine Quality of Life Questionnaire (24-hr-MQOLQ) World Headache Alliance (2016). Practice Nurse Conference. 1st October 16

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

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

  15. 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. 1st October 16

  16. Non-Prescription Supplements Riboflavin (Vitamin B2) 400mg/day Magnesium 300-400mg/day Co-enzyme Q10 150mg/day Feverfew 50-83mg/day Butterbur 150mg/day Frith, A. (2016). Moloney, M.F., Johnston,C.J. (2011). Practice Nurse Conference. 1st October 16

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

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

  19. 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. 1st October 16

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

  21. 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. 1st October 16

  22. 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, 3rd 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;i2610. 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 17th 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 16th, 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 16th, 2016. World Health Organization. Headache disorders. http://www.who.int. Accessed September 16th , 2016. Practice Nurse Conference. 1st October 16

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