FYI-migraine

5 Things You Should Question About Your Migraines

 5 Things you should question your Doctor about your Migraines

Here are 5 things that American Headache Society task force recommends to help physicians and patients make wise decisions about the most appropriate migraine care.

1.  There is no need to preform neuroimaging studies when you have stable migraine headaches.  This is based on the fact that there is numerous evidence-based guidelines have shown that the risk of intracranial disease is not elevated in people with migraine headaches.   A migraine diagnoses however needs to be made based on the International Classification of Headache Disorders criteria to avoid missing patients with more serious headache.

2. If you are going to get neuroimaging, make sure you get a MRI instead of CT scan, except in emergency setting.  A MRI is more sensitive than CT scan for the detection of many of the secondary causes of headache.  CT scan should only be obtained in the emergency setting when hemorrhage or acute stroke is suspected.

3.  Do not get surgical deactivation of migraine trigger points outside of a clinical trial.  The value of the form of ‘migraine surgery’ is still under question with limit evidence that it is effective or safe.  Long term side effects from these types of procedures are also unknown.
4.  Do not take opioids or butalbital containing medications as first line treatment for your migraines.  These medications  can impair alertness,  produce dependence or addiction.  They may worsen your headaches by increasing the frequency of your headaches and may make your headaches harder to treat.  These medications may also produce heightened sensitivity to pain.
 

5.  Do not use prolonged or frequent use of over the counter medication for your migraines.  Over the counter medications (OTC) can be used for occasional headaches if they work reliably without side effects.   Frequent use (especially of the caffeine containing medications) can lead to an increase in headache frequency/medication overuse headaches.   Overuse of Acetaminophen containing medications can cause liver damage.   Overuse of non-steroidal anti-inflammatory drugs can lead to gastrointestinal bleeding.  Thus it is recommended that you do not take OTC more than 2 days a week.

 

Reference:

Loder E, Weizenbaum E, Frischberg B, Siberstein S.  Choosing Wisely in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question. Headache. 2013:53:1651-1659.

Moran, M. From the American Headache Society: ‘Choosing Wisely’ in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question about Migraine. Neurology Today. 2014:14.

 

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Exercise to prevent your migraines

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Exercise can prevent your migraines!

Did you know that exercise can prevent migraines?  Well it is true, and there is recent study that proves it.  As a headache specialist, I always try to encourage my migraine patients to start a regular exercise program as a conservative way to decrease their migraine headaches, but up until now we did not much scientific evidence for this.

Individuals with migraine and other headaches have been shown to be less physically active than those without headache.  It is well recognized that individual with migraines there headaches can worsen with physical activity; this is even one of the major criteria on which migraines are diagnosed based on the International Headache Classification definition of migraine.  So it is unclear if the lack of exercise in individuals with migraines is the cause or effect of having migraines.

The reason why exercise can decrease migraines is unclear.  Some of the things that we do know are that exercise can increase the natural endorphins (feel good chemicals) in your brain.  Exercise can also decrease migraine triggers such as anxiety and stress.   Your sleep pattern is improved with regular exercise which can lessen migraines.  Other risk factors for migraine headaches such as obstructive sleep apnea, hypertension, and obesity are also improved with regular exercise.

In a randomized, controlled trial of adults with migraine where patients were randomized into three groups; an exercise group, a relaxation training group, or a group that received the preventive medication topiramate (Topamax).  The exercise group exercised three times a week for 40 minutes.  The study looked at how frequent migraines occurred compared to their base line migraine frequency. The study lasted three months.  What was found was that there was no significant differences between the groups, all decreased the frequency of migraines compared with the baseline.   No adverse effects were reported in the exercise or relaxation groups.  Adverse effects were reported in 33% of the participants in the topiramate group.  Restated, participants in this randomized controlled study who exercised regularly (3times a week) experienced an improvement in the frequency of their migraine attack that was not significantly different from the participants who received drug preventive medication topiramate without any side effect.1

No I am not saying that routine exercise will prevent all migraines.  However neither does medications.  So wouldn’t you rather try something that is good for you anyway either in addition to or instead of medications?

For more information on the causes and ways to prevent migraines see my Migraine Headache post.

As always please discuss with your physician before starting any strenuous physical activity. Also, please do not suddenly stop any of your medications without discussing with your physician first.  

Sites referenced:

1Emma Varkey, A. C. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalagia, 1428-1438.