The 2018 Migraine World Summit has come
to an end. It was by far the best yet with shorter more concise talks from a
fantastic range of migraine specialists. The audio and video quality were also
of a high standard. Gone are the crackly skype calls! Carl & Paula did a
great job with the interviews and asked lots of questions which I know myself
and many others were keen to have answered.
I’m aware that many of you were unable to
watch any of the summit or the talks that were of interest to you due to other
commitments or simply not being well enough to watch during that week. I
decided I would put together a summary for you of some of my favourite talks
that I managed to watch, highlighting the key points that were made.
If you would like to watch any of the
summit I believe you are now able to pay for an all access pass so you can
catch up yourself.
Day 1
Professor Goadsby: The
keys to finding new treatments
Prof Goadsby is somewhat of a superstar in the
migraine world. He speaks with passion and hope for migraine.
Diagnosis challenges
GP: often reluctant to make a diagnosis due to lack of
confidence or certain myths surrounding migraine even within the medical world
(for example there is always a visual aura with a migraine).
Family: often accept migraines as simply used to it and talk
of being a “headachy” family/person. Level of acceptance is often an issue with
diagnosis. People consider their migraines/headaches as “normal” as their mum
or dad is a “headachy” person too.
Be your own
advocate BUT don’t rub doctors up the wrong way!
Have a headache dairy which is CLEAR and SUMMARISED.
Don’t overload the doctor you are seeing with unnecessary information. Let them
see the medications you take, dose, side effect etc. Make the information
easily digestible so that there is a clear message for specialist to see.
Diagnosis is KEY (appointment with specialist)
1. What have they got? (medical history, physical tests)
By definition test will be normal for migraine patient
2. Assess burden of diagnosis (quantify the disability
using scales such as HIT test or MIDAS form)
3. Treatment plan
What does success look like?
Even a small improvement for migraine patients often
makes a real difference and is appreciated.
Migraine attack – success is pain free in 2 hours
Migraine prevention – 50% reduction in headache days
Important to note that WE ARE NOT AT CURE STAGE.
“Perfection
should not be the enemy of good”
Commonly overlooked treatments
Often issues with correct and appropriate dosing.
Aspirin: 900mg
Ibuprofen: 600- 800mg (realistic dose to treat an
attack)
Naproxen: 500mg (not the 250mg people often take)
Preventatives: length of exposure and dosage is key
Propranolol: 1-1.mg per kg body weight taken twice a
day
*Dose appropriate to weight is key when taking
preventative treatments.
Tolerability is hard with preventatives. Patience is key! A new preventative
medication needs to be taken for 10 weeks plus.
New treatments on the horizon
1. Neuromodulation (electrical currents change brain
behaviour)
2. CGRP- Antibody (1st
anti-migraine preventative treatment)
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