Monday 4 June 2018

The Migraine World Summit Summary: Day 3

Day 3

Lawrence Newman: Daily, unresponsive refractory headache

Types of chronic headache
1.     Chronic tension
2.     Chronic migraine
3.     New daily persistent headache
4.     15+ headache days a month

MOH (medication overuse headache) – adding fuel to the fire. Short term gain- long term making headaches and situation worse.

Misdiagnosis sometimes between chronic migraine and new daily persistent headache.

Primary headache disorder – headache itself is the problem
Secondary headache disorder- MOH, stroke, brain tumour etc

Important in diagnosis (frequency, location of headache and what does it actually feel like)

51 million people have daily refractory headache!

New daily persistent headache
1.     Migraine and tension headache features
2.     Different from type of headache they have ever experienced before
3.     No headache history and within 3 days onset
4.     Often comes on following; a virus, head trauma, stress or a surgical procedure

Treatment options?
1.     Anti-migraine drugs and tension headache drugs
2.     If it was after an infection – anti viral, anti-inflammatory and anti-asthma drugs
3.     Double jointed people (injections can interrupt the pain)
4.     Neuromodulation devices- both invasive and non-invasive can be used

Inpatient stay can sometimes be useful to help ramp down the cycle of pain. Nerve blocks are often administered along with stress management and biofeedback.

Chronic pain & depression sadly go hand in hand.

New daily persistent headache tends to be more medically resistant at the moment BUT

“There is hope and NO reason to give up!”

Important lifestyle factors
1.     Sleep: 8 hours a night
2.     Eating: Don’t skip meals
3.     Exercise: 3 days a week for 30 mins
4.     Drinking: 5 glasses of water +
5.     Stress reduction: exercise (can tick of two at the same time)

Day 3

Andrew Charles: 6 medications that can make migraine worse.

Andrew is part of the Goldberg migraine programme. Talks about non-migraine drugs that many of us take causing problems.

Not evidence based (needs more research), largely observation from in the clinic.

1.     SSRI – Anti-depressants (Prozac)
-        Observation in clinical practice
-        Exacerbating migraine
-        SNRI could be a good alternative to use instead
-        Depression and migraine (comorbidity) mood issues associated with people with migraine

2.     PPI – Proton pump inhibitors (gastro acid reflux)
-        Taiwan study (start on a PPI and saw an increase in headaches)
-        What is your biggest problem? Is the benefit of this medication worth the possible exacerbation of your migraines?
-        Look for alternative if you really think you need to be on something for this.
-        Possible rebound reaction when you first stop taking this drug

3.     Nasal steroids/decongestants
-        Claritin D & Pseudoephedrine
-        Look for something without a decongestant in them
-        Long term use of these steroids – exacerbates migraine
-        Good alternatives – anti histamines

4.     Oral contraceptives
-        Hypothalamus drives hormonal system (every hour hormone released in the brain)
-        Oestrogen falls – migraine attack
-        Having more oestrogen doesn’t seem to be good for migraine either
-        Low dose continuous can be helpful or coming off it completely

5.     Hormone replacement therapy
-        Oestrogen patches
-        Long term- not good for migraine

6.     Pain medication
-        Not frequent use
-        MOH
-        Pain meds making migraine worse
-  -        Study showed that those who were given anaesthetic pain meds wanted more pain meds         after than those who were given a saline solution
-        Need to be very careful with opioids- codeine
-        Caffeine containing analgesics can be worse for those with migraine for example, Excedrin
-        Important to communicate to neuro what you are taking

Coordinating pain from different doctors – patient has the ability to educate their physician and      increase awareness for primary care doctors and with OBGYN for example.

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