Friday 17 April 2020

The Migraine World Summit: Day 2

*This post is not sponsored by the Migraine World Summit but I am a participant in the Migraine World Summit affiliate program. This means I earn a commission from any qualifying purchases of the summit made through my link.

Why don’t people go to the doctor for headache/migraine?

-     Stigma (not considered a real disease)
-     Experience episodic migraine and think they are ok. Problems occur when episodic migraine isn’t treated appropriately and can escalate into frequent episodic or chronic.

Less than 50% of chronic migraine patients see a clinician.

Chronic migraine patients who have “tried everything” for example sometimes it turns out they didn’t really have CM and actually have a leak for example.


-        Primary (migraine, tension, cluster, trigeminal)
-        Secondary (due to another condition)

What condition is migraine mistaken for?

-Sinus headaches
-vestibular issues

On average patients will see 3-5 different specialists before they see a headache specialist.

Central sensitization and the issue for chronic migraine patients being on high alert all of the time and not just during an attack Problem with patient and how they are able to interact with the environment.

Head pressure can present as a migraine. Leaks in spinal fluid (spontaneous intercranial hypotension -SIH).

Symptom profile: (usually feel worse when upright, symptoms get worse throughout the day, nausea, vision problems).

Patient profile: (Tall & lean, hypermobile, mixed connective tissue disorders are often a comorbidity).
MOH > Secondary headache disorder and is often superimposed on primary headache disorders such as migraine.

Underdiagnosis is as much of a problem as misdiagnosis.

Discussed research using computers to find groups of migraine patients and explore trends in mass data. Larger amygdala found in patients with chronic migraine compared with non – headache participants. Link between big amygdala and high catastrophisation scoring. Episodic migraine patients have a mix of high and low catasrophisation scores. Higher scores a pre marker for those who go from episodic to chronic migraine perhaps?


Head injury:

-        A fall (most frequent in youth and elderly)
-        Flying object
-        Car accident
-        Sports

Head injury symptoms:

-        Headache
-        Nausea
-        Vision changes
-        Sleep distrubances
-        Difficulty with attention
-        Memory problems
-        Cognitive difficulties
-        Fatigue
-        More severe cases may include; weakness, numbness & tingling

What next?

-        Neuro exam
-        Look at any weakness
-        Sensory deficits
-        Eye exam
-        MRI/CAT scan

What is concussion? Movement of the brain in the skull, a jolt.

Migraineurs are more likely to have symptoms after a concussion compared with non-headache patients. It is important to focus on what is new symptom wise. Is there a different symptom you don’t usually experience or a new type of pain?

Most people are fine after concussion.

There is the acute phase (3 months post-concussion).

Persistent/chronic (still experiencing symptoms 3+ months after).

Refractory (continued symptoms over time)


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