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Controlling migraine headache pain

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Migraine Management Program

Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. ©2015 Aetna Inc. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.

Finding relief from your migraine headachesThis brochure can help you learn ways to:• Identify and treat or prevent

migraine headaches• Work with your doctor• Get more information

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1Migraine. National Headache Foundation. www.headaches.org/education/Headache_Topic_Sheets/Migraine. Accessed January 30, 2014.

What type of headache do you have?

Tension headaches and migraine headaches — what’s the difference?

There are two main types of headaches: tension and migraine. Your doctor can tell you what type you have. He or she can look at your medical history and perform a physical exam. Sometimes, you may need other tests.

Tension headaches may feel like a band of pain around the head. The pain can spread to the neck and scalp. This tension may be made worse by:

• Stress

• Tiredness

• Getting upset or angry

Migraine headaches usually cause a very severe, throbbing pain. They often start on one side of the head and spread to the face and entire head. Some people can have both migraine and tension headaches.

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Tension headache Migraine headache

Symptoms A band of pain around the head caused by tension in neck and/or scalp

A severe and throbbing pain that often occurs on only one side of the head

Frequency and duration

• May occur rarely or often

• Usually triggered by stress or anxiety

• May last for 30 minutes or several days

• May occur very rarely or several times per month

• Usually lasts from 4 to 72 hours

Location Usually occurs on both sides of the head in the forehead, temples or back of head and neck

Usually starts on one side of the head or in one small area, but may spread to entire head

Strength of pain Mild to severe; most people can still function as normal

Usually moderate to severe and very hard to tolerate

Nature of pain Dull, aching, not throbbing Pounding, throbbing, pulsing

Other symptoms May cause dizziness, poor concentration, sleepiness or facial pain

• Upset stomach; vomiting; sensitivity to noise, light or smell; blurry vision

• Some migraine headaches may be mild in pain but cause other symptoms

Aura Not present May be present

More than 37 million Americans have migraine headaches.1

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Signs, symptoms and causes of migraine headaches

Prodrome• An unusual feeling that a migraine is about to happen

• The feeling might be hunger, loss of appetite, tiredness, food cravings or mood changes

• Can happen up to several hours or even days before a migraine headache begins

AuraAn aura is a change in one of the senses that usually comes and goes 20 to 60 minutes before a migraine begins. For example, an aura may be related to:

• Vision — Blurry or strange vision, or seeing flashes of light

• Sensory — A sensation of numbness or tingling in the arm, face or tongue

• Verbal — Difficulty speaking

Identifying migraine headaches

These headaches are unique to each person. You may:

• Feel a throbbing pain that occurs on one or both sides of your head

• Have an upset stomach

• Feel the need to vomit

• Not want to eat

If these symptoms sound familiar to you, you’re not alone. About 37 million Americans have migraine headaches.1 They’re caused by complex chemical and physical reactions in the brain.

Early signs of migraine

Two symptoms of migraines that don’t happen in other types of headaches are a prodrome and an aura. Not all people with migraines have a prodrome or aura, but many do.

1 Migraine. National Headache Foundation. www.headaches.org/education/Headache_Topic_Sheets/Migraine. Accessed January 30, 2014.

Irritation and swelling of blood vessels in the brain cause migraine headaches. Experts think this occurs due to the overstimulation of nerves, but no one knows for sure.

Preventing and controlling migraine headaches

Migraine headaches make it hard to do everyday tasks. You can help prevent this. The key is to learn more about what causes these headaches.

Know what causes your migrainesYou may be able to avoid your migraine headaches. One of the best ways is to learn what “triggers” or causes your headache. Triggers act like a switch to “turn on” a migraine headache. They may not always cause migraines. But the more triggers that happen at one time, the more likely it is that a migraine will occur. Learn to identify and avoid your triggers. It’s the first step to help prevent a migraine headache. Here is a list of common triggers:

Diet• Alcohol (especially beer and red wine)

• Aged cheeses (cheddar, gruyere, brie, camembert)

• Monosodium glutamate (MSG, a preservative)

• Artificial sweeteners

• Caffeine

• Nuts

• Nitrates found in hot dogs, bologna and processed meats

• Citrus fruits like oranges and grapefruit

Stress• Let-down periods (after vacations, weekends or

major events)

• Busy schedules

• Trouble getting along with others

• Job stress, loss or change

• Crisis situations

Hormonal changes in women• Menses (monthly period)

• Ovulation

• Hormone replacement therapy

• Birth control pills

Environmental changes• Weather

• Seasons

• Travel (crossing time zones)

• Schedule changes

• Unusual or different sleep patterns than you’re used to

Overstimulation of the senses• Bright lights

• Hot or cold temperatures

• Loud noises

• Strong smells

Have the right medicine on handIt’s important to know how and when to use your medicine. There are two types of medicine to treat migraines. One works to keep them from starting. The other works to treat them after they start. Ask your doctor which type of medicine you need. For more information on drugs to treat headaches, see page 7.

Lowering your stress can help you manage your headaches

Learning to manage stress and taking steps to prevent a headache from starting are important in learning how to live with migraines. People with migraines who learn to cut back on stress often cut down on the number of headaches they get.

There are a number of ways to reduce the amount of stress you feel. Your doctor can provide more information on these techniques:

• Biofeedback — A way to relax by controlling body functions, like blood pressure and muscle tension.

• Progressive muscle relaxation — Deep relaxation to reduce stress, anxiety, insomnia and certain types of pain.

• Creative visualization — Making changes in the body by picturing them in your mind.

Reducing stress and avoiding certain triggers can help you prevent migraine headaches.

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Working with your doctor

Tell your doctor about your migraine headaches. Unfortunately, most people don’t make a special appointment to do this. Instead, they wait until they see their doctor for some other reason. They mention their headache problem then.

But you may want to make a special appointment with your doctor. Use this time to just talk about your headaches. You and your doctor can create a plan that’s just for you to help manage your migraines.

Keep a headache diary

Write down your headache symptoms. And keep track of medicine used to treat your headaches. You can share these details with your doctor. This can help you and your doctor to spot patterns and triggers. It will also help you understand when headaches are most likely to happen and the best treatment for you.

When you fill out your diary, try to include the following: • Frequency — How often your headaches occur

• Severity — How bad the headache is compared to others that you’ve had (Is it more or less painful?)

• Duration — How long each headache lasts

• Response to medicine — Which medicine you took and how well it worked

• Triggers — Any factors that you think might have turned on your migraine

• Side effects of medicine — Problems that you think might be caused by your medicine

Make a list of information to share with your doctor, such as:• How migraines affect your life

• Other medicine you take

Some medicine can treat your migraines by interacting with others you already take. This can happen with antidepressants or high blood pressure medicine. But other interactions could cause serious side effects or make your headaches worse. This can happen with birth control pills, for example.

Tell your doctor about all the medicine you take. These include prescriptions, drugs that don’t need a prescription, vitamins and herbal or “natural” products.

Treating migraine headaches

There are things you can do to help cope with migraines. Identify your type of headache and work with your doctor to find the right treatment. These are important first steps to feeling better.

Unfortunately, you can’t stop some migraines.

When you get a migraine, it’s important for you to follow the steps you and your doctor outlined in your migraine management plan. Here are some steps you can take to help ease the pain: • Keep your migraine pain relief medicine with you

at all times.

• Know the characteristics of your prodrome or aura.

• Recognize the start of a headache as soon as possible.

• Take medicine as directed by your doctor at the first sign of pain.

• Use self-care, as instructed by your doctor.

• Seek out a cool, dark and quiet place.

Make sure your headache doctor knows about all of the medicine you take. Even if a different doctor prescribed it or you bought it over the counter.

Understanding your medicine

Medicine to prevent migraines Your doctor may prescribe the following:

• Divalproex sodium

• Amitriptyline

• Propranolol

• Timolol

• Topiramate*

Migraine medicine is available in an oral form, as a nasal spray, in self-injectable form or as a rapidly dissolving tablet.

Always take your medicine exactly as your doctor instructs.

Medicine to take when the pain first starts Your doctor may suggest the following:

• NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, naproxen, etc.

• Triptans (Imitrex, Maxalt, etc.) can be used as the first treatment for migraines

• Other medicine such as aspirin or aspirin combination products

Call your doctor if:

• Your headache is much worse or much different than usual

• Your medicine doesn’t seem to work as you expected

• You have unusual or severe side effects from your medicine

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*This medicine will not help if you take it after a migraine starts.

This material is for information only. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

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©2015 Aetna Inc. 05.02.340.1 (3/15)

Resources for headache managementLearning how to identify, prevent and treat migraine headaches will help you get relief and get back to enjoying your life. Your doctor can provide you with the best advice for your migraine headaches. Here are a few resources that can give you more information on migraines:

National Headache Foundation1-888-643-5552 www.headaches.org

American Headache Society856-423-0043 www.achenet.org

National Institute of Neurological Disorders and Stroke1-800-352-9424 TTY: 301-468-5981 www.ninds.nih.gov

Aetna Pharmacy Managementwww.aetnapharmacy.com