Via Christi Women's Connection: Migraines
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Transcript of Via Christi Women's Connection: Migraines
Migraines: Oh, my
aching head!
Saad Kanaan, M.D.
Neurologist
Via Christi Clinic, P.A.
848 N. St. Francis, Suite 3901
Wichita, KS 67214
Phone: 316-268-8500
My background Internship year in internal medicine: 2010-2011
General neurology residency: 2011-2014
Via Christi Clinic: 2014-current
Main interest in Neurology: Migraine and other
headache disorders
Main interests in life: soccer and traveling
Disclosures Hired by Via Christi Clinic
No affiliation with any pharmaceutical companies
Some parts of this talk represent my personal
experience
Objectives Discuss the epidemiology of migraine
Define migraine and chronic migraine
Identify common symptoms of migraine
List some migraine triggers
Explore treatment options
Epidemiology In the United States, more than 30 million people have
1 or more migraine headaches per year.
Approximately 75% of all persons who experience migraines are women.
The economic cost resulting from migraine-related loss of productive time in the US workforce is more than $13 billion per year, most of which is in the form of reduced work productivity.
The incidence of migraine peaks in girls between age 12-17
• Stewart WF et al. (1991) Age- and sex-specific incidence rates of migraine with and without visual aura. Am J
Epidemiol 134:1111-20.
• Kors EE et al. (1999) Genetics of primary headaches. Curr Opin Neurol 12:249-54.
• Lipton RB et al. (2002) Migraine in the United States: epidemiology and patterns of health care use. Neurology
58:885-94.
Migraine: DefinitionPersonal definition:
Migraine disorder is the tendency to develop recurrent
migraine attacks.
Migraine attack: an episode of “brain dysfunction”
causing a variety of nervous system symptoms, most
common of which is a moderate to severe headache.
Chronic migraine headache: More than 15 headache
days/month lasting more than 4 hours/day.
Migraine: Prodrome Migraine prodrome is the phase that preceded the
migraine attack and could last several hours.
Symptoms:
Heightened sensitivity to light, sound, and odors
Sleepiness, fatigue, or uncontrollable yawning
Food cravings
Mental and mood changes (e.g. depression, anger,
euphoria)
Excessive thirst
Constipation or diarrhea
Migraine: Aura Aura are complex neurological symptoms that precede
or accompany migraines or occur in isolation. Common
aura include:
Visual aura: spots, flashing lights, floater, zigzag lines.
These typically move around, change in size, and
persist with closing eyes.
Migraine Aura (cont.) Sensory aura: tingling, burning, pins and needles…etc.
that usually travel from one site to the other
Dizziness: spinning sensation or lightheadedness, in
real life, this is one of the most common symptoms of
migraine.
Motor: uncommon, weakness on one side of the body
mimicking stroke.
Migraine Triggers Each person has their own triggers
None of the triggers are universal to all patients
Learning your own triggers and avoiding them can be
an effective tool in fighting your migraines!
Common Triggers
Hormonal changes:
menstruation, pregnancy
Stress let down
Excessive or insufficient
sleep
Medications
Smoking
Bright or fluorescent lighting
Strong odors
Head trauma
Weather changes
Motion sickness
Lack of exercise
Fasting or skipping meals
Red wine
Certain foods:
Artificial sweeteners (eg,
aspartame, saccharin)
Monosodium glutamate (MSG)
Citrus fruits
Foods containing tyramine (eg,
aged cheese)
Meats with nitrites
Treatment 2 main treatment modalities:
1. Migraine prevention
2. Migraine abortion
The best treatment plan should cover both modalities
Most intractable headaches are easy to treat if you
follow the simple plan above.
Migraine abortion Home medications (oral, injections, nasal)
Infusions (ER, infusion center, clinic)
Devices:
Ceflay
Migraine prevention Oral medications:
Blood pressure medications
Antidepressants
Antiepileptics (seizure medications)
Miscellaneous
Injections:
Onabotulinum A (BOTOX)
Migraine prevention:
Indications and goalsIndications
Frequency of migraine attacks > 2/month
Duration of individual attacks > 24 hours
The headaches cause significant disability
Abortive therapy fails or is overused
Goals:
Reduce attack frequency, severity, and/or duration
Improve responsiveness to abortive medications
Reduce disability
Onabotulinum toxin A
for chronic migraine Only approved for Chronic migraine
Candidates must have failed 3 other oral preventative
agents
Treatment cycles every 12 weeks
How do we know it works? PREEMPT trial (Phase III REsearch Evaluating
Migraine Prophylaxis Therapy)
Largest study of chronic migraine (1384 participants)
Responder defined as 50% reduction in headache days
or more
Results analyzed in this study and follow up study
ResultsResponders:
After 1st treatment: 49.3%
If no response after 1st treatment, 11.3% respond after
2nd treatment
If no response after 2nd treatment, 10.3% respond after
3rd treatment
Onabotulinum toxin A:
Pros. and Cons. Cons:
Side effects
Needle phobia
Cost
Pros:
Does not interact with other medications
All side effects are temporary
No effect on major organs (stomach, kidney, liver,
heart…etc.)
Assured compliance
Every 12 weeks rather than daily
Very effective
Kanaan’s way of treating
migraine Seek first to understand1
Then to be understood1
32 point checklist of items that cover all aspects of migraine symptoms, triggers, prior and current medication use, and red flags.
Full neurological examination
Individualized workup and treatment plan:
Abortive medications including infusions
Prophylactic medications including Botox
1. Stephen, RC. (2009) The 7 habits of highly effective people .