migraine basics presentation by decontee "dr. dee" jimmeh, md
DESCRIPTION
Dr. Dee shares basic information about migraines including causes, symptoms, and possible treatment options.TRANSCRIPT
The Basics about MigraineDecontee “Dr. Dee” Jimmeh
Norwood Clinic / Brookwood Medical CenterOctober 1, 2014
OutlineDefinition/ CriteriaCausesAssociated SymptomsEvaluationWarning SignsTreatmentCounseling
What is migraine?Severe headache lasting more several hours
(4-72)Typically unilateralThrobbing quality
Interrupts daily function
What causes migraine?Cortical spreading depression
Trigeminovascular system
Sensitization
Role of serotonin
Genetics
Cortical Spreading Depression
What causes migraine?Cortical spreading depression
Trigeminovascular system
Sensitization
Role of serotonin
Genetics
Trigeminovascular Activation
What causes migraine?Cortical spreading depression
Trigeminovascular system
Sensitization
Role of serotonin
Genetics
Notable TriggersFoodStressAromasHormonal changes (especially estrogen
surges)DehydrationPoor sleepSedentary lifestyle
Associated symptomsSensory AuraProdromeLight sensitivityNoise sensitivityNausea/ VomitingFatiguePost-drome
Visual Aura
Associated symptomsSensory AuraMalaiseLight sensitivityNoise sensitivityNausea/ VomitingFatiguePostdrome
EvaluationClinical History
Neurologic Exam
Neuroimaging (CT or MRI)
Warning Signs“Worst headache of my life”
Sudden change in headache character
New onset unilateral weakness or numbness or balance difficulty
Fever
Decline in mental status
Worst Headache of Life
Warning Signs“Worst headache of my life”
Sudden change in headache character
New onset unilateral weakness or numbness or balance difficulty
Fever
Decline in mental status
Treatment: Abortive Triptans
Imitrex, Zomig, Maxalt
ErgotaminesIntranasal or IV DHE
Non-steroidal anti-inflammatory meds (NSAIDs)Naproxen, Ibuprofen, Indocin, Diclofenac
Chronic Migraine CriteriaHeadache occurring 15 days or more per
month
Migrainous features on at least 8 days per month
Abortive therapies failing to effectively abate head pain
Treatment: ProphylacticAnti-hypertensives
Propranolol, Verapamil
Anti-seizure medicationTopamax, Zonegran, Depakote
Anti-depressantsElavil, Pamelor
Botulinum Toxin Therapy31 injections total
Every 12 weeks
Improvement noted after 2nd cycle
Common side effects: neck pain, headache, and eyelid droop
Headache in pregnancyWorse in 1st trimester
Most classic treatment options contraindicated
Conservative managementEating small frequent meals, good sleep hygiene,
proper hydration, low-impact exercise (e.g. pregnancy yoga or water aerobics), meditation
Can use Benadryl, Tylenol +/- narcotics if necessary
Counseling TipsAvoid 0ver-the-counter (OTC) medication
overuseAvoid triptan medication overuseMonitor caffeine intakeCardio exercise regimenProper hydrationSleep hygieneHeadache journalTrigger avoidanceStress management
SummaryMigraines are debilitating headaches that
interrupt daily function
With thorough evaluation, a patient-specific regimen can be designed.
Non-pharmacologic therapies, such as exercise, adequate sleep and proper hydration, are equally important in successful headache management.
Thanks to Brookdale Place!
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Contact Dr. Dee Brookwood Medical Center, Professional Office
Building, Suite 301 Phone 205-250-6940 Fax 205-250-6942 www.norwoodclinic.com