Bipolar Disorder

Bipolar Disorder and Migraine

There has a long been a well-known association between bipolar disorder and migraine headaches, but until recently, this had not been formally studied. Several recent studies have remedied this.

In one small series of psychiatric patients (62) admitted to the hospital, and assessed for migraine, 48% of the women and 39% of the men had migraine. The prevalence was highest in those individuals who had bipolar disorder type II at 77%, and those had more migraine attacks as well.

A study of Latino adults of Mexican-American origin found a stronger correlation between migraine and bipolar disorder than between migraine and depression. A Canadian study found that depression, anxiety, and bipolar disorder were all about twice as prevalent in migraine sufferers as in the general population.

Bipolar disorder has been assessed in large population-based studies, and the risk of developing bipolar disorder if you have migraine is between 3 and 7 times higher than if you do not have migraine.

These associations have led to a search for a common genetic marker for migraine and bipolar disorder.

References:

1. Low NCP, Merikangas KR. The comorbidity of migraine. CNS Spectr. 2003;8(6):433-434, 437-444. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12858133
2. Hamelsky SW, Lipton RB. Psychiatric comorbidity of migraine. Headache. 2006;46(9):1327-1333. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17040330
3. Dilsaver SC, Benazzi F, Oedegaard KJ, et al. Migraine Headache in Affectively Ill Latino Adults of Mexican American Origin Is Associated With Bipolarity. Prim Care Companion J Clin Psychiatry. 2009;11(6):302-306. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20098521
4. Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders–a national population-based study. Headache. 2008;48(4):501-516. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18070059
5. Oedegaard KJ, Greenwood TA, Lunde A, et al. A genome-wide linkage study of bipolar disorder and co-morbid migraine: Replication of migraine linkage on chromosome 4q24, and suggestion of an overlapping susceptibility region for both disorders on chromosome 20p11. J Affect Disord. 2009. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19819557

by Christina Peterson, MD

updated Feb 7, 2010

Twelve Myths About Migraine in Women

Why do migraine headaches occur more frequently in women than in men?

Did you know that women are more likely to experience headaches than men? While tension-type headaches affect slightly more women than men, migraine is much more likely to affect women, and afflicts three times as many women as men. Why would this be?

The reason is thought to be a combination of genetics and hormones. The World Health Organization has found that migraine is a leading cause of disability in women throughout the world. Despite all we now know about migraines, misinformation persists.

Here are some common myths about why women have migraines.

Twelve Migraine Myths

Because the general public is largely misinformed about this illness, numerous misconceptions about migraine have entered the popular lore. What follows are twelve myths about women and migraine. Once you’re armed with the facts, you can set the record straight when confronted with such troublesome fallacies.

Myth 1 – Women get more migraines than men do because women are more emotional and easier to upset.

FactWomen experience more migraines than men do as a result of hormonal differences and genetics and their effect on brain biochemicals. The majority of women – however “emotional’ they may be – do not get migraines.

Myth 2 – Many women bring on migraines to avoid something like sex or work.

Fact:  Migraine is a disorder of altered physiology. While there may be a subset of women (and men) with subconsciously triggered psychosomatic migraines, the vast majority of migraineurs have no psychological reason for their headaches.

Myth 3 – Women who suffer from many migraines probably need to see a psychiatrist or psychologist. They must have some inner conflicts that cause those headaches.

Fact:  Some women with migraines also suffer form emotional problems, and addressing inner conflicts in therapy can reduce migraine frequency and severity. (However, it will not “cure” the underlying migraine tendency in the brain.) Some experts believe that the neurochemical changes that cause migraine can also cause mental disorders, such as depression. If a woman who experiences migraines also has an emotional problem, she may need to consult with a mental-health professional. But most women who suffer form migraines don’t need to see a psychiatrist or psychologist; they just need help in averting migraine attacks and managing their pain.

Myth 4 – Women get migraines because they eat bad things, like chocolate.

Fact:  Various foods do act as a trigger in about 25% of all migraine sufferers, which means that they don’t precipitate a headache in the majority of migraineurs. Of that 25%, not all women react adversely to chocolate. Some women anecdotally report that chocolate actually makes them feel better. Why? Because chocolate contains a caffeine-like substance, which can help alleviate pain in some individuals. Other foods that often trigger migraines are red wine, aged cheese, and dishes prepared with MSG. (More about food triggers later in this chapter.)

Myth 5 – If a medication works for one woman’s migraines, then it should work for most other women, too.

Fact:  Women are not all made from the same mold. A medication or treatment that works for one woman may not work for the next one. There’s a tremendous amount of individual variation in responsiveness to given medications.

Myth 6 – Women who get migraines are just plain depressed.

Fact:  A disproportionately high number of women with migraine are clinically depressed; however, treating their depression does not cure their migraine. Does the recurring pain of migraine make women feel depressed because migraine is inherently depressing? Or is there another cause of both depression and migraine? Research actively continues to work toward determining the underlying factors of this relationship. It is known that depression places one at increased risk of developing migraines and migraine increases the risk of becoming depressed. But it’s important to realize that depression is highly treatable.

Myth 7 – Women who get migraines usually have PMS (pre-menstrual syndrome).

Fact:  The approach of a woman’s period triggers migraine in many women. But these women do not necessarily also get PMS. For other women, migraines have nothing to do with their menstrual cycle. Some women who do have PMS do not get migraines.

Myth 8 – People who get migraines take a lot of time off from work.

Fact:  People with migraines don’t appear to take any more time off from work than people with other chronic ailments. In fact, some people with migraines struggle to stay on the job and actually take less time off than people with other disorders.

Myth 9 – Women who get “weekend headaches” are avoiding their spouses and families.

Fact:  Unfortunately for migraineurs, many women experience migraines on weekends. this could be because of a change from high levels of stress to lower stress levels. It may also be due to changes in daily habits, such as sleeping patterns and decreased caffeine intake. But few (if any) women get migraines because they want to avoid their families.

Myth 10 – Only white women get migraines.

Fact:  Women of all races suffer form migraines, though the prevalence is higher among Caucasian women. One study showed a 20.4% rate of migraine among Caucasian women, a 16.2% prevalence among African-American women, and a 9.2% prevalence among Asian-American women.

Myth 11 – If a person tried hard enough, she could shake her headache problem.

Fact:  It is simply not possible to “will away” your tendency to migraine. Many migraineurs try hard to find their migraine triggers and to control the illness. Although many women never seek medical treatment, they do take over-the-counter medication in an attempt to lessen these debilitating headaches. Much can be done to minimize the frequency and severity of migraines. Recent research has yielded new medications and new ideas about migraine. Doctors have made amazing strides in helping people, but we haven’t yet learned to cure people of migraines forever.

Myth 12 – Women who get migraines are extremely intelligent, high-achieving, nervous people who have a “migraine personality”.

Fact:  Though migraine sufferers like the “extremely intelligent” part of this stereotype, unfortunately, no study supports this idea. Many of the women I’ve treated were very bright; many were also high achievers. Others were of average aptitude and accomplishment. The American Migraine Study and other research demonstrate that people from all walks of life are plagued by migraines. But women who are high achievers are more likely to have medical resources available to them, are more likely to consult a physician, and are more likely to speak out about their illness than their less privileged “sisters”. While there is an increase in the incidence of certain psychiatric disorders as concomitant conditions with migraine, it is neither fair nor accurate to describe all women with migraine as having personality abnormalities. Nor is the abnormal personality the cause of the migraines; one must have a predisposition to migraines.

Excerpted from The Women’s Migraine Survival Guide

Toxic/Metabolic Headaches

Hangover headache? That’s one kind of metabolic headache

There are several types of metabolic abnormalities that can result in headache. The two you might be most familiar with might be dehydration and hangover. It’s pretty important to make sure you stay hydrated. A less common metabolic headache would be low blood sugar from skipping meals.

Exposure to toxic substances can also cause headaches. Examples of this would be exposure to chemical fumes or even the fumes from household cleaning products. A

Another, however, would be drug-induced headaches. Common examples of medications that can cause a headache would be nitroglycerin and other nitrates taken for heart disease, or medications like Viagra®, Cialis® or Levitra®. Be aware that many medications can cause headaches. If you are taking something new, and you have started to have more headaches than usual, it could just be the medication.

Restless Legs Syndrome

Restless legs syndrome, a movement disorder, is one of the many conditions that is more common in migraine sufferers. Although it may begin as a simple urge to move or an itchy, tingly feeling in the calves, it can become disabling. A higher than expected rate of RLS (34%) has been found in chronic headache sufferers.

What are RLS symptoms?

Restless legs syndrome is an unpleasant sensation that is often hard to describe. Words sometimes used are tingling, itching, creeping, crawling, jittery, burning, or grabbing. RLS affects calves more often than feet or thighs, and is usually bilateral. Being still for long periods brings it on, and moving around helps.

RLS symptoms are usually worse in early evening or later at night, and may cause insomnia.

RLS is present in about 10-15% of US, Canadian, and European populations, but is less common in Asia. RLS affects African-Americans less than white persons. RLS affects women about twice as often as men. Women who have not borne children have the same risk as men.

Restless leg syndrome is often reported during pregnancy. It most often occurs in the third trimester, and resolves with delivery. RLS affects 25-40% of pregnant women.

The Sleep Heart Health Study showed more stroke or heart disease occurring in those with RLS than those without. There was a correlation between greater frequency or severity of RLS symptoms and occurrence of cardiovascular disease. RLS itself most likely does not cause heart disease. We do know, however, that interrupted sleep can be a risk factor for heart problems.

RLS is more common in smokers.

Causes of RLS

Most cases of RLS are primary, which means that it runs in families, and is most likely genetic. RLS is familial in 25-75% of cases. Several genes have been identified, both dominant and recessive. There are also several causes of secondary RLS, one of the most common of which is peripheral neuropathy.

Secondary RLS can be caused by:

  • peripheral neuropathy
  • iron deficiency
  • folate deficiency
  • magnesium deficiency
  • diabetes mellitus
  • Lyme disease
  • lumbosacral radiculopathy (pinched nerve root)
  • rheumatoid arthritis
  • Vitamin B12 deficiency
  • Sjögren syndrome
  • uremia (kidney failure)
  • pregnancy
  • medications (these can cause or make worse existing symptoms of RLS) -diphenhydramine (present in many over-the-counter medications) SSRI antidepressants lithium beta blockers antidopamine medications (many antipsychotics, some nausea medications)
  • alcohol
  • caffeine

Restless Legs Syndrome and Advances In Treatment

Treatments for RLS start with self-help measures, such as hot or cold baths, whirlpool baths, exercise, limb massage, and avoidance of any triggers. There are also several medication treatments. It’s important to work with your doctor to make sure you don’t have one of the conditions that cause secondary RLS.

References:

1. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology. 2004;63(6):1065-1069.

2. Winkelman JW, Shahar E, Sharief I, Gottlieb DJ. Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study. Neurology. 2008;70(1):35-42.

3. Walters AS, Hickey K, Maltzman J, et al. A questionnaire study of 138 patients with restless legs syndrome: The `Night-Walkers’ survey. Neurology. 1996;46(1):92-95.

4. Young, WB, Piovesan, EJ, Biglan, KM. Restless Legs Syndrome and Drug-Induced Akathisia in Headache Patients. CNS Spectrums. 2003; 8(6):450-456.

5. Hornyak M, Grossmann C, Kohnen R, et al. Cognitive behavioral group therapy to improve patients scoping strategies with restless legs syndrome: a proof-of-concept trial. J Neurol Neurosurg Psychiatry 2008;79:823–825.

Seizures and Epilepsy

Seizures, Epilepsy, and Migraine

Epilepsy affects 3% of the general population at any given time, but about 10% of us will have had a seizure at some point in our lives by the time we reach the age of 80. Epileptics are 2.4 times more likely to develop migraine than the general population. This increased risk is equal for men and women. No one type of seizure disorder is affected by this increased risk more than another.

The relationship between epilepsy and migraine is also bidirectional, that is, not only are you more likely to develop migraine if you have a seizure disorder; you are also more likely to develop a seizure disorder if you have migraine.

A recent study has discovered a familial occurrence of occipitotemporal epilepsy and visual aura, and linked it to a chromosome.

references:

1. Deprez L, Peeters K, Van Paesschen W, et al. Familial occipitotemporal lobe epilepsy and migraine with visual aura. Neurology. 2007;68(23):1995 -2002.
2. Winawer M. New evidence for a genetic link between epilepsy and migraine. Neurology. 2007;68(23):1969 -1970.
3. Bigal ME, Lipton RB, Cohen J, Silberstein SD. Epilepsy and migraine. Epilepsy Behav. 2003;4 Suppl 2:S13-24.

by Christina Peterson, MD

updated Nov 14, 2009

Organic Headaches

Organic Headaches

Organic headaches are due to underlying medical disorders such as infection, tumor, or stroke.

In the case of tumor, the headache usually appears and gradually grows worse over time. Infections also may grow worse over time, but may do so more quickly.

This type of headache is a type of secondary headache, meaning that it is due to a secondary cause.

Migraine Quiz

Migraine Quiz

If you think you may be experiencing migraines, it will help a lot to understand precisely what a migraine is. You know it’s an intense headache. But what else is involved?  Find out more about migraine as well as what’s going on inside your brain during a migraine, also known as pathophysiology.

Excerpted from The Woman’s Migraine Survival Guide

However, all answers are equally true for men or women.

Answer ” true” or “false” to the following questions:

1. My headaches are severe and pounding.

True

 

False

 

2. I often feel nauseous during a headache attack.

True

 

False

 

3. The headaches come before or during my period.

True

 

False

 

4. My mother or my sister (or daughter or father) has the same kind of headaches.

True

 

False

 

5. I have missed work or important events because of my headaches,

True

 

False

 

6. I can’t stand any light or noise when I have a bad headache.

True

 

False

 

7. Moving around too much or bending over can make the pain worse.

True

 

False

 

8. The pain is often on one side of my head.

True

 

False

 

9. Tylenol or aspirin doesn’t help much (or not at all).

True

 

False

 

10. My headache can last from about five hours to several days.

True

 

False

 

If you answered “true” to more than three of these questions, you may indeed be suffering from migraines. If you answered “true” to six or more, then you probably do have migraines. Have your doctor make the final analysis.

 

If you think you may be experiencing migraines, it will help a lot to understand precisely what a migraine is.
You know it’s an intense headache. But what else is involved? Find out more about migraine as well as what’s going on inside your brain during a migraine, also known as pathophysiology.

How to Know if You Are Having a Medication Reaction

Allergic Reaction or Medication Reaction — Do You Know What To Do?

You have taken your headache medication, and now you are feeling a little odd. Now what? Is it the medication? Is it part of the headache? Are you having an allergic reaction? How do you know, and what should you do?

This really depends on what you are feeling, how long you have been feeling this way, whether you have ever felt this way before, and on what you took. Here are some helpful facts.

Drug Allergies

True drug allergies occur in only 5-15% of people exposed to a given drug. Immediate reactions take place in 0-60 minutes; accelerated reactions take place in 1-72 hours, and a delayed reaction would be one that occurred in greater than 72 hours. Symptoms of a true drug hypersensitivity are fever, rash, and internal organ involvement, which could be breathing difficulty or involvement of the liver or blood, for example. Fever and rash are usually the first signs of medication allergy. If you experience this, stop the medication and call your doctor. If you develop breathing difficulty, you may need to go to the emergency room, or call 911 in North America or 112 in the EU.

There is a difference between a drug allergy and what is known as an adverse effect of a drug. Many medications have adverse effects—or what you might call a “side effect.”  These are things that might be uncomfortable, but are not necessarily dangerous to you. For example, the triptan medications, commonly prescribed for migraine headaches, can cause a hot sensation in the head, or a tight or pressure sensation in the throat or chest. This can be alarming if you have not been warned to expect this, or have not experienced it before. These sensations, however, have nothing to do with your heart—this has been tested extensively. Believe it or not, even though you feel it in your chest, it is coming from your brain.

Sometimes, when you take medication for a migraine, it seems like you are getting nauseated. It is hard to tell if this is due to the medication itself, or if this is just the headache progressing. If this happens to you regularly, you might want to ask your doctor for anti- nausea medication.

In order to tell if the symptoms you are experiencing might be due to the pill you took, you can look at the package insert—the paper that comes with the prescription—and see if the symptom is listed. The problem here is that when the drug is tested prior to being marketed, all symptoms reported by the test population have to be listed, regardless of whether they were experienced by the people taking the experimental drug or whether they were experienced by the people taking the placebo (the “sugar pills”). This is what is listed in the package insert, as required by the FDA. Some package inserts will list a comparison chart of the drug group side effects alongside the placebo group side effects, so that you can sort this out better. So if it seems like a lot of fine print, this is why.

Medication Interactions

Many headache sufferers are on more than one medication. Mixing medications can result in drug- drug interactions. Often, your pharmacist will catch a potential problem when your prescription is filled. However, your pharmacist may not know about everything you are taking, especially if you are on herbal preparations.  (See article on drug-herb interactions also.)

Foods can affect your medication as well—if you are on certain antidepressants, for example, you should not drink grapefruit juice. Also, sometimes the inert ingredients in medications can be a problem. If you are lactose-intolerant, some pills contain lactose, and this can create a problem for you. And finally, some of the orally-disintegrating tablets contain aspartame. If that is a migraine trigger for you, this could be a problem, although the amount in the tablet is so small it is probably not an issue unless you are very, very sensitive.

The best thing to do if you think you are having a reaction to a medication is to read the literature that came with the medication. If you are still concerned, call the pharmacy for advice. If the pharmacy is closed, and you are experiencing serious symptoms, call your doctor. If you are having difficulty breathing, go to the emergency department. The good news is that serious medication reactions are rare, and most are treatable simply by stopping the medication.

Headaches: Better Coping Through Biofeedback

Biofeedback for Relaxation Techniques in Headache Management

In the previous article, we reviewed the relationship between headaches and anxiety. Given this well-established connection, promotion of the relaxation response is a key goal for many seeking to reduce the frequency and intensity of headaches.

It would be nice if stress reduction were as simple as popping your favorite CD into the stereo or kicking your heels up on the couch for a few minutes. Unfortunately, it’s often not that easy, especially in the face of recurrent pain. Without the proper skills—that’s right, skills—in place, you may not get far in your quest for the elusive relaxation response. Even after weeks of doing various exercises in deep breathing, mental imagery, and muscular relaxation, the migraineur may be left to wonder: is this stuff really going to work, or is relaxation just another gimmick to be filed away with snake oil?

Real Step-by-step Progress in Relaxation Training Skills

With biofeedback, you can verify whether your new relaxation skills really are working. The proof is in the electronic sensor that monitors different physical functions that occur during the relaxation response. Depending on the type of biofeedback, you might see the rise and fall of your finger surface temperature on a computer monitor. Or, you might hear a tone that fluctuates with the levels of muscle tension in your forehead, neck, or shoulders. This feedback provides a window into your body’s functions, and it does so in a way that is comfortable and non-invasive.

With time and practice, better body awareness translates to better body control. Once the ability to evoke a relaxation response is established through the biofeedback equipment, it becomes easier for clients to apply the relaxation skills during their daily activities. Typically, after a few weeks of practice in biofeedback, many individuals naturally begin to apply their new skills to real-life situations. Of course, a good biofeedback practitioner will go a step beyond this natural learning process, by helping the client to develop individually tailored strategies for generalizing the skills.

Advantages of Biofeedback

The enhanced learning curve that comes through biofeedback is just one of the positive aspects of this type of treatment. Many clients like the fact that biofeedback involves neither needles nor drugs. A related advantage is the fact that, unlike with various headache and pain medications, there are few if any negative side effects associated with biofeedback. Also, the fact that biofeedback is a teaching tool for relaxation means that once the skills are learned, you can continue to benefit as long as you choose to maintain practice; there is no continuing cost after treatment is completed.

Finding a Biofeedback Practitioner

As in all areas of medicine and allied health, there are highly effective biofeedback practitioners as well as less skilled ones. If you are interested in finding a good clinician, you should plan to do a little research. Your primary care physician, neurologist, or migraine headache specialist may have information about where to find biofeedback providers in your area. Additionally, two good internet resources are the websites of the Association for Applied Psychophysiology and Biofeedback (aapb.org) and the Biofeedback Certification Institute of America (bcia.org). When you contact a potential provider, it’s a good idea to ask how long they’ve worked in biofeedback, what health conditions they have treated, and whether they are certified in biofeedback. Although there are effective clinicians who are not formally certified, finding a practitioner who has met certification requirements helps you to be more assured of your choice in a practitioner.

Biofeedback clinicians who work with migraine headache are often masters or doctoral level psychologists, but you may also find practitioners in counseling, physical therapy, and other allied health professions. What’s most important from a consumer standpoint is that you find a professional who has specific experience in treating headache conditions.

What About Insurance?

The willingness of health insurance companies to reimburse for biofeedback therapy varies among insurance carriers as well as among different health conditions. Fortunately, because the effectiveness of biofeedback for migraine is particularly well-documented, the chance of receiving insurance reimbursement is often greater than for other health conditions. Contact your insurance provider for further information, and solicit assistance from health care professionals familiar with your history and diagnosis. As an alternative to direct insurance, some individuals may be able to use flexible healthcare spending accounts or make affordable out-of-pocket payments. Such options are well-justified by the pain relief and improved functioning that the therapy can provide.

From Headache Understanding to Ability to Cope

The challenge of using relaxation skills to control migraines is not so much in understanding the connection between mind and body (you’ve already figured that out); the challenge is in building new skills to override the automatic and often subtle effects of anxiety on migraine pattern and intensity. If you’re willing to explore, biofeedback can help to light the way.

written by Luke Patrick, PhD

Luke Patrick, Ph.D. is a licensed psychologist practicing in Portland, Oregon. He specializes in the psychological management of chronic illness, as well as biofeedback and sport psychology.

Treat Your Migraine Attacks Early

When To Treat, and When Not To Treat

It’s important to know when you should treat your headaches as well as when not to treat them. We have talked elsewhere about overusing medications, and avoiding the trap of medication overuse headache. It’s also important to know that early treatment of a migraine can make a real difference.

You should treat a migraine attack in the mild-to-moderate stage, well before the pain becomes severe. This way, the medication can work on the appropriate brain receptors (targets) to kill your migraine attack before it becomes entrenched. There is sometimes a tendency to wait too long, hoping maybe it isn’t really a migraine after all. Maybe we think we won’t really need our medication, or maybe we think a cup of coffee or eating a meal will do the trick. It’s possible that waiting too long to treat your headaches might itself be a symptom. Your brain may be foggy due to the migraine, and you may not be making wise decisions.

The reason you should treat your migraine in the early stages is that migraine medications will be more effective if taken then, when the headache is in the mild to moderate stages.  If you wait too long, more stubborn neurotransmitters become involved, and the headache becomes more resistant.

When  Not To Treat—Avoiding Risk of Medication Overuse

If you find that you are slipping into a pattern of using medication more and more frequently, this may indicate the need for a headache preventative medication. Only about 10% of those who would benefit from preventive medications are on an effective regimen. If you are already on a medication for prevention, and you are still taking lots of painkillers, you should work with your doctor. Be certain your prevention medication is as effective as it could be—there are many preventive medications.

Your doctor can help you to decrease your pain medications to make certain you are not in danger of developing medication overuse headache. A recent large population-based study of chronic headache sufferers (Bigal et al, 2008) found that barbiturate-containing medications, such as butalbital, and opioid painkillers were the most likely to cause a transformation from episodic migraine to chronic headache.  The prevalence of transformed migraine was 2.5%, and that due to medication was found to be 1.5%. (Some people “transform” from episodic to chronic migraine spontaneously, and not due to medication use.) What was especially interesting in this study was that the number of headache days per month was an important risk factor for developing medication overuse headache.  The more headaches you have, ironically, the more susceptible you are to certain pain medications causing more headaches. 

Opiates and butalbital can cause the transformation of episodic migraine to chronic headache (more than 15 headache days per month). Triptans and nonsteroidal anti-inflammatory medications, however, do not cause this transformation from episodic to chronic migraine.  They only cause more headaches if you are already experiencing a high number of headache days per month.  The surprising finding of this study was that NSAIDs can be protective for those who have a low number of headache days per month. And finally, the study revealed that in general, women are more likely to experience transformed migraine.  Men, however, are at more risk for transformation due to opiate use, and men who already have chronic headache are more likely to develop medication overuse headache due to triptan usage.

Treatment Satisfaction

Is your migraine treatment as good as it could be? Migraine sufferers often think that they have tried everything that there is to try for their headaches. Your current treatment might be good as it can get. But are you sure? There are new medications being developed all the time.

What are reasonable expectations for the treatment of migraine? A reasonable expectation of migraine prevention would be to reduce headache frequency by half, and to reduce headache severity by about half. It is possible to become headache free, and many people with mild-to-moderate migraine can do so with medication and lifestyle changes. Unfortunately, this is not possible for everyone.  If you have been on a preventive medication for several months and you have not experienced at least a 25% reduction in severity, discuss this with your doctor. Often a dose adjustment can help, and if not, a medication change may be in order.

With an acute migraine medication—the kind you take when you first get an attack, you know, the kind you’re supposed to take early—you should expect to obtain some degree of pain relief within the first hour.  You should be experiencing relief of associated migraine symptoms (like nausea or avoidance of light and sound) with significant pain reduction within two hours. Many people will be migraine-free within two hours. Adding an anti-inflammatory medication to your migraine medication may make it work better. If you develop nausea in the initial stages of your migraine, anti-nausea medication may be helpful also. Be sure to stay well hydrated. Work with your doctor, remember to treat attacks early, and stay ahead of your migraines.

1. Bigal, ME, Serrano, S, Buse, D, Scher, A, Stewart, WF, Lipton, RB, Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population-Based Study, Headache, 2008; 48(8):1157-1168