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Posted By: Carol A. Barch, MN, FNP-BC
March 20, 2020
With a better understanding of migraine pathophysiology, the number of new migraine treatments has exploded in recent years. Over 40 million Americans suffer from migraine or other headache disorders, so it is inevitable that you will see patients with migraine, or will diagnose and manage them yourself—regardless of your area of expertise. That being said, it is imperative that clinicians become familiar with all the options available for prevention and treatment, including new classes of medications and devices. There are multiple sources available to gain this knowledge, but what counseling is essential for patients? What pearls or nuances should we offer them?
The first thing to keep in mind is that we cannot assume that people with migraine understand their diagnosis. There are so many misconceptions about migraine, including devastating stigma. Patients often bring their own misinformation and/or shame to appointments, and won't express this to you unless you explore it with them. It is important that patients with migraine understand that it is a disorder of the brain—most often a result of genetics—that they will have throughout their life, and there is currently no cure. It is critical that they embrace their diagnosis and learn how to best manage their lifestyle and medications for optimal control.
The foundation to achieving migraine freedom is lifestyle management. As we know, the brain regulates all sensory and emotional inputs, including hunger, fatigue, stress, strong odors, bright lights, and sounds. Managing these inputs can be a challenge for people with migraine, and can trigger migraine events. Regular sleep schedules, mealtimes, and exercise routines are critical for optimal brain regulation. Assessment of these areas and creating strategies together will help your patients succeed.
Instructing patients on how to use a headache log is also important, especially for someone just beginning to manage their migraines. Many apps and paper logs are available online. Most are selected based on patient and clinician preference. The goal is to learn about the:
- Qualities of your patients' migraines: duration, frequency, and intensity
- Triggers: poor sleep, missed meals, high stress, strong smells, etc
- Patterns: do they occur on weekends, during menstrual cycle, on days working late or days off
- Response to acute medication: pain free, pain relief, reoccurrence, or medication overuse
- American Migraine Foundation. Navigating life with migraine. americanmigrainefoundation.org/living-with-migraine/migraine-essentials/. Accessed March 20, 2020.
- National Headache Foundation. Resources. headaches.org/resources/#headache-tools. Accessed March 20, 2020.
All this information will help you and the patient develop coping strategies and/or adjust medications as needed.
Migraine is a chronic condition that requires ongoing patient education and medication management, while working towards behavioral changes that optimize migraine management overall. This is a basic, but essential, approach. Some patients can be quite complex with multiple comorbidities and may require a referral to one or more specialist.
Migraine management can be challenging in our fast-paced clinics. Acute and preventive medications and devices can be difficult to implement when coupled with lack of knowledge and poor management. Fortunately, there are excellent patient education resources to supplement the information you provide in person, such as the American Headache Society/American Migraine Foundation and the National Headache Foundation. In these resources you and your patients should find more than a few pearls!