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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Twitter: @drdeejimmeh Facebook: Decontee “Dr. Dee” Jimmeh, MD

Contact Dr. Dee Brookwood Medical Center, Professional Office

Building, Suite 301 Phone 205-250-6940 Fax 205-250-6942 www.norwoodclinic.com