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HomePopularA Patient Who Has Been Experiencing Frequent Severe Migraine

A Patient Who Has Been Experiencing Frequent Severe Migraine

Lifestyle Modification And Trigger Reduction

Precision Management of Chronic Migraine | Seizing Control

When patients have chronic severe headaches, it can be difficult to recognize specific triggers. Paradoxically it is often the case that as chronic headaches start to improve with treatment, triggers become more obvious. Regularity of regimen with regard to meals, hydration, sleep and stress is always helpful in reducing the tendency to migraines recognizing that this is helpful is straightforward, but actually making the requisite changes in a modern busy life may be more difficult.

Many patients with chronic migraine will have other problems that exacerbate their tendency to headaches: these include depression, anxiety, other pain syndromes such as fibromyalgia, localized pain in head and neck structures, and conditions that create metabolic strain such as sleep apnoea or postural orthostatic tachycardia syndrome. Proper management of these is necessary to maximize the effect of any other migraine treatments. It is particularly important to recognize and manage medication overuse as failure to do so will render most attempts at preventive treatment ineffective .

Headaches Related To Stress Or Mood Disorders

Work to reduce stress and promote relaxation in your environment. Self-massage or massage therapy may help ease the tension that causes ongoing headaches. You may also benefit from reducing stimuli and resting in a dark, quiet room.

Your doctor can help you address your stress, anxiety, or mood disorder through a combination of cognitive behavioral therapy and medication.

Your doctor may prescribe antidepressants or anti-anxiety medications that can help relieve the tension and stress causing your prolonged headaches. Some medications for anxiety also work to reduce headache.

When To Get Medical Advice

You should see a GP if you have frequent or severe migraine symptoms.

Simple painkillers, such as paracetamol or ibuprofen, can be effective for migraine.

Try not to use the maximum dosage of painkillers on a regular or frequent basis as this could make it harder to treat headaches over time.

You should also make an appointment to see a GP if you have frequent migraines , even if they can be controlled with medicines, as you may benefit from preventative treatment.

You should call 999 for an ambulance immediately if you or someone you’re with experiences:

  • paralysis or weakness in 1 or both arms or 1 side of the face
  • slurred or garbled speech
  • a sudden agonising headache resulting in a severe pain unlike anything experienced before
  • headache along with a high temperature , stiff neck, mental confusion, seizures, double vision and a rash

These symptoms may be a sign of a more serious condition, such as a stroke or meningitis, and should be assessed by a doctor as soon as possible.

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What Headache Symptoms Require Immediate Medical Care

If you or your child has any of these headache symptoms, get medical care right away:

  • A sudden, new, severe headache
  • A headache that is associated with neurological symptoms such as:
  • Weakness
  • Vision changes
  • Headache with a fever, shortness of breath, stiff neck, or rash
  • Headache pain that awakens you up at night
  • Headaches with severe nausea and vomiting
  • Headaches that occur after a head injury or accident
  • Getting a new type of headache after age 55
  • Symptoms requiring an appointment with your health care provider or a headache specialist

    Contact your health care provider if you or your child has any of the following symptoms:

    • Three or more headaches per week.
    • Headaches that keep getting worse and won’t go away.
    • Need to take a pain reliever every day or almost every day for your headaches.
    • Need more than 2 to 3 doses of over-the-counter medications per week to relieve headache symptoms.
    • Headaches that are triggered by exertion, coughing, bending, or strenuous activity.
    • A history of headaches, but have noticed a recent change in your headache symptoms.

    How Is Abdominal Migraine Diagnosed

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    There is currently no test to confirm abdominal migraine. Your doctor will make a diagnosis based on specific criteria that details the type, frequency, and severity of symptoms associated with abdominal migraine. The diagnosis will typically be made only after all other causes of abdominal pain have been ruled out.

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    Can A Migraine Cause A Stroke What Are The Risk Factors

    Migraine and stroke may occur at the same time, but a causal link has not been established. When an ischemic stroke occurs during a migraine attack it is called a “migrainous infarction.” The specific type of migraine associated with an increased risk of ischemic stroke is migraine with aura, a type of migraine that affects about one-quarter of all people with migraines. Rarely, people with specific migraine symptoms may be related to a higher risk of stroke.

    Migraines may be a risk factor for stroke, in that strokes occur more frequently in people who have had migraines, but the strokes do not necessarily occur during migraine attacks.

    How To Treat Migraine And Headaches

    There are a variety of ways to help reduce or prevent headache symptoms. The first step is to find a doctor who can diagnose what type of headache you have just seeing your primary doctor is not likely to get you the diagnosis or treatment you need. Instead seek out a neurologist or headache specialist. The Migraine Research Foundation provides a list of headache doctors by state and city.

    To diagnose your headache, you will probably be asked to fill out a detailed medical history and undergo a physical exam that will include testing your motor skills, senses, and reflexes. To rule out any possible serious conditions that may be causing your headaches, you also may be asked to undergo blood tests and imaging such as an MRI or CAT scan.

    Once the diagnosis is made, your doctor will recommend a treatment approach based on the type of headache you have and the severity of your symptoms. The most common approaches include medications and making lifestyle changes, such as avoiding your known triggers and reducing stress.

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    How Common Are Headaches In Adults

    If your head is throbbing, youre not alone. Headache is one of the most common pain conditions in the world. Up to 75% of adults worldwide have had a headache in the past year.

    Headaches are a major cause of absenteeism from work and school. They also take a toll on social and family life. For some people, continually battling headaches can lead to feeling anxious and depressed.

    % Of Patients Reported Experiencing Moderately Severe To Extremely Severe Migraines

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    Chronic migraines and disability often go hand in hand. As many as three-quarters of migraineurs have reduced ability to function during the attacks. Whats more, one-third of them require bed rest. Following that, it comes as no surprise that migraine is among the top-25 causes of years lived with disability .

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    How Is Abdominal Migraine Similar To A Migraine

    Abdominal migraine and migraine share similar triggers, such as stress, skipping meals, exposure to bright light, poor sleep, and foods containing chocolate, caffeine, and monosodium glutamate . Because there are so few studies on medications used to treat abdominal migraine, patients with the condition are often treated with medications shown to be effective on a migraine.

    Weather Triggers Migraines In 50% Of Patients

    Some people experience migraines upon changes in the air and temperature. Namely, headaches can be aggravated by increased temperature, humidity, or the arrival of storms, as well as sudden changes in barometric pressure or altitude. Many migraine sufferers are also sensitive to seasonal changes and the effects of traveling through time zones.

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    % Of Migraine Patients Improve Their Quality Of Life After Therapeutic Intervention

    Migraine statistics sure do give some hope. Results of an epidemiological study suggest that more than half of patients with migraines improved their quality of life in comparison to the two years before the intervention. The study also noted a 56% decrease in headache severity and a 36% decrease in post-traumatic headache frequency.

    Acute Migraine Headache: Treatment Strategies

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    LAURA MAYANS, MD, MPH, and ANNE WALLING, MB, ChB, University of Kansas School of Medicine, Wichita, Kansas

    Am Fam Physician. 2018 Feb 15 97:243-251.

    Patient information: A handout on this topic is available at .

    Migraine is a primary headache disorder characterized by recurrent attacks. Acetaminophen, nonsteroidal anti-inflammatory drugs, triptans, antiemetics, ergot alkaloids, and combination analgesics have evidence supporting their effectiveness in the treatment of migraine. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line treatments for mild to moderate migraines, whereas triptans are first-line treatments for moderate to severe migraines. Although triptans are effective, they may be expensive. Other medications such as dihydroergotamine and antiemetics are recommended for use as second- or third-line therapy for select patients or for those with refractory migraine. The pharmacologic properties, potential adverse effects, cost, and routes of administration vary widely, allowing therapy to be individualized based on the pattern and severity of attacks. Several treatment principles, including taking medication early in an attack and using a stratified treatment approach, can help ensure that migraine treatment is cost-effective.



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    How Prevalent Are Migraines

    Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.

    Things that can make the headaches more likely to occur include:

    • Alcohol

    How Long Does A Headache Last After A Migraine

    The length of migraines vary but can last anywhere from 4 to 72 hours. Predicting how long an individual migraine will last can be difficult, but charting its progress may help. Migraines are typically divided into the below five distinct stages:

    • warning phase
    • resolution period
    • recovery stage

    Some of these phases may only last a short amount of time, while others last much longer. Also, keep in mind that you may not experience each phase with every migraine you have. Keeping a migraine journal can help you prepare for whats to come and track any patterns.

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    What Is A Migraine Headache

    Although the term “migraine” is often used to describe any severe headache, a migraine headache is the result of specific physiologic changes that occur within the brain, and lead to the characteristic pain and associated symptoms of a migraine.

    Migraines usually are associated with sensitivity to sound, light, and smells. A migraine attack may be accompanied by nausea or vomiting. This type of headache often involves only one side of the head, but in some cases, patients may have pain bilaterally or on both sides. The pain is often described as throbbing or pounding and it may be made worse with physical exertion.

    Not all headaches represent migraines, and migraine is not the only condition that can cause severe and debilitating headaches. For example, cluster headaches are very severe headaches that affect one side of the head in a recurrent manner . The pain is sometimes described as “drilling,” and can be worse than migraine pain in some cases. Cluster headaches are less common than migraine.

    Tension headaches are a more common cause of headache. These occur due to contraction of the muscles of the scalp, face, and neck.

    Migraine In Children And Adolescents

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    Migraine is a complex and disabling inherited neurological condition which occurs in 4-10% of children. Nearly half of children with migraine never receive a diagnosis. It can be a cause of undiagnosed abdominal pain or headache in children. Studies suggest that around 60% of children aged between 7 and 15 experience headache but the diagnosis may be delayed because the presentation is not always one of headache. Abdominal pain, cyclical vomiting, travel sickness, limb pain and episodic dizziness can all confuse the picture. Headache may be absent or not follow the pattern more commonly associated with migraine in adults.

    Migraine can result in severe impact on the life of a child but also on their family, school life and social activities. Missing the diagnosis can result in further harms to the child including poor management of their symptoms, anticipatory anxiety about future attacks, inappropriate/ineffective medication use, a loss of confidence and low self esteem, poor attendance at school or school refusal and even being mislabelled as a malingerer. see Factsheet: Advice to schools.

    Migraine affects boys and girls equally until puberty, after which migraine is more prevalent in girls . Severe pain and vomiting which are not treated effectively can mean that children often have to remain at home during attacks and are unable to participate in normal daily activities.

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    How Common Are Headache Disorders

    Globally, it has been estimated that prevalence among adults of current headache disorder is about 50%. Half to three quarters of adults aged 1865 years in the world have had headache in the last year and, among those individuals, 30% or more have reported migraine. Headache on 15 or more days every month affects 1.74% of the worlds adult population. Despite regional variations, headache disorders are a worldwide problem, affecting people of all ages, races, income levels and geographical areas.

    Take A Detailed History

    Accurate history taking is vitally important in the diagnosis of migraine. It is important to give patients time to describe their attacks fully , and also to clarify the history with specific questions aimed at filling out the gaps in what the patient has told you spontaneously. The diagnosis of migraine lies in the history, and that the purpose of examination is primarily to look for other problems that may be exacerbating an underlying tendency to migraine. This may in most cases be restricted to fundoscopy, inspection and palpation of the head and neck structures, and a brief screening cardiovascular and neurological examination, unless, on the basis of the history, serious intracranial or systemic pathology is suspected.

    It is then useful to ascertain what treatments, current and previous, have been tried, and at what point these treatments are taken. Patients should be asked to bring a list of medications tried in the past, including doses, and be asked why these treatments were abandoned . The use of alternative or complementary therapies should also be sought.

    While superficially there seems to be a lot of information required, it is almost invariably the case that patients will volunteer much of this information without being specifically asked, and it usually does not take too much time to fill out the gaps if a structured approach to the history taking is followed. If there is uncertainty, then encouraging the patient to keep a headache diary can be very useful.

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    When Should I Take My Child To The Doctor

    It may be obvious, particularly if you have migraine yourself, that your childs symptoms are typical of migraine. If attacks have obvious causes, symptoms respond to painkillers, and your child is otherwise fit and well, it is probably not necessary to seek a doctors advice. However, you should make an appointment for your child to see a doctor if there is any doubt about the nature or cause of the headaches, if your child seems generally unwell, or if the headaches are interfering with daily activities.

    In particular, it is very important to see a doctor in the following circumstances: Headaches start under age 7 The headache changes An unaccountable increase in frequency, severity and duration of attacks Recent school failure Balance or co-ordination problems Failure to grow/attain normal developmental goals

    How Are Headaches Treated

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    One of the most crucial aspect of treating headaches is figuring out your triggers. Learning what those are typically by keeping a headache log can reduce the number of headaches you have.

    Once you know your triggers, your healthcare provider can tailor treatment to you. For example, you may get headaches when youre tense or worried. Counseling and stress management techniques can help you handle this trigger better. By lowering your stress level, you can avoid stress-induced headaches.

    Not every headache requires medication. A range of treatments is available. Depending on your headache type, frequency and cause, treatment options include:

    Stress management

    Stress management teaches you ways to cope with stressful situations. Relaxation techniques are helpful in managing stress. You use deep breathing, muscle relaxation, mental images and music to ease your tension.


    Biofeedback teaches you to recognize when tension is building in your body. You learn how your body responds to stressful situations and ways to settle it down. During biofeedback, sensors are connected to your body. They monitor your involuntary physical responses to headaches, which include increases in:

    • Breathing rate.
    • Brain activity.


    Occasional tension headaches usually respond well to over-the-counter pain relievers. But be aware that using these medications too often can lead to a long-term daily headache.

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    People Can Die From Migraines If Other Conditions Accompany Them

    Do people die from a migraine? In some cases, migraine is accompanied by migrainous infarction, a complication that might lead to a stroke. It has also been found that people who have migraines with aura are at about twice the risk of stroke than the general population. Note, however, that the incidence of migrainous infarction is very lowit accounts for 0.2%0.5% of all cerebral ischemic causes.


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