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10 STEPS MIGRAINE SUFFERERS SHOULD TAKE TO ENSURE PAIN RELIEF
MONTREAL -- People who believe they suffer from migraine headaches must be their own advocates in seeking pain relief, according to guidelines announced today. Those who have regular headaches should follow 10 steps to the best care, suggests migraine guidelines developed by the U.S. Headache Consortium, which are being announced here at the 42nd Annual Scientific Meeting of the American Headache Society (AHS).
"More than three years in the making, these guidelines include assigning a grade to all of the medications available and are designed to help physicians best treat their patients with migraine," said Stephen D. Silberstein, M.D., professor of neurology at Jefferson Medical College of Thomas Jefferson University, and director of the Headache Center at Thomas Jefferson University Hospital, Philadelphia. "But they're also designed to help patients be their own advocates in seeking that care."
The consortium guidelines represent the first national effort to provide a unified, recommended approach to care for a condition that is significantly under-treated.
While migraine headaches affect 28 million Americans, about 13 percent of the U.S. population, less than half of migraine sufferers have been diagnosed by a physician.
The guidelines suggest 10 steps sufferers should take to receive the best treatment for their migraine headaches:
1. Know your headache diagnosis. Headaches have many causes. Recurrent, disabling headaches are usually migraine headaches. Keep a diary to identify when your headaches occur and what seems to trigger them.
2. Find a good doctor. Find a physician who understands the problem and is willing to work with you to find appropriate treatment. In most cases, migraine can be diagnosed without the use of expensive diagnostic tests such as magnetic resonance imaging (MRI) or CT (computed tomography).
3. Tell your doctor exactly how your headaches affect your life. Migraine often causes temporary disability. The frequency and extent of disability are important guides to treatment.
4. Avoid headache triggers. Once migraine is diagnosed, try to avoid or reduce the incidence of things that your headache diary seems to indicate can trigger a migraine attack, whether a certain food, changes in sleeping patterns, etc.
5. Find appropriate medication for your attacks. Less severe migraines can be treated successfully with over-the-counter medication. If you have moderate to severe headaches, make sure your doctor prescribes the best medication available. One of the many triptans -- which block the production of serotonin, the body's pain receptor -- are generally best for treating these types of headaches. While one triptan may not work for you, another one might. Triptans are available as tablets, pills that melt on your tongue, nasal sprays and injections. If rapid relief is important or nausea is a problem, nonoral treatments may be helpful.
6. Don't overuse pain medication. Overuse of medication, whether over-the-counter or prescription, can cause rebound headaches. As the medicine wears off, it can trigger the next headache.
7. Have at least two treatment options available. Ask your doctor to prescribe a "rescue" medication that you can take if your regular medication fails, which can prevent trips to the emergency room to deal with overwhelming pain.
8. If one medicine doesn't work, try another one. Treat several attacks with each treatment to determine if it works. If the medication does not provide satisfactory relief after three attacks, ask for a new medication.
9. Ask your doctor about preventive drugs. If you have two or more headaches a week, ask your doctor to prescribe a preventive medication that you can take on a regular basis to reduce the number of headaches you get. The benefits of preventive medication develop over a period of several months.
10. Consider alternative treatment. If you are opposed to, or cannot take medication (due to pregnancy, nursing, overuse of pain medications, etc), consider an alternative therapy. Studies prove that biofeedback and relaxation training work for some people.
Based on a review of hundreds of studies of migraine treatments, the U.S. Headache Consortium assigned grades (A, B or C) to each of the medications. The consortium also devised a suggested protocol for physicians to follow in treating headache sufferers.
The consortium is composed of six associations in addition to the AHS: the American Academy of Neurology, the American Academy of Family Physicians, the American College of Emergency Physicians, the American College of Physicians-American Society of Internal Medicine, the American Osteopathic Association and the National Headache Foundation.
The American Headache Society (AHS), founded in 1959 as the American Association for the Study of Headache, is based in Mt. Royal, N.J. AHS is a professional organization for those interested in the study and management of headache and face pain. AHS has approximately 1,500 members. For more information, visit the AHS Web site at http://www.ahsnet.org. To fill the need for patient education, AHS established the American Council for Headache Education (ACHE), a non-profit patient-physician organization for the advancement of the treatment and management of headache and the encouragement of more constructive social attitudes towards the disease. Individuals who would like more information about headache, who would like a referral to a specialist who treats headache, or who would like information on support groups can call (800) 255-ACHE, write to ACHE at 19 Mantua Road, Mt. Royal, N.J. 08061, or visit the ACHE Web site at http:/www.achenet.org.
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