Malady Wise

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Migraine

Fact sheet

Step 1 - Education

  • Four stages of migraine 1) prodrome 2) aura 3) headache and then 4) postdrome

  • 75% of people have a prodrome with yawning, euphoria, depression, irritability, food cravings, constipation, or neck stiffness occurring 1 to 2 days before the headache

  • 25% of people have an aura lasting 5 to 60 minutes which may have positive symptoms (seeing bright lights, ringing in ears, tingling in skin, muscle twitches) or negative symptoms (loss of vision, hearing, feeling or movement)

Step 2 - Lifestyle factors that help

  • Regular sleep schedule

  • Limit variations in blood glucose (regular meals, avoid high sugar foods)

  • Stay hydrated (1.5 to 2 L of water per day)

  • Limit caffeine (1 to 2 cups daily)

  • Regular exercise (30 minutes 5 times a week) - walking is a good option, exercise that involves jumping or running may trigger migraines

  • Good workplace setup (optimal desk height, screening brightness, room lighting) with regular breaks (to stretch and rest eyes)

  • Regular relaxation (meditation, mindfulness, yoga, breathing techniques)

Step 3 - Avoid known triggers

  • Emotional stress (self reported in 80% of migraine sufferers)

  • Hormones changes in women (65%)

  • Not eating (57%)

  • Weather (53%)

  • Sleep disturbances (50%)

  • Odours (44%)

  • Neck pain (38%)

  • Lights (38%)

  • Alcohol (38%)

  • Smoke (36%)

  • Sleeping late (32%)

  • Heat (30%)

  • Food (27%)

  • Exercise (22%)

  • Sexual activity (5%)

Step 4 - Supplements

  • Evidence is not strong but a 3 month trial of any of these supplements can be tried separately or in combination

    • Magnesium (elemental) - 400 to 650mg orally once daily

    • Riboflavin - 200mg orally twice daily 

    • Coenzyme Q10 - 300mg once daily

Step 5 - Acute general measures

  • Cold pack over the forehead or back of the head

  • Hot pack over the neck and shoulders

  • Neck stretches and gentle range of movement exercises

  • Resting in a quiet dark room

Step 6 - Acute migraine attack medication

  • Aspirin 600 to 900 mg orally (2 to 3 tablets). Not safe for children OR

  • Ibuprofen 400 to 600 mg orally (2 to 3 tablets) OR

  • Paracetamol 1000 to 1500 mg orally (2 to 3 tablets)

  • Can combine and do Paracetamol and either Aspirin or Ibuprofen together

Step 7 - If nausea you can add

  • Metoclopramide (Maxalon) - 10 mg orally OR

  • Domperidone (Motilium) - 10 to 20 mg orally OR

  • Ondanestron (Zofran) - 4 to 8 mg orally OR

  • Prochlorperazine (Stemetil) - 5 to 10 mg orally 

Step 8 - If simple analgesia is not enough, you can add a Triptan

  • Eletriptan (Relpax) - 40 to 80 mg orally  OR

  • Rizatriptan (Maxalt) - 10 mg orally  OR

  • Sumatriptan (Imigran) -  50 to 100 mg orally  

  • If needed, can repeat dose but should wait at least 2 hours 

Step 9 - Consider long-term prophylaxis medication if frequent migraines

  • Propranolol (Inderal) - Blood pressure medication known as a Beta Blocker

    • Start with 20 mg orally at night. Increase dose by 20 mg at intervals of at least 1 week up to effect. Maximum daily dose 160 mg in 2 or 3 divided doses. Side effects may include worsening asthma, low blood pressure, tiredness

  • Amitriptyline (Endep) - Tricyclic antidepressant used for nerve pain

    • 10mg orally at night. Increase daily dose by 10 mg at intervals of at least 1 week up to effect. Maximum daily dose 75 mg. Side effects include sleepy, dry mouth

  • Candesartan (Atacand) - Blood pressure medication known as an ARB

    • 4mg orally daily. Increase daily dose by 4mg at intervals of at least 1 week up to effect. Maximum daily dose 32mg.

  • All medications take 8 to 12 weeks at maximum tolerated dose to assess if effective

Step 10 - Other options

  • Neurologist doctors are the experts and can help if simple measure fail

  • Regular Botox injections into the back of the neck is an effective option

  • Long-term use of simple analgesia and Triptans can lead to a medication overuse headache. Limit simple analgesia to less than 15 days per month and Triptans to less than 10 days per month

  • Menstrual migraines can be treated with Ibuprofen, Naproxen or Naratriptan starting 2 to 3 days prior to your period or through period suppression