Baxter Publishing 2008 Inc

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Q: What is migraine?

A: By definition, migraine is a headache that recurs over time.  Migraine is a condition of the nervous system, a neurologic disorder.  People who are prone to migraine are born with a highly sensitive, vigilant nervous system that is often inherited.  The brain of a migraine sufferer reacts to light and sound at a lower threshold than the brain of someone without migraine.  When their hyper-excitable brain interacts with potential migraine triggers the nervous system becomes overloaded and an attack of migraine ensues.  A migraine attack is always much more than a headache, evolving in stages that may last several days.  It is a complex biological process that begins in the brain and produces many other symptoms that occur before, during, and after the attack, such as nausea, aura, fatigue, emotional irritability, and muscle pain in the neck and shoulders.  While migraine cannot be cured, with effective care it can be managed.

Q:  What should I do when migraine symptoms appear?

A: Identifying prodromal (pre-migraine) symptoms is the key to early treatment and prevention of a fully-developed migraine attack.  During the prodrome, warning symptoms can be recognized as predicting migraine attacks and often consist of fatigue, emotional irritability, difficulty with concentration and thinking, food cravings or loss of appetite, sensitivity to light or noise, and muscle pain in the head, neck and shoulder areas.  These symptoms can begin a day or two before the onset of the headache, but more commonly start several hours before.  This window of opportunity offers the migraine sufferer a chance to reverse the process before the headache begins.  When pre-headache symptoms occur, preventive strategies include:  removing yourself from stressful situations, taking a nap, taking an over-the-counter medication.  During the prodrome phase it is better to practice behaviours that protect and nurture the nervous system, such as exercise and relaxation, than attempting to accomplish tasks before the attack occurs.

Q: How can I form a successful partnership with my healthcare provider?

A: One of the most essential tools for migraine sufferers is their healthcare professional.  A quality healthcare professional will be a source of education, evaluation, monitoring of medications, and of course prescriptions.  Honestly appraising the relationship between you and your healthcare provider is essential for success.  Finding a professional that is sincerely interested in helping you manage your migraines is paramount, as is someone who will make tough decisions on your behalf.  Good communication is also vital.  You must function as a team with a specific set of goals and objectives so that your needs can be effectively met.  It is essential that you assess your own ability to be honest and not simply provide misleading information to please your provider.  During your evaluation, express your concerns honestly and allow your provider to understand what is and is not clear to you about your diagnosis and treatment plan.

Q:  What lifestyle changes can I make to gain control over my headaches? 

A:  Take charge of your health by engaging in behaviours that promote overall wellbeing.  These include: eating nutritious foods, taking supplements (multivitamins, vitamin B and sometimes magnesium), exercising for twenty minutes per day, drinking one liter of water daily, and addressing upsetting interpersonal issues.  Learn to say “no” to the demands of others when necessary and put yourself first without feeling selfish, or guilty.  A schedule for three meals a day and a consistent time for going to bed and awakening is important.  Avoid junk food and limit caffeine consumption to two cups per day.  Identify foods that may trigger a migraine attack such as aged cheese, red wine, peanuts, and sausage containing nitrates. Eliminate these triggers from your diet.  Make sure to participate in one fun or relaxing activity each day.  If you believe that medication alone will lessen headache frequency you will rely on medicine and may lack the motivation to make important lifestyle changes.

Q:  What are the benefits of keeping a “headache diary”?

A:  Self-knowledge in monitoring your headaches and subtle physical cues is the foundation for successful migraine management.  Tracking your progress with a diary provides facts that help your clinician work with you to gain control over disabling headaches.  Being aware of how you function between attacks of migraine helps the clinician judge the effectiveness of your treatment strategy.  The headache calendar/diary is an invaluable tool for self-assessment, enabling you to record the frequency of migraine days, the number of days without reduced productivity, the quantity of medications used, or the quality of life that your are experiencing while managing your migraines.   Monitoring and reporting changes in mood, irritability, sleep, anxiety, reaction to changing weather, or weight gain provide essential medical information that can significantly improve medical decision-making.  Keeping a detailed diary will provide a basis for discussion with your healthcare provider.  Once you see that migraine follows a predictable pattern you will no longer fear a sneak attack and can identify risk factors that make you vulnerable.