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Objectives: The 5-Steps of Migraine Management

Step 1. Learn About Migraine (Tap the Topic for Details)

Is Migraine a Disease?
Migraine is a painful neurological disease... a migraine attack includes headache, nausea, and an increase sensitivity to your surroundings.
How did I get migraine?
Migraine is genetic, meaning it may run in your family.
What Causes migraine?
​External and Internal Factors, also called "triggers" excite your nervous system. Your nervous system responds by releasing a number of chemicals (CGRP) in your brain to protect you from threats.
migraine patterns
Patterns are how often you have migraine and what causes them. Find your Migraine Pattern by tracking your health daily... including headache days and triggers (light, noise, odors, diet, sleep, stress, weather, hormones)
episodic migraine
​Episodic migraine is less than 14 days of headache per month. 
chronic migraine
​Chronic migraine is 15 or more days of headache per month.
preventive medications
​Preventive Medications include MABs (Monoclonal Antibodies), BOTOX (Chronic Only), Blood Pressure Meds, Antidepressants, and Seizure Meds.  (They reduce how many headaches you have per month). Some are taken quarterly/monthly (MABs and BOTOX)... Others daily. even if no headache is present. 
acute medications
​Acute medications include NSAIDs, Triptans, Combinations, Ergots, Nausea Meds, Gepants, and Ditans. (They are taken when the headache begins)
behavioral therapies
​Behavioral therapies include biofeedback, progressive muscle relaxation, and visualizing your healthy self. You can learn these from a therapist or some online sources.
healthy lifestyle
​Healthy lifestyle includes a combination of a healthy diet, managing triggers, staying hydrated, good sleep, exercise, and practicing relaxation techniques (yoga, deep breathing, meditation).
Shared DEcision-Making
​Shared decision-making is when you and you healthcare provider understand and agree upon an evolving a treatment plan that works over time. Treatment plans should always include tracking on your part, preventive meds, acute meds, behavioral therapies, and a healthy lifestyle.
Treatment Adherence
​Treatment adherence is where you follow your plan and communicate any need for improvement to your healthcare provider over time.  Treatment adherence should always include tracking your migraines, taking meds as prescribed, behavioral therapies, and a healthy lifestyle.
Migraine IQ

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Step 2. Balance Your Life

The Balancing Act of Life
​Life and health is a balancing act. This means for every risk factor you should practice a protective factor. Learn your risk factors and learn how to balance them with protective factors.
External Factors
  • Risk Factor: Light
  • Protective Factor: Shades
  • Risk Factor: Noise
  • Protective Factor: A quiet place or ear protection
  • Risk Factor: Odors
  • Protective Factor: Fresh air
  • Risk Factor: Weather Change
  • Protective Factor: Prevention therapy, prepared w/ acute treat, and behavioral therapy. 
Internal Factors
​Risk Factor: Stress
Protective Factor: Relaxation techniques and organization
Risk Factor: Diet
Protective Factor: Healthy foods and drinks
Risk Factor: Poor Sleep
Protective Factor: 7-9 hours at consistent times
Risk Factor: Hormones
Protective Factor: Prevention therapy, prepared w/ acute treat, and behavioral therapy. 
Communicate with Your Doc
  • Discuss Preventive Medications with your doctor. These prevent migraine from happening or reduce days with headache.
  • Discuss Acute medications with your healthcare provider. These relieve pain and nausea after the migraine starts. 
  • Track your headaches and risk and protective factors... also called triggers.
  • Schedule regular check-ups, and communicate what is working and what is not.
Work Life Balance
​Be mindful when you are at work and when you are not. Allow yourself to be present and good at the task at hand, whether it may be family, friends, activities, play, or work.
Re-Connect with Your body
​Try practicing biofeedback, progressive muscle relaxation, and visualizing your healthy self. 
Live Healthy
Practice a combination of a healthy diet, managing triggers, staying hydrated, good sleep, exercise, and practicing relaxation techniques (yoga, deep breathing, meditation). If you notice, non-healthy habits have a very short-term gratification period. Healthy habits have long-term benefits. 

Step 3. Prevent Migraine

What are preventive medications?
​Preventive Medications include MABs, BOTOX (Chronic Only), Blood Pressure Meds, Antidepressants, and Seizure Meds.  (They reduce how many headaches you have per month). Some are taken quarterly/monthly (MABs and BOTOX)... Others daily... even if no headache is present.

ALWAYS consult your healthcare provider for all healthcare decisions.
MABs (Monoclonal Antibodies)
How they work: External and Internal Factors (Triggers) elevate levels of CGRP in certain parts of the brain, which cause inflammatory events. CGRP is involved in the transmission of pain when it binds to CGRP receptors. ​MABs block binding, which prevents headache pain. 

MAB Options (FDA Approved in 2018)
  • MAB: Fremanezumab-vfrm
    • Delivery: Self-Administered Quarterly or Monthly Injection
    • Brand Name: Ajovy
    • Website: https://www.ajovy.com
    • Made by: Teva
    • How it works: Binds to CGRP Blocking Pain Signals
    • For Episodic or Chronic Migraine (Must have tried a previous prevention option).
  • MAB: Eptinezumab-jjmr
    • Delivery: 30 min Intravenous Quarterly or Monthly
    • Brand Name: Vyepti
    • Website: https://www.vyeptihcp.com/
    • Made by: Lundbeck
    • How it works: Binds to CGRP Blocking Pain Signals
    • For Episodic or Chronic Migraine: Must have tried a previous prevention option.
  • MAB: Erenumab-aooe
    • Delivery: Self-Administered Monthly Injection
    • Brand Name: Aimovig
    • Website: https://www.aimovig.com/
    • Made by: Amgen and Novartis
    • How it works: Binds to CGRP Receptor Blocking Pain Signals.
    • For Episodic or Chronic Migraine: Must have tried a previous prevention option.
  • MAB: Galcanezumab-gnlm
    • Delivery: Self-Administered Monthly Injection
    • Brand Name: Emgality
    • Website: https://www.emgality.com/
    • Made by: Lilly
    • How it works: Binds to CGRP Blocking Pain Signals
    • For Episodic or Chronic Migraine: Must have tried a previous prevention option.
​ONABOTULINUMTOXINA (BOTOX)
​OnabotulinumtoxinA (FDA Approved in 2010)
  • ​Delivery: 31 injections every 3-months by Healthcare Provider
  • Brand Name: BOTOX
  • Website: https://www.botoxchronicmigraine.com/
  • Made by: Allergan
  • How it works: Blocks Pain Signals
  • Must be diagnosed with Chronic Migraine (15+ Headache Days Per Month)
​​BLOOD PRESSURE MEDS
  • ​Beta Blockers
    • Propranolol/Inderal (Brand)
    • Timolol/Blocadren (Brand)
    • Metoprolol/Toprol (Brand)
    • Nadolol/Corgard (Brand)
  • Calcium Channels Blockers
    • Verapamil/Calan, Isoptin (Brands)
  • ARB (Angiotensin Receptor Blocker)
    • Candesartan/Atacand (Brand)
​ANTIDEPRESSANTS
  • ​​Tricyclic Antidepressants
    • Amitriptyline/Elavil (Brand)
    • Nortriptyline/Pamelor (Brand)
  • SNRI (Serotonin and Norepinephrine Reuptake Inhibitor)
    • Venlafaxine/Effexor (Brand)
​SEIZURE MEDS
  • ​Topiramate/Topamax, Trokendi, Qudexy (Brands)
  • Valproate/Convulex, Depakote, Epilim, Stavzor (Brands)

Step 4. Treat Migraine

What are acute medications?
​Acute medications include NSAIDs, Triptans, Combinations, Ergots, and Nausea Meds. (They are taken when the headache begins)
NSAIDs (​NONSTEROIDAL ANTI-INFLAMMATORY DRUGS)
  • Ibuprofen/Advil, Motrin (Brands)
  • Naproxen Sodium/Aleve, Anaprox (Brands)
  • Diclofenac Potassium/Cambia (Brand)
  • Ketorolac/Toradol (Brand)
Triptans
  • Almotriptan/Axert (Brand)
  • Eletriptan/Relpax (Brand)
  • Frovatriptan/Frova (Brand)
  • Naratriptan/Amerge (Brand)
  • Rizatriptan/Maxalt (Brand)
  • Sumatriptan/Imitrex, Zembrace, Onzetra, Tosymra (Brands)
  • Zolmitriptan/Zomig (Brand)
Combinations
  • Naproxen + Sumatriptan/Treximet (Brand)
  • Aspirin + Acetaminophen + Caffeine/Excedrin Migraine, Goody's, BC Powder (Brands)
ERgots
  • Dihydroergotamine/Migranol (Brand)
  • Ergotamine/Ergomar (Brand)
Nausea Meds
  • Prochlorperazine/Compazine, Compro (Brand)
  • Metoclopramide/Reglan (Brand)
Gepants
  • rimegepant (Nurtec ODT)
  • ubrogepant (Ubrelvy)
Ditans
lasmiditan (Reyvoy)

Step 5. Achieve Health

Do Your Part
  • Healthy lifestyle includes a combination of a healthy diet, managing triggers, staying hydrated, good sleep, exercise, and practicing relaxation techniques (yoga, deep breathing, meditation).​
Communicate With Your Doc
​Shared decision-making is when you and you healthcare provider understand and agree upon an evolving treatment plan that works over time. Treatment plans should always include tracking on your part, preventive meds, acute meds, behavioral therapies, and a healthy lifestyle.
Demand Quality Care
​Treatment adherence is where you follow your plan and communicate any need for improvement to your healthcare provider over time.  Treatment adherence should always include tracking your migraines, taking meds as prescribed, behavioral therapies, and a healthy lifestyle. But always demand quality health. This means schedule regualr appointments and continue to improve your migraine management plan. 
Advocate for Your Health
​If your doctor is not working out, find a headache specialist. It is up to you to find the help you deserve.
​Here is some inspiration...

A Real-Life Migraine Hero

This is Jennifer's Story.
Made possible by a grant from Teva Pharmaceuticals