Objectives

The 5 Steps of Migraine Management

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

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: 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)

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.