Managing Migraine, Preventive Therapies Can Reduce the Frequency and Severity of Acute Attacks

Main Category: Headache / Migraine
Article Date: 16 Aug 2004 - 12:00 PDT

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Preventive therapies can reduce the frequency and severity of acute attacks. When the attack does hit, abortive medications can usually return the patient to normal function within about two hours. Physicians can quickly screen for migraine with considerable accuracy. The clinician's role, according to one migraine expert: "…it's the management decisions."

"A recent study assessed loss of productivity time and cost due to pain disorders in the United States workforce and it found the most common condition resulting in lost productivity time was migraine," says Frederick R. Taylor, MD. "It's an enormous issue for employers. In addition to significant pain, patients suffering from severe migraine can become bedridden, and have poor cognition and disordered thoughts. Because it can be so disabling, migraine is a significant issue for all physicians."

A study published in the August 2003 issue of Neurology assessed patients who reported suffering headaches with disability, nausea, and/or light intolerance within the past three months. It found that patients having at least two of those three symptoms met the International Headache Society (IHS) criteria for migraine with 93% positive predictability. Patients reporting all three headache symptoms were 98% likely to be defined as a migraineur.

"That study basically illustrates that physicians can quickly screen for migraine by simply asking their patients if their headaches are recurring over time and if nausea, disability, or light sensitivity accompany them," says Dr. Taylor. "The IHS criteria require five or more headaches with at least two of four criteria of moderate to severe pain, unilaterality, throbbing pain, pain worsened by activity associated with either light and noise intolerance, or nausea or vomiting. But migraine in actuality is defined as any headache that causes functional limitation and is intermittent with a normal exam. We have learned that nearly everyone who presents to a primary care physician with headache essentially has migraine.

"Additionally, the physician has the 'watchdog' role for sinister or worrisome headaches. Studies have shown that only about one-third of patients will actually discuss their physical disability from their headaches with their physician. Physicians therefore need to ask if there are systemic signs, such as fevers, or abnormal neurological signs. Is there sudden onset of headache? Is the patient older or especially young? Is the suspected migraine sub-acutely progressive? It doesn't take much time to ask these questions, but physicians can gather critical information that will help them identify whether a patient has a secondary headache or is a migraineur. It's fairly simple, but what isn't simple is getting patients to manage their condition appropriately and getting practitioners to help with that management."

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