What is the difference between a headache and a migraine?
Are the treatments for migraine different from headache treatments?
Is there more than one type of migraine?
This video is the first in a series about headaches and migraines.
Watch to the end, and I’ll tell you about my next videos.
So, let’s talk about migraine today.
I made this video series in collaboration with Migraine Canada.
If you want to learn more about migraines,
visit their website.
They have a lot of resources, events, and education materials for you to learn more
about migraines.
A migraine is not the same as a headache.
A headache is just a pain in the head, without other symptoms or any specific recurrence
pattern.
A migraine includes pain in the head (headache) and many other symptoms.
There are many types of migraines, not just one.
We can’t diagnose migraine with a blood test or imaging study.
The diagnosis is based on the typical symptoms.
The doctor will do a physical examination to ensure there is no other cause for the
headache.
The International Headache Disorder Classification has suggested the following criteria to diagnose
migraine: The person has days with headaches and days
without headaches.
The pain in the head always has the same characteristics.
They always start the same way and follow the same pattern.
If you have a new type of headache, it could be something else.
The episodes of headaches usually last from a few hours to a few days.
The most common type of pain involves one side of the head, throbbing and severe in
intensity.
We will talk about the many types of migraines and how they vary in pain characteristics.
Other symptoms.
So here is the big difference between a migraine and a headache.
Migraines come with other symptoms from two categories.
One is hypersensitivity to light, noise, and smells.
The other is gastro-intestinal, with nausea, vomiting, or just an upset stomach.
2/3 have neck pain and many report sinus or facial pain.
They may also have poor concentration, dizziness, and vision problems.
The most severe type of migraine is called “Chronic Migraine.”
It means that the person has headaches at least 15 days per month; fortunately, it is
less common than “Episodic Migraine” which affects the person between 0 and 14 days of
the month.
Migraine is the second most common type of headache.
The first is tension-type headaches.
Migraine affects 25% of women, 8% of men, and 10% of children in Canada.
There are migraines with aura and without aura.
Aura is a symptom that occurs before the headache starts.
The most common aura symptom is visual disturbance such as flashing lights, bright colour spots,
zigzag lines, and foggy vision, but they can also include numbness, tingling, and in some
cases weakness.
There is also a period of postdrome, after the headache ended, the person may still have
symptoms of feeling extremely tired, difficulty to concentrate, or with mood swings.
The patient usually knows that the episode of migraine is about to start.
People with migraine tend to use a lot of pain mediations, then they may have an overlapping
MOH.
This type of headache is caused by taking too many pain medications and is called medication
overuse headaches.
Before I continue, let me remind you that this video is not intended to replace medical
advice.
It is for educational purposes only.
Please talk to your doctor about the diagnosis and treatment plan for you.
In case of emergency please go to the nearest emergency department or call an ambulance.
What are the treatments for a migraine attack?
Each person is different, and record your results on a headache diary.
It will help you identify if there are any triggers for your migraine and what works
best for your episode.
Talk to your physician about all the options that are available to you.
You may use a Headache diary to track your symptoms.
Migraine Canada has a version that you can download and an App version.
Here are some things to remember: The sooner you start treating a migraine episode,
the better the results.
Start with an NSAID and a triptan medication if you have a severe attack.
I’ll give some examples.
Treat nausea with some specific medicines or ginger.
Avoid overuse of medications to prevent MOH.
If your attack frequency is high, you may consider a preventive treatment.
Do not use opioids for migraines.
Here are some medications that I recommend: Analgesics like acetaminophen or paracetamol
are often insufficient to treat migraine attacks.
If they’re not useful, stop taking them to decrease your medication overuse risk and
try other options.
Caffeine is effective to treat migraine attacks, but in most cases people drink it on a regular
basis and it may contribute to headaches.
NSAIDs like ibuprofen, diclofenac, naproxen, acetyl salicylic acid (Aspirin).
Careful with stomach and bowel bleeding.
People with high blood pressure and cardiac diseases should avoid NSAIDs as there is a
risk of a heart attack.
The risk of MOH with NSAIDs is lower than with other treatments.
Triptans like sumatriptan and zolmitriptan.
There are 7 different triptans and they can be a life changer for a person with migraine.
Side effects include nausea and fatigue.
If one does not do the trick for you, try another.
Some people with migraine do not respond to triptans.
If this is the case, discuss with your physician.
Ergotamine is not available in Canada anymore.
Opioids like codeine, hydrocodone, oxycodone, and meperidine.
They act on the mu receptors in the pain system.
They carry the highest risk of MOH.
Side effects include nausea, sleepiness, constipation, and the risk of addiction and overdose.
Anti-nausea medications such as dimenhydrinate or metoclopramide.
They act in the histamine and dopamine systems.
The side effects include somnolence and fatigue.
They do not cause MOH.
Odansetron is now commonly used for nausea.
Steroids like prednisone or dexamethasone are used in the emergency setting and occasionally
for people who have attacks over many days (called status).
They should not be used on a regular basis.
Cannabis is not recommended to treat migraine.
There are many risks associated with cannabis intake, including addiction, medication overuse
and recurrent vomiting syndrome.
How about exercises?
Do they work for migraines?
The person does not have any limitations on what they can do between migraine episodes.
During an acute migraine attack, the person may choose not to perform vigorous physical
exercises.
Physical activity may make a migraine worse.
However, it is advisable to return to physical activity as normally as possible when the
episode ends.
There is another type of headache, cervicogenic headache, that is caused by pain radiating
from the muscles in the neck.
In that case, there are specific exercises for the neck muscles that can help with that
kind of headache.
I will have another video about cervicogenic headaches in this series.
People with migraine often have neck pain and neck triggers that can be addressed.
How about acupuncture?
During an acute migraine episode, the person may seek an acupuncturist for a few sessions,
but we know that the effects are more related to a strong placebo response.
When should yoinu go to the emergency department?
Try to avoid going to an emergency department as much as you can because it is very stressful,
with noise and lights, and may worsen your migraine.
It would be best if you went to the emergency department:
when the headache is different from your usual headache,
if you feel any other symptom that is not your typical migraine symptom,
if you are vomiting too much and are at risk of becoming dehydrated
or if the migraine lasts more than 72 hours.
This is called a Status Migrainosus.
Usually, they will do a physical examination at the emergency department, including a neurological
exam to exclude any other serious condition.
They may give you intravenous fluids for rehydration, medications for nausea, NSAIDs, steroids,
dihydroergotamine, or opioids.
The most critical aspect of managing migraine is to prevent these attacks.
Remember the toolbox that I always mention, and it includes the 5M IS.
And here are a few things known to reduce the number of episodes.
Mind, Movement, Manual, Modalities, Medications, Interventional, and Surgery
Mind-based therapies.
There are some brain retraining exercises that people do to reduce the number of migraine
attacks.
Migraine is considered a primary chronic pain and has many features of central sensitization.
Watch my other video about central sensitization.
Various mind-based therapies effectively reduce the sensitization of the neuronal pathways
in the pain system.
I call them physiotherapy for the brain.
They have to practice regularly to obtain good results.
Movement.
Choose an activity that you enjoy.
Walking, running, dancing, swimming, yoga, Tai Chi, Pilates, anything.
You may choose to engage in a sports activity or get a gym membership.
Whatever you choose, try to fit it into your schedule and make it fun.
Start with a few minutes per day, and increase gradually.
Try to achieve 150 minutes per week and include some aerobics exercise, which means your heart
rate and breathing are accelerated.
If activity triggers your migraine, modify the type and intensity next time.
Manual therapy.
In some individuals, massage reduces the number of migraine attacks.
But be mindful that these can be expensive, and they are passive modalities.
I usually encourage my patients to engage in active modalities that they can do for
themselves.
Modalities.
You may try the application of heat, cold, or TENS electrical device.
You may try on the muscles of your neck.
Medications.
Here I like to talk about vitamins, and supplements.
There is some evidence that magnesium citrate and glycinate are helpful to prevent migraines.
The dose is 600 mg/day.
I have another video about Magnesium.
I recommend people take Coenzyme Q10, 300 mg/day.
Watch my other video here.
Vitamin B2 is also recommended at a dose of 400 mg/day.
Petasites, feverfew and melatonin have also been studies
Some medications can be used daily to prevent future episodes of migraine.
They include: anti-hypertensive meds like propranolol or
candesartan antidepressants like amitryptiline, or venlafaxine,
anticonvulsants like topiramate or gabapentin, CGRP antibodies are recent options, there
are many of them available now I do not recommend opioids for the prevention
of migraines.
Actually, if the person has migraines and takes opioids for something else, we usually
recommend them tapering and stop the opioids.
Then, the number of migraine attacks reduces dramatically.
Interventional strategies include injections of botulinum toxin and nerve blocks.
That is all about migraines today.
In this series, I will release other videos about cluster headaches, trigeminal neuralgia,
tension-type headache, and cervicogenic headache.
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channel.
Goodbye!