One of the unmet needs of the migraine population is the identification of individuals who actively require treatment. When migraine is left untreated or inadequately treated, increased medical costs and decreased productivity result. Of the roughly 25 to 30 million Americans with active migraine, around 6 million have the chronic variant, meaning they have suffered headaches at least 15 days per month for at least 3 consecutive months. Chronic migraine accounts for a disproportionate share of the economic burden associated with migraine generally. Prevention or suppression of headaches associated with chronic migraine assumes paramount importance.
It can be challenging for physicians to choose the most appropriate therapy for treating migraine, and there are many issues to consider when determining the most appropriate management strategies. Clinicians must ask themselves if their patients are in need of acute therapy only or prophylactic therapy in addition to acute therapy. Although guidelines are available to assist clinicians in prescribing prophylactic therapy, treatment needs and responses vary from patient to patient. Arriving at an effective treatment regimen may take time, and patients should be warned not to expect instant success. A commitment from patients to adhere to prescribed treatment strategies typically will be required to achieve a successful outcome. Open communication between providers and patients and the provision of educational materials are essential to fostering positive outcomes.
The importance of patient education cannot be overestimated. My colleagues and I have conducted studies in which migraineurs attended a headache school taught by lay instructors. Patients who received this type of education—which focused on the biology of migraine as well as acute and chronic treatments—experienced considerable improvements in clinical outcomes; these patients had fewer headaches, made fewer calls to their doctors, made fewer emergency room visits, and used their acute symptomatic medications appropriately.
“It can be challenging for physicians to choose the most appropriate therapy for treating migraine.”
By taking time to educate patients about their disorder and the medications required to treat it, physicians can help patients progress toward a life no longer dominated by headache. This also will help patients avoid the frustrations commonly associated with treatment. For effective patient education, the materials provided should be easily comprehended. A simple solution may be to refer patients to informative, professionally reputable websites for information about their disorder and treatment.
An important treatment for migraine—chronic migraine in particular—is exercise. In well-conducted research, aerobic conditioning has been associated with remission of chronic migraine to its episodic form. In most cases, physicians should encourage migraineurs to initiate at least some sort of aerobic conditioning program, starting with modest physical activity and sequentially increasing to more rigorous exercise. Obesity appears to be linked to migraine “chronification,” and while weight loss has not yet been demonstrated to promote improvement in migraine, other health benefits may accrue, and quality of life tends to improve.
The key to optimizing clinical outcome for migraine sufferers is a multimodal management strategy that actively engages patients. While we need to develop more effective medicinal treatments, we also must remember to take time to educate and involve our patients in the treatment process. Empowering patients through education and encouraging them to become active participants in their own healthcare management can lead to substantial benefits. Physicians should use all available tools to help patients control their migraine and ultimately improve their quality of life.
Readings & Resources (click to view)
Modi S, Lowder DM. Medications for migraine prophylaxis. Am Fam Phys. 2006;73:72-78, 79-80. Available at: http://www.aafp.org/afp/2006/0101/p72.html.
Ramadan NM. Current trends in migraine prophylaxis. Headache. 2007;47: S52-S57.
Pesaturo KA, Wooding FG. Modern Management of the Migraine Headache. Am J Lifestyle Med. 2009:3:147-159. Available at: http://www.medscape.com/viewarticle/704767_print. Accessed January 21, 2010.
Rothrock JF. Preventive (prophylactic) therapy. Headache. 2009;49:1253-1255.
National Headache Foundation. Headache Types: Migraines. Available at: http://www.medscape.com/viewarticle/704767_print. Accessed January 21, 2010.
Marlow RA, Kegowicz CL, Starkey KN. Prevalence of depression symptoms in outpatients with a complaint of headache. J Am Board Fam Med. 2009;22:633-637.