TOPIC: "TAKE CHARGE"

The East Bay Headache Support Group met on June 8, 1999 for a special two-hour meeting sponsored by Glaxo Wellcome, Inc. The topic was about taking charge of the problem of your migraine headaches, rather than having your headaches control you. Julie Wong, our local Glaxo Wellcome representative, was the MC for this meeting, which was held in the Ball Auditorium at John Muir Medical Center. Advertised in the newspaper as an informational meeting for women who suffer with migraine headaches, a total of 71 people attended (including 46 people new to the East Bay Headache Support Group).

Donna Johnson was the first speaker. As a long-time migraine sufferer, Donna told the audience about her struggles, and successes, with living with a migraine condition and offered hope to others who also suffer from chronic headaches.

Then Michael Stein, M.D., a Walnut Creek neurologist, gave a talk on taking charge of your headache condition. 

Dr. Stein said there are four main categories of solutions to a headache condition:

Attack-Aborting Medications, including:

1. Over-the-counter (OTC) pain relievers (aspirin, Excedrin, Advil, Anacin, Tylenol).
2. Non-steroidal anti-inflammatory drugs (NSAIDS). These are usually prescription drugs, like naproxen sodium, but some are available OTC.
3. Proprietary combination drugs, such as Midrin, Fiorinal.
4. Cerebral vasoconstrictor abortive agents, designed specifically for migraine (Ergotamine, Cafergot).

Prophylactic or Preventative Medications, including:

1. Beta-blockers (Inderal).
2. Antidepressants (Elavil, Pamelor). These affect serontonin in the brain.
3. Calcium channel blockers. These affect construction.
4. Anticonvulsants (Depakote, Neurontin).

Alternative Measures, including:

1. Lifestyle changes.
2. Biofeedback (useful for pregnant women).
3. Acupuncture.
4. Physical therapy, exercise.
5. Chiropractic.
6. Herbal (not regulated by the FDA).

Non-drug approaches are sometimes used to help relieve migraine pain, but generally do not usually treat all of the symptoms associated with migraine. Most of these approaches are best when used as a part of an overall migraine treatment program.

With all of these treatment options, it’s a wonder why we continue to be impacted so severely by migraine. Twenty-five million people are still impacted by this problem. Well, it has to do with being satisfied with your treatment program. Are you satisfied with your life? Do your headaches seem to control how you live, to control your activities? Dr. Stein stated that most people are not satisfied.

He then mentioned the isolation that people, especially women, experience as migraine sufferers. For instance, many migraineurs think they’re the only ones with the problem.

Effective treatment needs to be a balance of symptom relief and lifestyle suitability. Diagnosing a migraine headache, or any type of headache, is a complex issue. The physician relies upon information from his patient, and must ask many questions to get a history of the patient’s headaches. He needs to know the frequency, severity, and duration, and the amount of disability caused by pain or symptoms. The doctor must also gather information about the patient’s lifestyle and his/her personal preferences.

Treatment is also complex. Again, the physician relies upon information from his patient, but for treatment lifestyle issues and personal preferences are important. For instance, a patient may not be willing to tolerate the side effects of certain drugs the doctor may want to prescribe.

Communication is critical to the process. The patient must take an active role in his/her treatment, so he will have to sacrifice less. What are some specific steps to follow:

· Make an appointment with your physician specifically to talk about your headaches.

· Write down details of specific symptoms¾ keep a headache diary. Note the frequency of your migraines. How often do you have headaches? What is the degree of disability for each headache (do you have to go home from work, or call someone to watch the kids?). What are the symptoms of each migraine (are you nauseous or sensitive to light or sound?).

· Write down details of impact. What activities have you missed¾ work, family, social?

· Provide the doctor with detailed information about your lifestyle. Where do you spend most of your time? Are you an athlete? Are you concerned about weight gain? Do you have young children? Do you work outside the home? Do you travel a lot? Do you have a stable schedule? This information will impact our treatment recommendation.

· Provide detailed information about preferences. Is fast pain relief important? Is non-sedation important? Is convenience of the medication delivery system (tablet, nasal spray, injection) important? Is the track record of the medication important to you?

· Discuss advantages and disadvantages of a treatment program with your doctor. Work with your physician to agree upon a treatment program that meets: symptom relief needs and lifestyle needs.

Remember, treatment only makes sense if it allows you to defend your lifestyle.

· Set up a follow-up appointment before leaving the physician’s office. Three months is a reasonable time period. Regularly re-evaluate the effectiveness of treatment based on lifestyle and personal preferences. Be willing to try different options.

Handouts were given to the participants, which are designed to improve communications between patients and their physicians. The treatment issues discussed in each handout should be reviewed before and discussed during each office visit. Now you should feel equipped to communicate better with your doctor to get what you need in a migraine treatment program. Just remember…

Take Charge! Be persistent. Become a migraine manager. Become a student of migraine (pay attention to the media, learn all you can to help communicate better with your physician). Join a support group, such as the East Bay Headache Support Group. Become a Take Charge Ambassador. You owe it to yourself and the people you care about most.

For more information:

Migraine Resource Center (1-800-377-0302) (www.migrainehelp.com)

American Council for Headache Education (ACHE) (1-800-255-ACHE) (www.achenet.org)

National Headache Foundation (NHF) (1-800-543-7373) (www.headaches.org)

East Bay Headache Support Group (925-938-5252) (www.headachesupport.org)

Questions and Answers were then taken from the audience.

The intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician.