Importance of Early Intervention in Acute Migraine with Dr. Heather Pim


The good news about migraines today, is that
we know much more what is migraine. While both men and women suffer from migraine,
women are three times more likely to experience migraines than men. Globally, one in eight have migraine. From the patient’s perspective, an acute
attack is a pain that starts somewhere in the head and neck area and progresses, usually
predominates on one side of the head, and it tends to have a pulsating quality, almost
like a beating heart. There’s also many associated symptoms such
as nausea, vomiting. Patients can become very sensitive to light,
sound. While it may be well understood that migraines have a negative impact on patient’s qualityof life, the extent of that impact is underestimated. Migraines impact every aspect of a person’s
life, including friendships, relationships with significant others, relationships with
children, employment, mental health and much more. Patients will often say that during a migraine
attack, they have to stop doing whatever they’re doing, go into a dark room and lie down for
the most part. So they miss out on many family activities,
work-related activities, school-related activities. And this has a significant impact on their
quality of life. Acute treatment aims to reverse, or at least
stop, the progression of a migraine that has started. So the Canadian Headache Society came out
with guidelines a few years ago, and they made it very clear that the goal was to reduce
headache pain rapidly and efficiently, so that people could get on with their lives. Key to effective management of an acute migraine
attack is early recognition and early treatment. So when I see a patient for the first time
to help them understand the importance of treating their migraines early, I always give
the analogy of a fire in the kitchen. So if they came in and they saw a fire burning,
what would they do? They’d react very quickly, and they would
try to put out that fire as quickly as possible to minimize the damage. This is the exact same approach they should
have with their migraines. So they need to take their abortive medication
very rapidly, at the first signs of their migraine. And then repeat the dose approximately two
hours later if they have any residual symptoms. Abortive, or acute treatment, begins with
NSAIDs. Examples of NSAIDs are aspirin, Advil and
Aleve available over the counter, or CAMBIA® available by prescription. So the Canadian Headache Society guidelines
are organized according to the strength of the migraines. So, by definition, migraine is a moderate
to severe disease, but the headache starts out mild. So in the mild condition, you always want
to start with non-steroidal, anti-inflammatory drugs, or NSAIDs. And if those do not work and the migraine
becomes moderate to severe, then you would want to either add on a triptan or use a rescue
medication, such as an anti-nausea type medication. But we always start with non-steroidal, anti-inflammatory. If a patient were to ask me if all non-steroidal,
anti-inflammatory drugs were equal, I would actually tell them that the mechanisms of
action differ somewhat. But what’s so important, what differentiates
most of them is how quickly they work. And by far, the non-steroidal, anti-inflammatory
that works the fastest is diclofenac potassium solution, or Cambia. And that’s why it’s been approved by Health
Canada for migraine, uh, and compared to the other NSAIDs that
take a little bit longer to act. Many people believe that the nausea and vomiting
that often accompany migraine attacks may be caused by gastric stasis. Gastric stasis is a phenomenon that we see
in migrainers, especially when they have nausea. This is important for migrainer. It will help them
choose their medications. Patients that have predominant nausea, we
know they have important gastric stasis, and therefore we’ll choose medications such
as injectables, or liquids that will be better absorbed. I think the most important message that I
could leave for a migraine sufferer today is the importance of being implicated in their
care. It’s very important to get involved with
your care, understand migraine and work with your physician to achieve the best results. To learn more about Acute Migraine, please
speak with your doctor or visit the website below.

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