Preventive Medication and the American Migraine Communications Study

By Dr. Seth Haplea Monday, April 02, 2007

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The American Migraine Communications Study (AMCS) recently highlighted the need for improved communication between patients and healthcare professionals. Typically, physicians and patients discuss the frequency of their attacks and ignore other important factors such as the degree and duration of impairment with each migraine. Physicians should not ask closed-ended questions limited to migraine frequency. Several open-ended questions that assess migraine impairment should be asked by your healthcare provider. How do migraines make you feel even when you're not having one? How does migraine impact your daily life? How do migraines impact your work, family and social life? What activities have you given up because of your migraines?

The perceptions of the physician and the patient regarding the frequency and severity of migraine attacks vary greatly and the result can be a lack of discussion of preventive therapies in individuals who meet criteria for the initiation of preventive medication. Even today, about 50% of migraine sufferers are unaware of preventive medication as a treatment option. Therefore, healthcare professionals must spend adequate time with patients educating them about the options for preventive therapy as well as acute migraine treatment.

Acute medication is not always adequate to control migraine attacks. Preventive therapy should be discussed with patients requiring more than one dose of acute therapy per week or in those individuals experiencing prolonged disability during a migraine or significant side effects from their acute therapy. The physician must individualize migraine therapy. Some patients with only one migraine every few months are interested in preventive therapy while other patients with more frequent migraines are content with acute migraine therapy only, as long as it is effective.

Realistic expectations about the response to treatment are necessary on both sides of the fence. Patients must allow a month or longer, especially if the medication dose is being adjusted, on each preventive therapy to determine its effectiveness. Physicians must take into account the amount of impairment with each migraine attack. Total resolution of all migraines may be impossible without significant side effects. Lifestyle changes and medication therapy in combination may afford the best results.

Migraine is a chronic yet manageable disease. With good communication between physicians and patients, the best results and the lowest disability can be achieved.

Comments (11) |

maggierae

4/ 2/07 10:39pm

I've suffered with migraines for over 20 yrs and in the past 7 they have gotten worse. I'm on my 6th neurologist and crossing my fingers. I've tried preventatives in the past and have had very little success.

I do take relpax at least 2-3 times a week. It has decreased the number of times I've had to go in for a hypo. but I think I should be able to do better.

I'm wondering which preventatives you've found that work well for most patients? I realize that everyone will react differently but I guess I'm looking for someone with new ideas that I may bring up to my neurologist.

Right now I'm also not on a rescue med. I'm suppose to take 3 aleve with my relpax and hope for the best. I think it would be great for a rescue med for those times I wake up from a bad one and the abortive doesn't work. Or when I go to bed with a bad one and can't get comfortable because it feels like my head is on a cement block instead of my pillow.

Any suggestions that I could bring to my doc would be great!!

Thanks

Maggie

Angela7497

4/14/07 11:20pm

I have suffered with migraines for 16 years and most of the current treatments that most doctors use were very unsuccessful for me. My doctor and I finally decided that the best thing to do was to go preventative for me. I was suffereing with terrible migraine aura, nausea vomiting that sometimes would require hospitalization. We decided on Topamax. WHAT A DIFFERENCE IT HAS MADE IN MY LIFE !!!! I usually suffered on average two to three times a week with one a week requiring treatment from a hospital as no medicine was working. The only bad thing with me having no medical insurance is the cost. A thirty day supply is over 200.00. OUCH!!! But to me it is well worth it. I am slowly getting my life back. I am able to exercise now, something I missed dearly and I am hoping that with continued improvement I can go back to work in the next couple months. So anyone willing to ask your doctor give it a try. It really helped me.

Sammy

6/ 2/07 11:26am

This is a great article, thanks Dr Haplea. It's much needed.

But, your plea for physician-patient communication is entirely predicated on the interest, or lack thereof, of the physician.

Also, there's a big question about whether the physician actually believes the patient or not. It's not a good starting point if the physician is sceptical about what the patient is reporting!

In my own case, my migraine records and journal which I thought was the recommended way to help physicians, have been construed by such as almost obsessive and actually demonstrating my 'need to control my environment'. Thus they seem to have been taken as an indicator of some underlying psychiatric issue!

I have given up a) keeping migraine journals etc and b) talking to doctors.

mary

7/11/07 1:00am

you have said that keeping a journal. made the dr think you where phycotic (sp). you are so right. I have have a had time just finding a dr who look at it was stressful too. But don't give up. there has to be one Dr who understands Migraine.

Daisy

6/25/09 10:29pm

This is an good article, but even going to the top headache clinic that everyone on this site would know if I mentioned was the biggest nightmare of my life. They treated me horribly and all the things I did for my local neuro were looked at as my being fixated on migraine and pain... (migraine diary, etc). I was in my early 20's accepted to top grad schools. I was so sick though I was in and out of inpatient constantly and it all started after a bad injury to the head/jaw. The psychs had a hayday with me. They were distressed when I talked about medications and had working knowledge - that happens when you have had pharmacology. Being an informed patient made my stay so bad that they finally decided I was a histrionic, narcisistic mess and that it was in my head psychologically...lots of money and three weeks later I came home exhausted in tears only to be told by a local psych I went to see over how upset and distressed I was by the way I was treated and how at that point I thought I didn't know how to handle anything related to migraine that I was one of many patients he'd seen that had been to this prestigious clinic only to be told this when they couldn't fix the problem. I was a lab rat for this clinic and treated so badly that I was yelled at after a surgery when they forgot to administer steroids for inflammation and then ended up giving me one shot of Nubain due to severe pain. It was terrible and trying to help them understand how it was impairing me was unfortunately the very worst thing. In an ideal world or a perfect one the docs would listen and see that if you are missing classes and you are a highly motivated student working extremely hard to be in school then it just doesn't make sense that your faking, fixated, or just histrionic. I have taken the MMPI a few times and always comes back the same "patient is having real daily pain" this is what the psychs say, except when I took the very same test at their clinic -- interesting? While acknowleding that there are some therapies that help, sometimes just talking it out, if the person you are dealing with seems to be predisposed to looking for people that malinger....your up a creek. I came back to my local neuro and that is who I have had the most help from. Every referral out to other specialists ended in the doctor accusing me of drug seeking or other things because they simply didn't get it. I'd like to think you could take your migraine chart to these pain docs, but I'd never do it. NEVER. The only doc I would let know how truly impaired I am by migraine is the one I have had for nine years since my injury. The rest put me in tears and struggling with the migraines are enough, you don't need added stress. So I think we need a lot of doctor education even amongst our so called TOP experts who failed me miserably because they couldn't look at the MRI and CT to see the damage and the extensive surgery -- they just couldn't, so when you have hard evidence of a situation that starts the migraine, then your having them, and they still can't listen, that is not a patient problem that is a physcian issue and it is unfortunate that these clinics seemed to treat not only me but many others the same way. I think they like the easy cases that the basic neuro doesn't fix and they do so it makes them look fantastic, but if your too complex for them it is all in your head.

Daisy

6/25/09 10:33pm

Oh, and Topamax -- it is the closest thing to a cure for me. Clearly, they could have helped. They were to busy looking for a malingerer when I shared how I was impaired. Once bitten, twice shy!

scottyfry

8/30/07 3:46pm

Can migraine symptoms start after having a concussion. I have had two concussions over the past seven years. A couple months after my last concussion I started having migraines with aura (I think that is right) no headache but other symptoms such as not being able to articulate my thoughts. I need to know if this is possible.

Bob

9/ 7/07 10:18am

I am not a clinician, but I can tell you from personal experience that periodic migraines can follow a concussion. I suffered a concussion at age ten (44 years ago). I never had migraines before the injury, but have had periodic migraines since that time. As in your case, I suffer from migraines with aura.

There seems to be no real pattern or particular trigger to my migraines. I have exeperienced occasional periods without them, e.g., I never had one while I was an undergraduate in college. Generally, though, I begin to get symptoms a few times a year.

In my case, I don't need prescription medication to deal with the migraines. I have found that I can take aspirin when I notice the aura, and it will dramtically reduce the intensity of the headache (acetominophen doesn't seem to be as effective, and aspirin doesn't completely eliminate the headache). If I don't take an off-the-shelf pain reliever until after the migraine starts, the analgesic will be ineffective.

Karen

9/ 7/07 11:45am

I have been told many times that a concussion cannot cause migraines but like you it seems very strange that I started having these migraines after the concussion. So far I have been told to not worry about it just to take a BC Poweder at the beginning. Not being able to articulate my thoughts after is quite hampering when you are a teacher. Thank you for sharing you information with me. I guess I will just have to learn to live with it.

scottyfry

9/ 7/07 12:08pm

I have read that after a certain age 50+ that starting migraines are unsual and that further investigations are necessary, is this true? Back ground, I had a second concussion 1 1/2 years ago and before that never experienced any migraines. My general Dr. stated that the concussion could not have caused this problem (migraine with aura).

I also started experienceing the inability to articulate my thoughts after the last migraine episode. This is a scary thing considering I am a teacher.

The only support from my general and my ophthimologist is take something for the headache after the first symptom and if it is a stroke I will know because I will not get over the symptoms. Not very helpful to say the least.

If that is the case how would you know if it is neurological in nature or vascular? I do suffer from Reynolds (?) syndrome (my mother was a heavy smoker) does that play into this problem after all these years.

I am reaching I know for straws but I really need some information that will answer these questions.

Grace

10/21/08 10:45am

I have migraines with a vistibular disorder. I think it is the same as Janet Jackson's disorder. What would be the best treatment and prevenitive medicine?

Preventive Medication and the American Migraine Communications Study

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