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  • Occipital Nerve Block - Migraine
    may be recommended for additional injections when the symptoms return Can I have as many Occipital Nerve Blocks as I need With some exceptions in any given six month period experts will generally not perform more than three occipital nerve blocks This is because giving more injections could increase the likelihood of side effects from the steroids that are injected Likewise if the patient needs more frequent injections other treatments should probably be considered Will the Occipital Nerve Blocks help me It is difficult to predict if the injection will help you or not Generally speaking patients who have recent onset of pain may respond much better than the ones with a longstanding pain Usually the first injection is as much a test as a treatment The first block will confirm that the occipital nerves are involved in the pain and be helpful Or it will not help and the occipital nerves will not be suspected as part of the pain What are the risks and side effects of Occipital Nerve Blocks Generally speaking this procedure is safe However with any procedure there are risks side effects and possibility of complications The most common side effect is temporary pain at the injection site Other uncommon risks involve infection bleeding worsening of symptoms etc Fortunately serious side effects and complications are uncommon Who should not have an Occipital Nerve Block If you are allergic to any of the medications to be injected if you are on a blood thinning medication if you have an active infection going on or if you have poorly controlled diabetes or heart disease you should not have an occipital nerve block or at least consider postponing it if postponing would improve your overall medical condition Home Migraine Medications and Treatments Migraine Medications Occipital Nerve Block Occipital Nerve Block What is an Occipital Nerve Block An occipital nerve block is an injection of a steroid or other medication around the greater and lesser occipital nerves that are located on the back of the head just above the neck area What is the purpose of an Occipital Nerve Block The steroid injected reduces the inflammation and swelling of tissue around the occipital nerves This may in turn reduce pain and other symptoms caused by inflammation or irritation of the nerves and surrounding structures Typically headaches over the back of the head including certain types of tension headaches and migraine headaches may respond to occipital nerve blocks How long does the Occipital Nerve Block take The actual injection takes only a few minutes What is actually injected The injection consists of a local anaesthetic and a steroid medication Will the Occipital Nerve Block hurt The procedure involves inserting a needle through skin and deeper tissues So there is some pain involved However the skin and deeper tissues are numbed with a local anaesthetic using a very thin needle during the performance of the block Will I be put out for the Occipital Nerve Block No This procedure is done

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  • Complementary Approaches to Help Manage Migraine
    may have at least some scientific benefits for some people e g Biofeedback Physiotherapy Relaxation therapy Behavioural therapy However as of yet most complementary practices have not yet been scientifically studied in enough detail to prove beyond doubt that they are safe and more importantly effective Another problem for people in Ireland interested in trying complementary therapies is the lack of regulation of the sector although plans are in progress to introduce regulations Further Information If you are interested in obtaining further information on complementary treatments for migraine see the list of websites below for the self regulatory bodies of each of the different treatment areas We would suggest that you try to match the therapy to the trigger For example if stress is your trigger then relaxation therapy may help If you are attending a complementary practitioner make sure that they are qualified and operating under the National or International Regulatory group for their area of expertise You should also always inform your doctor Some herbal preparations can negatively interact with certain medications Acupuncture Traditional Chinese Medical Council of Ireland www tcmci ie Alexander Technique Society of Teachers of the Alexander Technique UK www stat org uk Chiropractic Chiropractic Association of Ireland www chiropractic ie Herbal Medicine The Irish Institute of Medical Herbalists www iimh org Homeopathy Irish Society of Homeopaths www irishhomeopathy ie Kinesiology Association of Systematic Kinesiology in Ireland www kinesiology ie Nutritional Therapy The Irish Institute of Nutritional Health www iinh net Osteopathy Irish Osteopathic Association list of practitioners at www osteopathy org uk Physiotherapy Irish Society of Chartered Physiotherapists www iscp ie Reflexology Irish Reflexologists Institute www reflexology ie Reiki Reiki Association of Ireland www reiki ie Yoga Yoga Therapy Ireland www yogatherapyireland com Home Migraine Medications and Treatments Complementary Approaches to Help Manage Migraine Complementary Approaches to Help Manage Migraine Complementary Approaches to Help Manage Migraine Complementary therapies are defined as techniques that are not part of a medical school curriculum Over the last ten to fifteen years there has been a dramatic increase in the number of people using complementary techniques to treat migraine as the concept of integrated medicine has become more acceptable Many Irish migraine sufferers have gained at least some relief through therapies such as acupuncture herbal medicine homeopathy biofeedback reflexology reiki meditation yoga and a plethora of others The conventional medical profession has viewed this growth with some scepticism However MAI believes that if the individual can get some benefits from using complementary practices then their use is to be supported for that individual Some doctors will have trained in complementary approaches and many more encourage their use Scientific research continues in complementary medicine for migraine and it is now accepted that certain treatments may have at least some scientific benefits for some people e g Biofeedback Physiotherapy Relaxation therapy Behavioural therapy However as of yet most complementary practices have not yet been scientifically studied in enough detail to prove beyond doubt that they are safe and more importantly

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  • Migraine Diary
    t forget to include ALL medication that you have taken including aspirin paracetamol etc Again abbreviate the name of the drug for simplicity P for paracetamol for example You can apply the same principle to all of the information and come up with a system that works for you It is not necessary to write down preventative medications When rating the headache pain score 1 means that your headache has had no real impact on your ability to carry out a normal day while 10 represents an attack so debilitating that you were unable to go about your business as normal at all perhaps you were confined to bed etc There are countless potential trigger factors and they differ for everybody so you will have to pay close attention to lifestyle environmental and dietary factors in the 48 hours preceding the attack Some of the most common triggers include Lack of food missed meals delayed meals specific foods commonly cheese coffee citrus foods fizzy drinks to name a few onset of menstruation noise strong smells stress anxiety lack of too much sleep excess exercise travel excitement bad news light weather fatigue alcohol Remember the list is not exclusive Remember also that food is not the only aspect that you should watch carefully The vast majority of attacks about 80 are brought on by non dietary factors Make a note of anything that you may even vaguely suspect The migraine diary also monitors the success or failure of treatments and medications Have the attacks become less frequent since you started taking a certain medicine Are they less severe Are there side effects The migraine diary provides you with a tool to answer all these questions if you use it accurately Home Migraine Medications and Treatments Use a Migraine Diary Use a Migraine Diary The Migraine Diary is a simple but effective way of managing your migraine A migraine diary can help you to establish certain patterns in your attacks Perhaps you get most of your headaches at weekends or perhaps every time you are presented with deadlines at work or at home These examples would be quite easy to notice but most people s headaches are not as easy to predict Attacks may only be triggered by a certain combination of trigger factors say when you miss a meal AND experience stress Either factor on their own may not be enough to trigger an attack but when combined they do Using the migraine diary religiously for a period of time may establish some patterns to your headaches and may enable you to take action to prevent them or better manage them It can also help you to feel more in control and this in itself can also reduce the frequency of the attacks The migraine diary will also demonstrate to your doctor the impact that migraine has upon your life Whenever you visit your doctor you should bring your migraine diary along as it will help him her to implement a

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  • Health Professionals and Migraine - Migraine
    for health professionals Diagnosing migraine The migraine attack Clinical guidelines and treatment Health professional training Impact of migraine Acute treatments More From This Section Migraine Diagnosis Migraine Diagnosis Headache is a very common condition The vast majority of headache resolves without need to consult a doctor In primary care the most commonly encountered headache disorders are Migraine Tension type Headache Chronic read more The Migraine Attack The Migraine Attack The typical migraine attack is split into four phases Prodrome Aura Headache Phase Postdrome Not every patient will experience all four phases and even in patients that do the phases can vary from one attack to the read more Migraine Clinical Guidelines and Treatment In the absence of a cure for migraine the aims of migraine management at primary care level are The successful treatment of the migraineur s acute attack The prevention and limitation of future attacks To encourage migraine sufferers to read more Health Professional Training Any upcoming Health Professional training events will be listed here Our events generally receive CPD points and our talks are delivered by experts in their field 23rd May 2014 BASH Educational Meeting on Headache Belfast The British read more Impact of Migraine Background Information The impact of migraine is that it is the most common neurological condition in the world It is also the most frequently seen disabling headache in primary care In Ireland 12 15 of the population have migraine Only about read more Acute Treatment of Migraine Acute Treatment of Migraine In acute therapy the key concerns to be addressed from the patient s perspective are The efficacy of the treatment The time to onset of action The consistency of response form one attack to the next The read more Home Health Professionals and Migraine Health Professionals and Migraine Health Professionals and Migraine Management of migraine for health professionals Diagnosing migraine The migraine attack Clinical guidelines and treatment Health professional training Impact of migraine Acute treatments More From This Section Migraine Diagnosis Migraine Diagnosis Headache is a very common condition The vast majority of headache resolves without need to consult a doctor In primary care the most commonly encountered headache disorders are Migraine Tension type Headache Chronic read more The Migraine Attack The Migraine Attack The typical migraine attack is split into four phases Prodrome Aura Headache Phase Postdrome Not every patient will experience all four phases and even in patients that do the phases can vary from one attack to the read more Migraine Clinical Guidelines and Treatment In the absence of a cure for migraine the aims of migraine management at primary care level are The successful treatment of the migraineur s acute attack The prevention and limitation of future attacks To encourage migraine sufferers to read more Health Professional Training Any upcoming Health Professional training events will be listed here Our events generally receive CPD points and our talks are delivered by experts in their field 23rd May 2014 BASH Educational Meeting on Headache Belfast The British read

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  • Migraine Diagnosis - Migraine
    lasting Non spreading aura Papilloedema Persistent headache in children Occipital headache in association with uncontrolled hypertension Signs or symptoms of ongoing neurological deficit between headaches I H S Diagnostic Criteria Once secondary headache has been ruled out the next step is to make the correct diagnosis of primary headache Headache diagnosis has been made easier by the International Headache Society I H S Diagnostic guidelines first published in 1988 and updated in 2004 More From This Section Diagnostic Resources Diagnosing Migraine Migraine Diagnostic Questionnaire 15 Key Questions GP Migraine Algorithm The Treatment of Migraine Patient Treatment Plan IHS Classification of Headache Disorders NICE Guidelines on read more Diagnosing Migraine I H S Criteria The I H S criteria for diagnosing Migraine are both inclusive certain features must be present and exclusive secondary headaches must first be ruled out The criteria are outlined below Please note that none of the features even headache are read more Tension Type Headache Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability read more Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and read more Chronic Daily Headache Chronic daily headache CDH is a descriptive term rather than a specific diagnosis It can evolve from any primary headache disorder or can be de novo Studies in the US and Europe indicate that 4 5 of the general population are affected by CDH read more Home Health Professionals and Migraine Migraine Diagnosis Migraine Diagnosis Migraine Diagnosis Headache is a very common condition The vast majority of headache resolves without need to consult a doctor In primary care the most commonly encountered headache disorders are Migraine Tension type Headache Chronic Daily Headache Cluster Headache These are all Primary Headache Disorders and account for almost all headache Only a tiny proportion of headache is secondary in nature i e due to a more serious underlying pathology However there are certain symptoms indicative of sinister headache that GPs should watch out for that may need referral Eliminating Secondary headache Warning signs that may indicate possible secondary headache Sudden onset Patients with a subarachnoid haemorrhage typically report having a sudden onset of severe headache The age of the patient Temporal arthritis typically occurs in older people and is extremely rare in individuals younger than 50 Primary headache disorders usually begin at a much younger age Associated symptoms Fever and neck stiffness may indicate Bacterial meningitis or Herpes simplex encephalitis Mental deterioration seizures or weakness of the extremities or face may be symptoms of brain tumors Recent head trauma Headaches soon after trauma to the head may be caused by subdural or epidural hematomas Worst headache Triggered by coughing sneezing Repetitive

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  • Diagnosing Migraine - Migraine
    3 of all migraine does not fit the standard diagnostic criteria for Migraine with Aura or Migraine without Aura Basilar Migraine Basilar artery migraine is a rare form of Migraine with Aura seen most commonly in young women and has an aura that is believed to be due to vertebro basilar ischaemia Features of the aura may include vertigo dysarthria ataxia diplopia bilateral visual impairment or sensory symptoms The headache associated with Basilar migraine is usually occipital Hemiplegic Migraine Hemiplegic Migraine is a rare form of Migraine and has two separate variations Familial Hemiplegic Migraine FHM which is a genetic condition linked to mutations of specific genes on chromosomes 1 and 19 Sporadic Hemiplegic Migraine SHM has no genetic link Both FHM and SHM usually begin in childhood and cease during adult years They also share the same symptoms Because the symptoms are also indicative of vascular disease a full neurological examination is necessary to rule out other causes and confirm the diagnosis In addition to the symptoms of typical migraine the following symptoms may present Episodes of prolonged aura up to several days or weeks Hemiplegia Impaired consciousness ranging from confusion to profound coma Headache which may begin before the hemiplegia or be absent Ataxia Status Migrainosus In this condition a patient often with a previous history of migraine suffers an unrelenting migraine 72 hours which is refractory to conventional therapy The pain is severe unilateral and throbbing Retinal Migraine Retinal Migraine is a rare form of migraine in which the patient experiences vascular spasm affects the vessels supplying blood to the eye resulting in a fully reversible visual loss Retinal migraine is a diagnosis of exclusion and embolic and other vascular diseases need to be ruled out Home Health Professionals and Migraine Migraine Diagnosis Diagnosing Migraine I H S Criteria Diagnosing Migraine I H S Criteria The I H S criteria for diagnosing Migraine are both inclusive certain features must be present and exclusive secondary headaches must first be ruled out The criteria are outlined below Please note that none of the features even headache are compulsory in order to make a diagnosis so the criteria should be used with a certain flexibility in practice Criteria for Diagnosing Migraine Without Aura A At least five attacks fulfilling B D B Attacks lasting 4 72 hours if untreated or unsuccessfully treated C Headache has at least two of the following characteristics Unilateral location Pulsating quality Moderate or severe pain intensity Aggravation by or causing avoidance of routine physical activity D During headache at least one of the following Nausea and or vomiting Photophobia Phonophobia E Headache not attributable to any other disorder Criteria for Diagnosing Migraine With Aura A At least two attacks fulfilling criteria B D B Aura consisting of at least one of the following but no motor weakness Fully reversible visual symptoms including positive features e g flickering lights spots or lines and or negative features i e loss of vision Fully reversible sensory symptoms including

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  • Tension-Type Headache - Migraine
    Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability It usually presents as a low impact mild to moderate band like featureless headache Patients with frequent episodic tension type headache 1 15 days of TTH per month often have co existing Migraine without aura Patients should be educated to differentiate between the two disorders and encouraged to use a Headache Diary to record individual episodes so that treatment can be maximised and medication overuse headache avoided I H S Criteria for diagnosing episodic tension type headache A At least ten episodes occurring 15 days per month on average and fulfilling criteria B D B Headache lasting from thirty minutes to seven days C Headache has at least two of the following characteristics Bilateral location Pressing tightening non pulsating quality Mild to moderate intensity Not aggravated by routine physical activity D Both of the following No nausea or vomiting No more than one of photophobia or phonophobia E Not attributed to another disorder Home Health Professionals and Migraine Migraine Diagnosis Tension Type Headache Tension Type Headache Tension type headache is the most common type of primary headache with a lifetime prevalence of up to 78 However episodic tension type headache requires little intervention from medical professionals as it rarely produces significant disability It usually presents as a low impact mild to moderate band like featureless headache Patients with frequent episodic tension type headache 1 15 days of TTH per month often have co existing Migraine without aura Patients should be educated to differentiate between the two disorders and encouraged to use a Headache Diary to record individual episodes so that treatment can be maximised

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  • Cluster Headache - Migraine
    Diagnosis Cluster Headache Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and characteristically come in clusters of attacks which can last weeks or months Individual clusters can be separated by periods of remission lasting months or years Age of onset is usually between 20 40 years Less than 0 5 of the population are affected and it is 3 4 times more common in men The causes of cluster headache are unclear but biochemical hormonal and vascular changes are known to induce individual attacks Attacks seem to be linked to changes in day length and may also be triggered during clusters only by alcohol tobacco histamine stress or exposure to nitroglycerine Decreased blood oxygen levels can also act as a trigger particularly during sleep About 10 20 of patients with Cluster Headache have Chronic Cluster Headache which is defined as attacks occurring for more than one year without remission or with remissions lasting for less than 1 month I H S Criteria for diagnosing Cluster Headache A At least five attacks fulfilling criteria B D B Severe or very severe unilateral orbital supraorbital and or temporal pain lasting 15 to 180 minutes if untreated C Headache is accompanied by at least one of the following Ipsilateral conjunctival injection and or lacrimation Ipsilateral nasal congestion and or rhinorrhoea Ipsilateral eyelid oedema Ipsilateral forehead an facial sweating Ipsilateral miosis and or ptosis A sense of restlessness or agitation D Attacks have a frequency of one every other day to eight per day E Not attributed to another disorder Home Health Professionals and Migraine Migraine Diagnosis Cluster Headache Cluster Headache Cluster headaches are primary headaches consisting of a severe stabbing pain that usually lasts between fifteen minutes and two hours and affect one side of the head usually around the eye Cluster headaches can occur several times per day and characteristically come in clusters of attacks which can last weeks or months Individual clusters can be separated by periods of remission lasting months or years Age of onset is usually between 20 40 years Less than 0 5 of the population are affected and it is 3 4 times more common in men The causes of cluster headache are unclear but biochemical hormonal and vascular changes are known to induce individual attacks Attacks seem to be linked to changes in day length and may also be triggered during clusters only by alcohol tobacco histamine stress or exposure to nitroglycerine Decreased blood oxygen levels can also act as a trigger particularly during sleep About 10 20 of patients with Cluster Headache have Chronic Cluster Headache which is defined as attacks occurring for more than one year without remission or with remissions lasting for less than 1 month I H S Criteria for diagnosing Cluster Headache A At least five attacks fulfilling

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