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  • Prodrome - Migraine
    of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine The Migraine Attack Migraine Prodrome Migraine Prodrome Migraine Prodrome Although the migraine Prodrome occurs hours or even days before the headache begins it is considered to be an integral component of the migraine process It often acts as a warning sign that a migraine is imminent About 60 of people with migraine experience prodromal symptoms Typical prodrome symptoms can include Physical symptoms Muscle stiffness especially in the neck Altered perception of heat and cold Increased thirst Increased urination Food cravings Loss of appetite Yawning Constipation Diarrhoea Fluid retention Sensitivity to light and or sound Psychological symptoms Depression Euphoria Irritability Restlessness Hyperactivity Fatigue Drowsiness Difficulty in concentration Some patients are not always aware of these symptoms or may mistake them for migraine triggers A Migraine Diary can help patients discover their prodromal symptoms thus giving them valuable time to prepare for the later stages of the attack Home Health Professionals and Migraine The Migraine Attack Migraine Prodrome Migraine Prodrome Migraine Prodrome Although the migraine Prodrome occurs hours or even days before the headache begins it is considered to be an integral component of the migraine process It often acts as a warning sign that a migraine is imminent About 60 of people with migraine experience prodromal symptoms Typical prodrome symptoms can include Physical symptoms Muscle stiffness especially in the neck Altered perception of heat and cold Increased thirst Increased urination Food cravings Loss of appetite Yawning Constipation Diarrhoea Fluid retention Sensitivity to light and or sound Psychological symptoms Depression Euphoria Irritability Restlessness Hyperactivity Fatigue Drowsiness Difficulty in concentration

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/the-migraine-attack/migraine-prodrome/ (2014-07-21)
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  • Migraine Aura - Migraine
    Events from the MAI No events View All Events Home Health Professionals and Migraine The Migraine Attack Migraine Aura Migraine Aura Migraine Aura The migraine aura phase involves the occurrence of one or more fully reversible focal neurological symptoms It is experienced by about 20 of migraine sufferers although not all patients with Migraine with Aura will experience the aura symptoms with every attack This phase occurs just before the headache phase begins but in some patients the migraine aura phase can overlap with the later headache phase Aura usually develops over five to twenty minutes and lasts for up to one hour Aura symptoms are most commonly visual though they can also be sensory or more rarely motor Aura symptoms include Scintillation scotomas e g Bright rim around an area of visual loss fortification spectra Flashing lights Jagged lines that block the visual field Visual resizing or reshaping of objects Blurred vision Unilateral sensory parasthesia that usually begins as numbness in the hand and migrates up the arm before moving into the face lips and tongue Muscular weakness Partial paralysis on one side of the body Temporary dysphasia Home Health Professionals and Migraine The Migraine Attack Migraine Aura Migraine Aura Migraine Aura The migraine aura phase involves the occurrence of one or more fully reversible focal neurological symptoms It is experienced by about 20 of migraine sufferers although not all patients with Migraine with Aura will experience the aura symptoms with every attack This phase occurs just before the headache phase begins but in some patients the migraine aura phase can overlap with the later headache phase Aura usually develops over five to twenty minutes and lasts for up to one hour Aura symptoms are most commonly visual though they can also be sensory or more rarely motor Aura

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/the-migraine-attack/migraine-aura/ (2014-07-21)
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  • Headache Phase - Migraine
    one third of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine The Migraine Attack Headache Phase Headache Phase The headache phase is the most disabling feature of a migraine attack and is the most common reason for consultation Typically the following characteristics apply Headache lasts from 4 72 hours Moderate or severe pain Usually gradual in onset Throbbing pounding or pulsating in character although it may begin as a mild non throbbing headache Unilateral in 70 80 of patients but can alternate from one side to the other in different attacks Exacerbated by routine physical activity Extends from the periorbital and frontal areas backwards to the temporo parietal and occipital regions and can sometimes extend to the shoulder area Frequently is present on awakening in the morning However the headache is almost always accompanied by other symptoms which generally intensify along with the headache Nausea accompanies the headache in 70 90 and leads to vomiting in 20 50 Vomiting may occur early or late in the headache phase and when it occurs after the headache is well established it may result in a precipitious easing of the headache Photophobia Phonophobia and Osmophobia These symptoms lead patients to seek seclusion in a dark quiet room Stiffness or tenderness of the neck Other possible symptoms during this phase can include blurry vision diarrhoea abdominal cramps facial pallor sensations of heat or cold and localised edema of the scalp the face or the periorbital regions Cranial autonomic symptoms such as nasal congestion rhinorrhea and lacrimation can also occur Home Health Professionals and Migraine The Migraine Attack Headache Phase Headache Phase The headache phase is the most disabling feature of a migraine attack and is the most common reason for consultation Typically the following characteristics apply Headache lasts from 4 72 hours Moderate or severe pain Usually gradual in onset Throbbing pounding or pulsating in character although it may begin as a mild non throbbing headache Unilateral in 70 80 of patients but can alternate from one side to the other in different attacks Exacerbated by routine physical activity Extends from the periorbital and frontal areas backwards to the temporo parietal and occipital regions and can sometimes extend to the shoulder area Frequently is present on awakening in the morning However the headache is almost always accompanied by other symptoms which generally intensify along with the headache Nausea accompanies the headache in 70 90 and leads to vomiting in 20 50 Vomiting may occur early or late in the headache phase and when it occurs after the headache is well established it may result in a precipitious easing of the headache Photophobia Phonophobia and Osmophobia These symptoms lead patients to seek seclusion in a dark quiet room Stiffness or tenderness of the neck Other possible symptoms during this phase can

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/the-migraine-attack/headache-phase/ (2014-07-21)
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  • Postdrome - Migraine
    to migraine sufferers and those with other headache disorders THE MIGRAINE Association Of Ireland Providing information support and reassurance to migraine sufferers and those with other headache disorders Latest News Latest News and Research from the Migraine World 17th July 2014 Read our submission on chronic migraine and medical card eligibility 14th July 2014 Loss of funding may cost MAI one third of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine The Migraine Attack Migraine Postdrome Migraine Postdrome Migraine Postdrome The postdromal or resolution phase follows the headache and may last for up to 48 hours Many of the symptoms of this phase appear initially during the prodrome or with the headache phase Typically these include Fatigue Sore muscles Food intolerance Malaise Alteration in mood Impaired concentration Scalp tenderness Decreased energy requiring a period of rest A minority of sufferers immediately after an attack feel energised euphoric and can return to normal activities at once Home Health Professionals and Migraine The Migraine Attack Migraine Postdrome Migraine Postdrome Migraine Postdrome The postdromal or resolution phase follows the headache and may last for up to 48 hours Many of the symptoms of this phase appear initially during the prodrome or with the headache phase Typically these include Fatigue Sore muscles Food intolerance Malaise Alteration in mood Impaired concentration Scalp tenderness Decreased energy requiring a period of rest A minority of sufferers immediately after an attack feel energised euphoric and can return to normal activities at once Donate Now Will you help us to continue our work We are only too aware of the devastating impact migraine can have

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/the-migraine-attack/migraine-postdrome/ (2014-07-21)
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  • Migraine Clinical Guidelines and Treatment - Migraine
    case the initial therapy fails The MIDAS and Headache Impact Test HIT tests can be useful for helping the doctor implement a stratified treatment plan More From This Section Prophylactic Treatments for Migraine Prophylactic Treatments for Migraine The role of prevention is to achieve a reduction in the frequency severity and duration of attacks Effective prophylaxis can achieve up to a 50 reduction in the frequency in approximately 50 of read more General Information on Triptan Therapy Triptan Therapy There are six Triptans available in Ireland Almotriptan 12 5mg orally Frovatriptan 2 5mg orally Sumatriptan 50mg 100mg orally 20mg 40mg intranasally mg subcutaneously on a named patient basis Zolmitriptan 2 5 g read more General Principles of Migraine Prophylaxis Migraine Prophylaxis There are no sound criteria for preferring one prophylactic drug over another However the following should be taken into account 1 Comorbidities 2 Drug interactions 3 Possible side effects 4 Lifestyle issues e g a read more Options in Migraine Prophylaxis Migraine Prophylaxis β Blockers The β Blockers have been used for prophylaxis for more than 25 years and continue to be a strong option unless contraindicated in patients with asthma or peripheral vascular disease Propranolol 80mg 160mg is read more Chronic Daily Headache Chronic Daily Headache Successful management of CDH depends on Identification of the cause of the CDH e g medication reliance co morbidities injury Commitment from patient and doctor There is no simple answer so a thorough approach to read more Cluster Headache Cluster Headache Acute Drug Treatment The goal of treatment for cluster headache is to decrease the pain severity and duration of each attack Early intervention is critical yet difficult since a single cluster headache can be as short as 15 read more Home Health Professionals and Migraine Migraine Clinical Guidelines and Treatment 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 continue with their care The identification and referral of the minority of patients who need specialist services The Stratified Care approach The Stratified Care approach is the approach of choice when treating headache disorders whereby the doctor decides what treatment is necessary based on the evidence for that treatment and the individual patient s needs Recent best practice guidelines on the management of migraine such as the Migraine in Primary Care Advisors MIPCA guidelines from the UK the US Headache Consortium and the Primary Care Network guidelines are based on the Stratified Care model Stratified Care has now largely superceded the stepped care approach which began with analgesics perhaps with an anti emetic for all patients regardless of headache impact severity or frequency and if those are not effective the patient is stepped up to the next level of treatment reserving the more powerful triptans as third line options Under a stratified approach Each patient should have

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraineclinical-guidelines-and-treatment/ (2014-07-21)
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  • Acute Treatment of Migraine - Migraine
    of their migraine Therefore these patients should be prescribed a Triptan before trying drugs that are not as migraine specific Mode of Action The triptans have potent agonist activity at the 1B 1D receptor sites The specificity of these drugs to these receptors sites limits their side effect profile and make them well tolerated The triptans have three sites of action They cause vasoconstriction of the dilated meningeal dural extracerebral and pial blood vessels by stimulating the 5HT 1B receptors located on these blood vessels They inhibit the release of C G R P substance P and neurokinin from the periphereal end of the trigeminal nerve by stimulating the 5 HT 1d receptor sites located on the pre synaptic nerve terminals They have a high affinity for the 5 HT 1D located centrally in the region of the trigeminal nucleus caudalis in the brainstem This site of action modulates in coming nociceptive or painful sensory information from the periphery and inhibits its upward transmission to the thalamus and higher brain centres where pain is perceived Adverse Events Triptans are generally well tolerated The most common side effects with the triptans are paresthesias flushing fatigue nausea dizziness and feeling warm Chest and throat tightness occurs occasionally and is thought to be non cardiac in origin Contraindications Pregnant or lactating women Because of their vasoconstrictive properties triptans act on coronary blood vessels as well as meningeal arteries Therefore all of the triptans are contra indicated in patients with coronary disease cerebrovascular disease or untreated hypertension They should also be used with extreme caution in patients with risk factors for cardiovascular disease Patients with Hemiplegic Migraine or Basilar Migraine two rare forms of migraine thought to be associated with excessive cerebral vasoconstriction Home Health Professionals and Migraine Acute Treatment of Migraine 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 tolerability of the medication The two main options in the acute treatment of migraine are Analgesics NSAIDs and Triptans Analgesics NSAIDs Up to 1 3 of migraineurs effectively manage their attacks without needing to consult their GP Paracetamol aspirin or ibuprofen can be effective for some patients with mild moderate migraine although the data suggests that their efficacy is limited to about 1 3 of patients Analgesics are more effective if taken early in the headache phase Although generally well tolerated frequent use can lead to the development of Analgesic Rebound Headache Simple analgesics can be combined with other medications to improve their efficacy in migraine treatment If nausea is a symptom then the concomitant use of the pro kinetic drugs Domperidone or Metoclopramide will relieve the nausea and also prevent the gastric stasis associated with migraine which can slow absorption Combination analgesics containing caffeine or codeine are also effective for some but there is an inherent

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/acute-treatment-of-migraine/ (2014-07-21)
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  • General Information on Triptan Therapy - Migraine
    to predict who will or will not respond Failure with one Triptan does not necessarily mean that the patient will not benefit from another in the family An evaluation of each patient as to his or her clinical needs should drive the choice of Triptan Evaluation of efficacy for a particular patient should be based over three consecutive attacks with the aid of a migraine diary Patients with Nausea Although oral administration is the simplest it may not be appropriate for many of the 70 of migraineurs who have associated nausea and vomiting When taken intranasally or subcutaneously Triptan onset of action may be as fast as fifteen minutes Alternatively an oral Triptan can be taken with 10 mg metoclopramide to encourage absorption Rebound Headache Medication induced headaches can result from overuse of triptans but are less likely to result from triptans than analgesics or ergotamine If a patient is taking a Triptan more often than three days per week Triptan therapy should be discontinued and replaced by preventive therapy A Note on Ergotamine Since Triptans have a more favourable side effect profile they have now largely replaced ergotamine as a first line migraine treatment Ergotamine is a vasoconstrictor that specifically counteracts the dilation of some arteries and arterioles primarily the branches of the external carotid artery It has also been closely linked to Rebound Headache For these reason it can no longer be recommended as an alternative to the Triptans Please remember that all information contained on the migraine ie website is intended for informational and educational purposes The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition Home Health Professionals and Migraine Migraine Clinical Guidelines and Treatment General Information on Triptan Therapy General Information on Triptan Therapy Triptan Therapy There are six Triptans available in Ireland Almotriptan 12 5mg orally Frovatriptan 2 5mg orally Sumatriptan 50mg 100mg orally 20mg 40mg intranasally mg subcutaneously on a named patient basis Zolmitriptan 2 5 g orally conventional and orally disintegrating formulation Naratriptan 2 5mg Eletriptan 40mg Meta analysis has confirmed that although minor variations exist among the Triptans in terms of efficacy and tolerability no one Triptan is substantially superior to another especially in oral format For reasons that are unclear some patients respond better to one Triptan than another so it is important to be familiar with them all as well as the different formulations available Almotriptan Almogran Available in a 12 5mg dose Almotriptan has few drug interactions and a low adverse event profile It also has a low headache recurrence rate The drug s onset of action is similar to that of sumatriptan Frovatriptan Frovex Frovatriptan is a long duration Triptan with a half life of approximately 25 hours It also has a lower headache recurrence rate than the other triptans However its onset of action is slower than that of the shorter duration triptans Frovatriptan may be

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraineclinical-guidelines-and-treatment/general-information-on-triptan-therapy/ (2014-07-21)
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  • Prophylactic Treatments for Migraine
    other headache disorders Latest News Latest News and Research from the Migraine World 17th July 2014 Read our submission on chronic migraine and medical card eligibility 14th July 2014 Loss of funding may cost MAI one third of staff 26th June 2014 Take this important survey on chronic migraine and medical card eligibility View All News Become a Member Sign up or Log in Events Upcoming Events from the MAI No events View All Events Home Health Professionals and Migraine Migraine Clinical Guidelines and Treatment Prophylactic Treatments for Migraine Prophylactic Treatments for Migraine Prophylactic Treatments for Migraine The role of prevention is to achieve a reduction in the frequency severity and duration of attacks Effective prophylaxis can achieve up to a 50 reduction in the frequency in approximately 50 of migraineurs Prophylaxis cannot be expected to eliminate migraine completely It is thought that while about 50 of all people with migraine are candidates for prophylaxis only about 10 are actually on a preventative medication Indications for Prophylaxis Prophylaxis is indicated in patients who Experience two or more attacks per month and do not respond satisfactorily to acute therapy Suffer from concomitant co morbidities Suffer from a medical illness precluding first line acute therapy Suffer attacks that significantly interfere with the patients daily routine Demonstrate regular patterns to their attacks Experience long duration attacks Have Basilar or Hemiplegic migraine Are at risk of Medication induced headache from over use of acute treatments Mode of Action of Prophylactic Agents The preventative therapies are thought to mediate their benefit by antagonism of central serotonergic receptors by regulation of calcium ion channels and by enhancement of central antinociceptive mechanisms This results in raising the threshold for both cortical spreading depression and trigeminovascular activation Home Health Professionals and Migraine Migraine Clinical Guidelines and Treatment Prophylactic Treatments for Migraine Prophylactic Treatments for Migraine Prophylactic Treatments for Migraine The role of prevention is to achieve a reduction in the frequency severity and duration of attacks Effective prophylaxis can achieve up to a 50 reduction in the frequency in approximately 50 of migraineurs Prophylaxis cannot be expected to eliminate migraine completely It is thought that while about 50 of all people with migraine are candidates for prophylaxis only about 10 are actually on a preventative medication Indications for Prophylaxis Prophylaxis is indicated in patients who Experience two or more attacks per month and do not respond satisfactorily to acute therapy Suffer from concomitant co morbidities Suffer from a medical illness precluding first line acute therapy Suffer attacks that significantly interfere with the patients daily routine Demonstrate regular patterns to their attacks Experience long duration attacks Have Basilar or Hemiplegic migraine Are at risk of Medication induced headache from over use of acute treatments Mode of Action of Prophylactic Agents The preventative therapies are thought to mediate their benefit by antagonism of central serotonergic receptors by regulation of calcium ion channels and by enhancement of central antinociceptive mechanisms This results in raising the threshold for both cortical spreading depression

    Original URL path: http://www.migraine.ie/health-professionals-and-migraine/migraineclinical-guidelines-and-treatment/prophylactic-treatments-for-migraine/ (2014-07-21)
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