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Headache : Migraine Last Updated: Oct 6, 2009 - 12:07:30 PM

Migraine, headache, migraine Common Morbidities, migraine diagnosis, migraine Prognosis
By usadruglist
Oct 5, 2009 - 1:39:23 PM

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For many patients, migraine is associated with other illnesses such as:
  • Depression
  • Anxiety
  • Stroke
  • Irritable bowel syndrome
  • Epilepsy
  • Hypertension
These illnesses are now recognized as being common migraine comorbidities. The term comorbidity is used when two illnesses occur at a greater than coincidental rate than what is seen in the general population. This suggests that at some level, the two illnesses are interrelated.
When two conditions are found in the same person but the incidence is not greater than what is seen in the general population, these are referred to as coexisting conditions. For example, a patient may have migraine and diabetes. There is no evidence suggesting that these two conditions exist in a single patient more frequently that these conditions exist in individual patients in the general population. In contrast, migraine and depression appear to be comorbid because they occur together more often than they occur in individual patients in the general population.
Understanding the association of migraine with other health conditions is an important part in providing optimal care. Once a person has been diagnosed with migraine, it is important to consider that other medical conditions may also be present. This is why a complete medical history and exam is needed in all patients receiving a work-up for migraine.
When a comorbid condition is identified along with migraine, treatment now becomes more complex because there are two separate conditions to manage, and both conditions may be interrelated. For example, if someone is struggling with a bout of difficult depression, they may find their migraine attacks become worse. If depression improves, they may find that their migraine also improves. For this reason, migraine and potential comorbid conditions need to be accurately diagnosed.
If migraine and another associated illness is considered, there are several easy steps to you can take.
  1. DIAGNOSIS: Get an accurate diagnosis for the type of headache you may have and the existing comorbid or coexisting condition.

  2. TREATMENT: Get a clear treatment plan. For some patients, a single medication may successfully manage both conditions, while others may need more than one medication.
    1. Monotherapy: For example, some patients with depression may be well controlled with an antidepressant that is also effective in reducing migraine frequency.
    2. Polytherapy: However, it is important to acknowledge that for many patients, polytherapy is the optimal approach. This means that each condition can be treated independently using separate medications with individual dosing regimens. This may take some time getting used to the routine of managing two conditions using different medications.

  3. LIFESTYLE: Often lifestyle factors are an important part of managing any medical condition, and migraine is one of these. Patients with migraine will benefit from monitoring and addressing lifestyle factors that may be making migraine or other conditions worse. Below are common lifestyle factors to consider as playing a potential role in migraine and associated cormorbidities.
    1. Maintain routine sleep and appropriate amounts of sleep
    2. Maintain routine eating and drinking habits. Prolonged periods of fasting, dehydration, or hyperglycemia (too much sugar) may all make migraine or other conditions worse.
    3. Limit caffeine, alcohol and other nonprescription medications. Use of any medication should be discussed with the health care provider.
    4. Follow treatment plans as instructed. Any need to make modifications to the treatment or dosing plan should be addressed with the physician first.
    5. See appropriate cognitive, behavioral, and psychological therapy as recommended.

Overall, many individuals find that they have multiple health conditions at the same time. It is important to realize this is NOT unusual, rather a common occurrence. Seeking an accurate diagnosis and initiating treatment is the most important step to improving your overall health.

Prognosis

Migraine can be a very misunderstood and frustrating disorder. It may take months to find the best combination of treatments. Once you find the right combination, your symptoms could change and cause you to need an adjustment to your treatment plan.

Although there is no cure for migraine headache, there are a number of treatments that can help most people control them. Current advances in medical research are leading the experts to a better understanding of causes and treatments. For example, the most up-to-date research suggests that a disorder in the CNS triggers blood vessels to dilate and cause a migraine. This belief is supported by the effectiveness of triptans in stopping acute attacks of migraine without aura.

Finding the best treatment for your migraines can take a lot of time and patience. Be an active, informed decision-maker. Learn all you can about migraines, regular medical treatments and complementary treatments. Together with your health care provider or team, you can identify and learn how to control migraine triggers. You can tell your provider how various treatments are working (or not working). You can work as a team to find the most effective treatment options for managing your migraines.

Diagnosis

If your headache problem is new, visit a health care provider to get a correct headache diagnosis. Also make a medical appointment if you have an existing headache problem that has changed and/or is not controlled by your current treatment plan. Your health care provider will do a history, which is a list of detailed questions about your health and your headaches.

Questions Your Doctor May Ask


  • Is this a new headache problem?
  • If this is a recurrent headache problem, have your headaches changed? For example, do you have it in new parts of your head, is the pain worse or different and do you have new symptoms? Are you getting headaches more often?
Your health care provider will also do a physical exam and neurological exam. If the provider needs to know more, he or she may order blood tests or imaging tests such as a CT scan or MRI. Combining information about your headaches, medicines, exams and tests can help your provider diagnose your headache type. It may also help him or her plan the best treatment and “rule out” other medical disorders.
 
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