Treating Your Headache

Acute and Preventative Treatment

Dr Raeburn Forbes MD(Hons) FRCP

Consultant Neurologist

Southern HSC Trust

www.severe-headache-expert.com

Control

Accept v Strive

Understanding

Values v Goals

So what acute treatment and preventative treatment should you take?

>200 'food triggers'

Allergy Anxiety

Gluten Free Tastes Bad

Fear v Feasting

2. Kill the Painkillers

10 treatment days per month

(2 days per week)

Avoid Codeine medicines (Neurofen Plus!)

STOP

WAIT

RESET in 8 weeks

Physiotherapy

Manual Treatment

Low Velocity

Within Range

Needs repeated

30-50% response

Acupuncture

Acute Rescue Treatment

Prophylaxis / Prevention

Pain Self Efficacy

Headache Locus of control

You control (internal)

Someone else (external)

Internal - better health

External - less good

Catastrophisation

Helplessness

Rumination

Magnification

Thank You

Migraine Trust

Migraine Association of Ireland

Exercise Enough

Walking

Swim

Cycle

Make it Enjoyable

(Gym)

(Muscle v Fat)

The TRIGGER Trap

Negative

Failure Inevitable

Be sensible

Fear is unhelpful

Prodrome of Migraine changes you

Sleep Well

Sleep Disorder

Sleep Hygiene

Weight / BMI

Eat Well

Sleep Checklist

Sleep Apnoea

Overweight

Daytime sleepiness

Poor sleep quality

Heavy Snoring

High Blood Pressure

Is your bedroom a sleep room?

Do you prepare for sleep?

Caffeine and Energy Drinks

Emotional distress / Fear / Anxiety

Regular routine

Train your brain to sleep (NB Babies)

Sleep Training

Acute Headache Rescue Plan

Avoid Daytime Nap

When tired

Prepare for bed

Go to bed

Try x 2 to sleep

Get up

Wait till tired

Try again

Keep going....

...wake with your alarm

Repeat...repeat.repeat...

Aim for healthy level

Feel good about yourself

Acceptance / Values

Sumatriptan + Naproxen + Buccastem

Distraction or Sleep

Sumatriptan + Naproxen + Buccastem

Distraction or Sleep

Paracetamol

Diazepam to induce sleep

(Nurse Specialist / GP)

• BE BRAVE
• UNDERSTAND
• CHANGE
• EAT

4. Use Medicines Intelligently

Hydrate

Prevention

How Much Fluid?

Start Low

Build

Get to maximum tolerated

Stick for 8 - 12 weeks

Topiramate

Amitriptyline

1.5 litres per day

(Holland)

Week 1 - 25mg

Week 2 - 25mg twice a day

Week 3 - 50mg am, 25mg pm

Week 4 - 50mg twice a day

Week 5-12 - 50mg twice a day

Assess effect

Week 1 - 10mg

Week 2 - 20mg (feels a bit heavy)

Week 3 - 30mg (feels too strong)

Week 4 - 20mg

Week 5 - 20mg....

Week 8 - 20mg (?50% less headache)

Spigt M et al

A randomized trial on the effects of regular water intake in patients with recurrent headaches.

Fam Pract. 2012 Aug;29(4):370-5

1: 'Headache Friendly Lifestyle'

Positive Steps You Take

Not Negative Avoidance

HYDRATE

EAT WELL

SLEEP WELL

EXERCISE ENOUGH

WEIGHT

The 'Trigger Trap'

Anxiety and depression

PHQ-9

GAD-7

Anxiety

Depression

None

Mild

Moderate

Severe

6. Healthy Thinking

Extreme Negative Thinking

Website / Social

Managing Your Headache

Do you cope with pain (efficacy)

Are you in control?

Extreme Negative Thinking

Depression

Anxiety

www.severe-headache-expert.com

@raeburn

Dr Raeburn Forbes MD(Hons) FRCP

Consultant Neurologist

Southern HSC Trust

plus/google.com

Who controls your health?

THINGS

YOU

CAN

DO

www.severe-headache-expert.com

score >40 means you cope

score <40 - you need to think/reflect/act

6 Steps You Can Take

• 1 Headache Friendly Lifestyle
• 2 Avoid Painkiller Overuse
• 3 Drug Free Options
• 4 Use Medication Intelligently
• 5 Understand the False Alarm
• 6 Healthy Thinking

5. Understand the False Alarm

3. Drug Free Options

Physiotherapy

Biofeedback

Vitamins and Herbal Treatment

Vitamins / Herbal

Biofeedback