Managing Your Headache

Managing Your Headache

Dr Raeburn Forbes MD(Hons) FRCP

Consultant Neurologist

Southern HSC Trust

THINGS

YOU

CAN

DO

'Headache Friendly Lifestyle'

Positive Steps You Take

Not Negative Avoidance

How Much Fluid?

1.5 litres per day

(Holland)

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

Eat Well

>200 'food triggers'

Allergy Anxiety

Gluten Free Tastes Bad

Fear v Feasting

• BE BRAVE
• UNDERSTAND
• CHANGE
• EAT

Sleep Hygiene

Sleep Checklist

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

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...

Sleep Disorder

The TRIGGER Trap

Negative

Failure Inevitable

Be sensible

Fear is unhelpful

Prodrome of Migraine changes you

HYDRATE

EAT WELL

SLEEP WELL

EXERCISE ENOUGH

WEIGHT

The 'Trigger Trap'

Acute Headache Rescue Plan

Sumatriptan + Naproxen + Buccastem

Distraction or Sleep

Sumatriptan + Naproxen + Buccastem

Distraction or Sleep

Paracetamol

Diazepam to induce sleep

(Nurse Specialist / GP)

Acute Rescue Treatment

Prophylaxis / Prevention

Prevention

Start Low

Build

Get to maximum tolerated

Stick for 8 - 12 weeks

Use Medicines Intelligently

Deal with Painkiller Overuse

10 treatment days per month

(2 days per week)

Avoid Codeine medicines (Neurofen Plus!)

STOP

WAIT

RESET in 8 weeks

• Headache Friendly Lifestyle
• Use Medication Intelligently
• Avoid Painkiller Overuse
• Drug Free Options
• Understand the False Alarm
• Healthy Thinking

Physiotherapy

Biofeedback

Vitamins and Herbal Treatment

Physiotherapy

Brain can't tell difference between head and neck pain

Stiff facet joints / trigger points in muscles

Manual Treatment

Low Velocity

Within Range

Needs repeated

30-50% response

Biofeedback

Suppress natural pain responses

Viscious circle controlled

Breathing exercises and thinking or distraction / music

Randomised Trials

80% effective in simpler headache

Vitamins / Herbal

Vitamin B2 - Riboflavin 400mg

Feverfew

Magnesium

Acupuncture

Drug Free Options

Pain Self Efficacy

score >40 means you cope

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

Who controls your health?

Headache Locus of control

You control (internal)

Someone else (external)

Internal - better health

External - less good

Extreme Negative Thinking

Catastrophisation

Helplessness

Rumination

Magnification

Do you cope with pain (efficacy)

Are you in control?

Extreme Negative Thinking

Depression

Anxiety

Anxiety and depression

Website / Social

www.severe-headache-expert.com

@raeburn

plus/google.com

Thank You

Migraine Trust

Migraine Association of Ireland

Exercise Enough

Walking

Swim

Cycle

Make it Enjoyable

(Gym)

(Muscle v Fat)

Sleep Well

Managing

Your Headache

Dr Raeburn Forbes MD(Hons) FRCP

Consultant Neurologist

Southern HSC Trust

www.severe-headache-expert.com

Weight / BMI

Sleep Apnoea

Overweight

Daytime sleepiness

Poor sleep quality

Heavy Snoring

High Blood Pressure

Aim for healthy level

Feel good about yourself

Acceptance / Values

Hydrate

Topiramate

Amitriptyline

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)

PHQ-9

GAD-7

Anxiety

Depression

None

Mild

Moderate

Severe

Healthy Thinking

Control

Acceptance

Understanding

Values v Goals

Action

www.severe-headache-expert.com

6 Steps You Can Take

Understand the False Alarm

Your primitive brain

Your advanced brain

You are not in danger

It is a FALSE ALARM