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Symptom to Diagnosis: An Evidence-Based Guide, 4e

Chapter 20-1:  Approach to the Patient with Headache - Case 1

Jennifer Rusiecki

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Chief complaint, constructing a differential diagnosis.

  • RANKING THE DIFFERENTIAL DIAGNOSIS
  • MAKING A DIAGNOSIS
  • CASE RESOLUTION
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Ms. M is a 34-year-old woman who comes to an outpatient practice complaining of intermittent headaches.

Figure 20-1.

Diagnostic approach: headache.

A flowchart shows the diagnostic approach for headaches.

Headache is one of the most common physical complaints. Because < 1% of all headaches are life-threatening, the challenge is to reassure and appropriately treat patients with benign headaches while finding the rare, life-threatening headache without excessive evaluation.

Headaches are classified as primary or secondary. Primary headaches are syndromes unto themselves rather than signs of other diseases. Although potentially disabling, they are reliably not life-threatening. Secondary headaches are symptoms of other illnesses. Unlike primary headaches, secondary headaches are potentially dangerous.

The distinction between primary and secondary headaches is useful diagnostically. Primary headaches, such as tension headaches, are diagnosed clinically, sometimes using diagnostic criteria (the most commonly used are published by the International Headache Society, IHS). Traditional diagnostic studies (laboratory studies, radiology, pathology) cannot verify the diagnosis. Secondary headaches, such as headaches caused by central nervous system (CNS) tumors, often can be definitively diagnosed by identifying the underlying disease of which the headache is a symptom.

Clinically, primary and secondary headaches can be difficult to distinguish. The single most important question when developing a differential diagnosis for a headache is, “Is this headache new or old?” Chronic headaches tend to be primary, while new-onset headaches are more likely to be secondary. This is the first and most important pivotal point in diagnosing headaches. This distinction is not perfect. There are some chronic headaches that are secondary headaches (headaches caused by cervical degenerative joint disease for example) and even classic, primary headaches (such as migraines) can present as a new headache. The differentiation of old versus new also depends on how rapidly a patient brings his or her symptoms to medical attention. This being said, the classification of headaches as primary versus secondary and new versus old provides not only a memorable framework for the differential diagnosis but also a clinically useful structure by which the differential can be organized by pivotal points. The differential diagnosis appears below. Figure 20-1 shows the potential diagnoses in a more algorithmic form as they are often considered clinically. The IHS’s classification website ( https://www.ichd-3.org/ ) is also a terrific resource for an annotated differential diagnosis.

Old headaches

Tension headaches

Migraine headaches

Cluster headaches

Cervical degenerative joint disease

Temporomandibular joint syndrome

Cranial neuralgias (maybe either primary or secondary)

Headaches associated with substances or their withdrawal

Analgesics (often presenting as chronic daily headaches)

New headaches

Benign cough headache

Benign exertional headache

Headache associated with sexual activity

Benign thunderclap headache

Idiopathic intracranial hypertension (pseudotumor cerebri)

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Management of Headache and Headache Medications pp 65–78 Cite as

Migraine Headache Sample Case Studies

  • Lawrence D. Robbins M.D. 4 , 5 , 6  

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Julie is 20 years old with severe, prolonged 2 to 3 day migraines twice per month. She also has mild chronic tension headache (CDH). She has difficulty sleeping and is mildly anxious. She occasionally utilizes an inhaler for asthma.

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  • Beta Blocker
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  • Chronic Daily Headache

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Robbins, L.D. (1994). Migraine Headache Sample Case Studies. In: Management of Headache and Headache Medications. Springer, New York, NY. https://doi.org/10.1007/978-1-4684-0195-0_5

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The curious case of an atypical headache, a case report and review of literature

Hamza paracha.

1 International American University College of Medicine, Saint Lucia;

Syed Asim Hussain

2 Department of Family Medicine, University of Calgary, Calgary, Canada

Atypical headaches are uncommon and require special consideration by a primary care physician. We report the case of a 37-year-old male, who presented to the family medicine practice with persistent headaches which subsided postprandial and was later hospitalized for stroke-like symptoms. The lumbar puncture (LP) suggested viral etiology; however, cerebrospinal fluid (CSF) yielded no evidence of a specific virus. The patient computed tomography (CT) was non-diagnostic and magnetic resonance imaging (MRI) confirmed no acute intracranial abnormalities. Electroencephalogram (EEG) showed no definite epileptiform discharges, electrographic seizures, or evidence of non-convulsive status epilepticus. He was started empirically on intravenous (IV) acyclovir 800 mg Q6 for 10 days, followed by another 10 days of oral valacyclovir 500 mg twice a day (BID) antivirals leading to a complete resolution of his symptoms and confirming the diagnosis as viral encephalitis. This case is unique in its presentation due to the postprandial resolution of the patient’s headache with no evidence of a specific virus in the CSF. In primary care setting, headaches are often referred routinely to neurologist for further management. However, more insidious causes for a headache, such as viral infections, should not be ruled out; and if the symptoms are acute and severe, an immediate inpatient work-up with empiric treatment for the most probable etiology may be warranted, despite unequivocal exam and laboratory findings.

Introduction

Patients with headaches are frequent occurrences in primary care practices. The headaches have an estimated lifetime prevalence of 66%—of which, 14% to 16% corresponds to migraine, 46% to 78% to tension-type headache, and 0.1% to 0.3% for cluster headache ( 1 - 3 ). The economic effects of a headache are also substantial. It is estimated that headache accounts for 20% of work absences ( 4 ).

Tension-type headaches have an increased incidence in patients observing fasting. The frequency of these headaches also increases with the duration of the fast and may be associated with factors like hypoglycemia, caffeine withdrawal, dehydration, or lack of sleep ( 5 ). Management of these headaches is dependent on the physician’s ability to effectively assess and diagnose them. It is important to obtain an extensive history and physical examination in order to identify any possible causes of headaches ( 6 ). Acyclovir is frequently started empirically in patients with clinical suspicion of infective encephalopathy, even if the etiology is unknown ( 7 ).

Acute viral encephalitis is a neurological emergency which often requires prompt diagnosis and treatment to prevent severe disability or death. Making this diagnosis hinges crucially on a lumbar puncture (LP) that is often delayed in practice ( 8 ).

We report the case of a 37-year-old male, who presented to the family medicine practice with persistent headaches which subsided postprandial and was later, was admitted to the hospital for stroke-like symptoms. We present the following case in accordance with the CARE reporting checklist (available at http://dx.doi.org/10.21037/acr-20-88 ).

Case presentation

A 37-year-old male with no prior history of headaches presented with a 2-week history of severe right-sided headaches behind the eye. The patient also reported a previous episode of blurry vision in his left eye a week before the onset of right-sided headache. During this time the patient was fasting for religious reasons and stated that the headache was accompanied with vomiting without nausea which subsided after a meal. The patient stated that he had recently traveled to India for a conference a month prior to the onset of his symptoms, but did not visit any rural areas or get ill during his visit. He did not report any previous episodes.

On examination, his vital signs were normal and he appeared mildly anxious. Upon central nervous system (CNS) examination, pupils were equal, round and reactive to light, cranial nerves II–XII were intact, reflexes were symmetric and intact bilaterally, Glasgow Coma Scale of 15, and no meningeal signs or photophobia.

The initial diagnosis of migraines secondary to hypoglycemia while fasting was made. The patient was requested to discontinue fasting until his symptoms resolved along with 50 mg of Cambia. A follow-up appointment was scheduled for 1 week.

The patient’s symptoms worsened and presented to the emergency room (ER) the following day with sudden onset of dysstasia, aphasia, with right-sided hemiparesis and fluctuating loss of consciousness (LOC). He reported intermittent headaches, generally worse in the back of the head and right-sided blurriness. He did not have any neck stiffness or back pain. The patient reported that he was asymptomatic in the morning but noted unsteady gait, and staring spells as the day progressed. He then began to have worsening dysphasia and dysarthria; however, he was able to follow commands and instructions.

Given the severity of his symptoms, the patient was admitted to the hospital for further evaluation. Initially, he was empirically managed with intravenous (IV) ceftriaxone 2 g Q12, vancomycin 1 g Q12, and acyclovir 800 mg Q6 for suspected viral encephalitis. Computed tomography (CT) angiogram of the head and neck showed no acute intracranial abnormality. The patient’s CT was non-diagnostic and magnetic resonance imaging (MRI) confirmed no acute intracranial abnormalities.

Traumatic LP revealed an opening pressure of 35, protein 2.89 g/L, white blood cell (WBC) 133 (10 6 /L) with 53% lymphocytes, red blood cell (RBC) 38,000 (10 6 /L). However, cerebrospinal fluid (CSF) showed no evidence of Japanese encephalitis, HSV (type 1 or 2), varicella-zoster virus, enterovirus, or parechovirus. Serum tests for HIV, West-Nile virus PCR, Ebstein-Barr virus, cytomegalovirus, and viral hepatitis (A, B, and C) also yielded non-diagnostic results.

Electroencephalogram (EEG) was recorded in a confused patient during wakefulness and drowsiness. There was mild to moderate diffuse slowing of the background which appeared nonspecific secondary to a mild encephalopathic process. In addition, there was a continuous delta slowing over the left hemisphere through the recording that could be due to structural lesions or postictal changes. There were no definite epileptiform discharges, electrographic seizures, or evidence of non-convulsive status epilepticus.

The patient received 10 days of IV acyclovir which showed improvement in the repeat LP; protein 0.67 g/L, WBC 28 (10 6 /L) with 94% lymphocytes, RBC 73 (10 6 /L) with negative CSF infectious workup. Antibody screening was conducted and ruled out autoimmune encephalitis.

Ten days after admission, he was discharged with 10 days of valacyclovir 500 mg twice a day (BID) for a total of a 20-day course of anti-viral. The patient presented to the outpatient clinic after concluding the valacyclovir. Neurological examination was within normal limits (WNLs) and the patient had complete resolution of viral encephalitis. Figure 1 describes the timeline for the sequence of events in chronological order. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this manuscript.

An external file that holds a picture, illustration, etc.
Object name is acr-04-20-88-f1.jpg

Timeline with sequence of events. CSF, cerebrospinal fluid; ER, emergency room; CT, computed tomography; MRI, magnetic resonance imaging; LP, lumbar puncture; IV, intravenous; EEG, electroencephalogram; BID, twice a day; WBC, white blood cell; RBC, red blood cell; WNL, within normal limit.

Patients with headaches are frequent occurrences in primary care practices. The headaches have an estimated lifetime prevalence of 66%—of which, 14% to 16% corresponds to migraine, 46% to 78% to tension-type headache, and 0.1% to 0.3% for cluster headache ( 1 - 3 ). The economic effects of a headache are also substantial. It is estimated that headache accounts for 20% of work absences ( 4 ). Majority of these headaches are managed in an outpatient setting without an immediate referral to the emergency department or non-emergent referral to the neurologist. These headaches can be caused by psychosocial factors, prescription medications, or other neurological conditions like migraines. Effective management of these headaches heavily depends on the physician’s ability to assess and diagnose. A detailed and focused history, along with a complete physical examination is essential to identify any causes of headaches. Early detection and diagnosis from the presenting illness allow creating an effective management plan.

Encephalitis is a pathological term meaning inflammation of the brain. This inflammation can be ascertained clinically by patients presenting with fever, seizures, or functional neurological deficits, CSF parameters, imaging, or EEG. CSF typically exhibits increased pressure with a slightly elevated protein and normal glucose concentration. Glaser et al. reports that even in patients with clear signs of an acute infection, more than 10% did not exhibit an underlying relationship to the illness ( 9 ). Acute viral encephalitis is a neurological emergency, which often requires prompt diagnosis and treatment to prevent severe disability or death. Making the diagnosis of viral encephalitis hinges crucially on a LP, which is often delayed in practice ( 8 ).

Headaches have an increased incidence in patients observing fasting ( 5 ). While following the “ Guideline for primary care management of headache in adults ”, our patient presented without red-flag symptoms to rule out any secondary causes of headache ( 10 ). In a previous study, Awada et al. reports that 41% of patients fasting have a headache predominantly of tension-type. The frequency of these headaches also increases with the duration of the fast and may be associated with factors like hypoglycemia, caffeine withdrawal, dehydration, or lack of sleep ( 5 ). The resolution of our patient’s headache, with a meal after a prolonged state of fasting, can certainly mask the underlying symptoms of the patient. Therefore, the threshold for referral of atypical headaches or unusual headache precipitants should be low.

Not every patient will present with classic headache symptoms. These patients should be followed up more frequently to monitor changes in their presentation. More insidious causes for a headache, such as viral infections, should not be ruled out. If the symptoms are acute and severe, an immediate inpatient work-up with empiric treatment for the most probable etiology may be warranted, despite unequivocal exam and laboratory findings. Acyclovir is frequently started empirically in patients with clinical suspicion of infective encephalopathy, even if the etiology is unknown. However, Chaudhuri et al. reports that acyclovir has no therapeutic benefit in patients with non-herpetic encephalitis ( 7 ). This leads us to believe that our patient in fact did have herpes simplex virus encephalopathy despite yielding no results in the CSF.

Primary care physicians tend to refer mainly to the pathway presented in the referenced flowchart ( Figure 2 ) ( 10 ). However, as per the uncharacteristic presentation of our patient, it is essential to think beyond the four main subgroups of headaches. Educating the patient on potential red flags and creating a safety plan is paramount to the outcome in patients with atypical headaches. Figure 3 illustrates a suggested guideline for primary care physicians in atypical presentation ( 10 , 11 ).

An external file that holds a picture, illustration, etc.
Object name is acr-04-20-88-f2.jpg

Guideline for primary care management of headache in adults.

An external file that holds a picture, illustration, etc.
Object name is acr-04-20-88-f3.jpg

Primary care guide for diagnosing viral encephalitis. CSF, cerebrospinal fluid; ER, emergency room; CT, computed tomography; MRI, magnetic resonance imaging; LP, lumbar puncture; IV, intravenous; WBC, white blood cell; LOC, loss of consciousness.

Effective management of headaches in an outpatient setting is heavily dependent on the physician’s ability to assess and diagnose through a focused history and a complete physical examination. Physicians have a referral bias towards diagnostically challenging cases based on the severity of the patient’s presenting illness ( 9 ). While making the diagnosis of viral encephalitis hinges crucially on a LP, failure to identify and treat these headaches due to delayed testing may lead to more serious sequelae. Glaser et al. also states the need for new approaches and better tools for identifying the etiology ( 9 ).

Conclusions

This case highlights the importance of diagnosing headaches promptly in patients with atypical presentations. In addition, when these findings are identified, a full history including a timeline of the symptoms should be conducted. Given that the prevalence of adult headaches in primary care is fairly frequent, it is not realistic or practical to investigate every patient with an LP or radiological imagining of the brain. However, it is important to have careful consideration of the signs and symptoms presented. A significant portion of the consultation should incorporate patient education regarding red flag symptoms and safety planning. Furthermore, with the possibility of subtle presentation and the nonspecific symptoms of viral encephalopathy, physicians are urged to keep this diagnosis on their differential for headaches.

Acknowledgments

Funding: None.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient for publication of this manuscript.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/ .

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at http://dx.doi.org/10.21037/acr-20-88

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/acr-20-88 ). The authors have no conflicts of interest to declare.

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S5:Ep1 – Migraine Stigma, Treatment, and Access: OVERCOME Study Findings

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Voice-over : Welcome to Spotlight on Migraine hosted by the Association of Migraine Disorders. Join us for fresh perspectives by medical experts and advocates as we explore the spectrum of migraine and dig deeper into this complex disease. Hear from Dr. Eric Pearlman, Associate Vice President at Eli Lilly, as we dive into their findings from the OVERCOME study. This study aims to further understand the stigma experienced by people living with migraine, identify barriers to the appropriate treatment, and assess how novel treatment options may influence delivery of migraine care and outcomes.

Molly O’Brien : Hello, and welcome to Spotlight on Migraine . I’m your host, Molly O’Brien. I’d like to introduce and welcome our guess today, Dr. Eric Pearlman. Dr. Pearlman is a neurologist and headache medicine specialist who serves as the Associate Vice President of Neuroscience Clinical Design for Eli Lilly and Company. Dr. Pearlman is responsible for leading clinical design teams for Lilly’s neuroscience portfolio.

Dr. Pearlman, thanks so much for joining us today. I’m excited to chat with you.

Dr. Eric Pearlman : Hi, Molly, it’s a pleasure to be here. I’m excited as well.

O’Brien : Well we’re so excited to have you, and we’re talking today about research and an educational program that Lilly has for those living with migraine. The research that’s come out is really interesting, so let’s dive into that first. Talk to us just a little bit about the research that Lilly has gone into, the OVERCOME study, and talk to us a little about why it’s important.

Pearlman : Well OVERCOME is a very important bit of information or research study for a few reasons. One, it’s a population-based survey and so, in essence, it’s a questionnaire sent out to consumers and then asked them questions around their health status. And if they have migraine, it goes into a lot more detail around migraine. And it’s the largest study of its kind encompassing over 60,000 participants in the United States. And what makes it really important in understanding the journey that people with migraine go through is that it goes…you don’t have to be engaged in the healthcare system to be part of this study.

Most other research studies, you have to be in a clinical trial or be seeing a healthcare provider and have a medical record or fill prescriptions to have prescription claims, so then, you know, the system can look at your information and understand about you. But we know that there’s a significant portion of people with migraine who aren’t engaging with the healthcare system, and this study allows us to understand the impact that migraine has on their lives and the journey that they go through. And so it’s unique in its ability to tap into a population that most other research misses.

O’Brien : And I think that’s what’s fascinating, too, because it likely depicts a much better picture of those people living with migraine because you’re tapping into, so to speak, untapped communities. So really excited to talk about some of the research and some of the findings.

Pearlman : While it gives us a more complete understanding, it’s not necessarily better because, on the one hand, you’d think it’d be better because if people aren’t seeing a provider, then it might not be so bad. But as we can talk about, it’s actually a bit disheartening because we found that a lot of people, who don’t engage in the healthcare system, are significantly impacted by migraine. And that’s something that we have overlooked because we haven’t done this type of study before.

O’Brien : Better is not the right word – a clearer picture might be a more accurate term. Well that’s very exciting to hear. So let’s dig into some of these findings. The OVERCOME study revealed that there has been slow but steady progress in the diagnosis and treatment of migraine, which is exciting to hear. But despite some of these studies or strides, excuse me, the study found that many living with migraine have unmet needs. So can you talk to us just about some of these significant findings from the OVERCOME study.

Pearlman : Sure. So, the way we looked at it is first off, we went to people and asked them if they suffered from headache and then used a validated tool to make a diagnosis of migraine. And so we could understand that a person had migraine even if they’ve never actually been diagnosed by a healthcare provider. And so, you know, some of the interesting things, although a big disheartening, are of all of those people who suffer from migraine and are impacted by migraine – so at least 2 times out of a month they have some degree of impact from migraine – about 37% of them had never gone to a healthcare provider to talk about migraine. So, you know, a third of people impacted, right, two days out of a month, that’s reasonable. You know, don’t even talk to a healthcare provider about it.

And then, if they do talk, there’s still a percentage who don’t even get a diagnosis, so they get diagnosed with something else or, you know, they’re sent off for testing. Or the doctor may say – or the healthcare provider may say – you have migraine, but the patient doesn’t remember it. So there’s that group. And then, you know, there’s another group that don’t get appropriate treatment even if they get diagnosed. And so of those people who are impacted, only 28% are actually getting appropriate treatment for their migraine.

O’Brien : That is significant. That’s not a high percentage. So let’s talk about some more of these stats. One of the significant stats was less than 1 in 5, who have frequent migraine attacks, are taking a recommended preventative drug. So why do you think that is? What have we learned from this research?

Pearlman : You know, it’s interesting. Again, there’s that whole waterfall of what a patient would have to go through to actually get that preventive medicine. So, to be eligible, you know, the American Headache Society and American Academy of Neurology say if you have 4 days out of a month that you’re impacted by migraine, you should consider being on a preventive medicine, something you take on a regular basis to decrease the frequency and severity of those attacks. So that’s sort of what’s that recommended group. And again, if you look at who’s going to a doctor, who’s getting diagnosed, who’s getting treatments that are recommended by those same organizations, only about 15% of people impacted 4 or more days a month impacted by migraine, only about 15% are on a recommended preventive medication.

O’Brien : Let’s talk about some more of the findings related to migraine stigma. And what do they mean for people who live with migraine disease and their caregivers and loved ones?

Pearlman : Well, stigma’s really interesting and well it’s not interesting…when we looked at stigma and first, stigma is my perception – I’m a person with migraine – that other people view me in a negative light because of my disease, in this case, migraine, right? And when we talked to people with migraine and asked them if they felt like other people viewed them as not doing what they should be doing or trying to get out of things, trying to achieve some secondary gain from their migraine, a really high percentage of people felt that they were…they felt stigma either often or very often.

And the most common things they were feeling was that people thought they were trying to use migraine to get out of something or to avoid work or, you know, to have people feel sorry for them. But that’s really not the case, right? When we talk to people with migraine, most people with migraine, you know, they’re pushing through, right? They’re trying to figure out how to get done what they can accomplish as they’re working through the pain and trying to figure a workaround – turning the lights off, doing what they need to do to try and still be productive. They want to get to their kid’s activities; they want to be able to commit to a social engagement and be able to follow through on it. They’re not really trying to get out of things.

But when we talked to people who didn’t have migraine – so we actually surveyed people who didn’t have migraine – if they knew one or more people with migraine, they were much more likely to believe that people with migraine were using it to get out of things. And so that’s really what drives the stigma. You had asked about, you know, why so many people who are impacted by migraine aren’t going to their healthcare provider or are hesitating to seek care, right? And the two most common reasons were: 1) I thought this was something that I could deal with on my own, which on the one hand, yeah, I’m tough, I can take it. But it also implies that people aren’t taking it seriously, right? That they don’t recognize that this is a neurologic disease that’s really impacting them in a meaningful way, and there’s options out there that can help them.

And the other was that they didn’t feel like their healthcare provider would take them seriously. And that’s that burden of stigma, right? That’s even if I talk to you about migraine, you’re not going to listen to me, or you’re going to think that I’m, you know, trying to get out of something, or I’m just not tough enough, right? And that’s really unfortunate because you go to the doctor with and your healthcare provider with any other complaint, you don’t expect them to not take you seriously.

O’Brien : That’s so disheartening to hear that so many people out there are feeling that way. Those are the two most common reasons why people with migraine aren’t discussing these things with their healthcare provider. That feels like a physical weight. But it’s good to know that because it means we still have a lot of room for migraine education out there, awareness, and how to combat migraine stigma.

So it’s good to hear these results – even though it’s probably not what we want to hear – and that way we can look for better education and programs, which we’re going to talk a little bit more about some programs that Eli Lilly has available for people living with migraine, which is exciting. So we’ll get to that in a minute. But whoa, really interesting findings. Like you said, stigma’s interesting – it’s not but it’s good to learn this stuff, and we do love research over here, at the Association of Migraine Disorders.

So let’s talk a little bit about why it’s important for people living with migraine to have honest conversations with their healthcare providers. You just mentioned that there is a little bit of a barrier there because of that believability factor. So let’s talk about why – besides that – it’s important to sit down and have these conversations with a healthcare provider.

Pearlman : Well, I think, you know, there’s two parts to that. One, it’s important that if you’re impacted by migraine – if you’ve got disabling headache – there’s things that can be done, and there’s many more treatment options available today than there were just even 5 years ago, right, and even before that. There’s options out there, and you deserve the opportunity to be able to do the things that you want to do and get the right treatment for your neurologic disease that’s migraine.

And so, you should be bringing it up and having those conversations. I think it falls to us to work to destigmatize migraine amongst healthcare providers, so that people don’t have the perception that they won’t be taken seriously. And destigmatize it in the general community as well, so people feel confident that if they bring it up, they’ll be taken seriously, and they’ll be heard.

The other piece of it, though – and I think what’s even…well not more critical but equally critical – is the idea of what you say to your healthcare provider is important. Because if you convey to your healthcare provider the degree that migraine impacts your ability to function, you are more likely to get appropriate treatment than if you just say, I’m having headaches, and they affect me 7 days out of a month, right? So, you know, I’m having 7 migraine headache days a month. Okay, well that’s not great. But if you really talk about I have headaches 7 days per month, and I’ve missed work twice, and I’ve had to cancel activities 4 times, and I can’t plan a vacation because if I travel, it triggers migraine attacks. And if I change my sleep habits, I know I’m going to have a migraine attack.

Talking about impact, sort of, as the spark that will get a provider to act more definitively. And it doesn’t have to be a really long conversation. I think that’s the other fear that both patients and providers have, right? The patient says, if I start talking about headache, it’s going to be 30 minutes of question and answer, and I’m going to get drilled. And the provider says, oh if that patient, I see they marked headache on their sheet here. If I mention that, I’m going to be trapped in this room for 45 minutes trying to figure out what to do. It doesn’t have to be that complicated. It’s how often does migraine impact your ability to function? And, you know, if the answer is one day a month, then you need an appropriate acute treatment. If it’s one day a week or four days a month, then you should consider preventive treatment.

And it doesn’t have to be a really long involved conversation, right? Do you have headache? Does it have associated symptoms – sensitivity to light, sensitivity to noise, nausea? Does it impact your ability to function? If the answer to that is yes, it’s migraine. Okay. Check that box, move on. How often is migraine impacting your ability to function? You get that answer pretty quickly. You can do that in a reasonable amount of time in a typical primary care visit. So you just have to spark the conversation and use the right words. Because if a patient uses the right words, the provider will respond.

O’Brien : You know what’s really interesting about that – talking about impact and how migraine or headache (if you don’t know that you have migraine yet) impacts your life – it’s another good reminder to keep a headache diary, which I know we have this conversation a lot among the migraine community. And speaking as someone who’s lived with chronic migraine for way longer than I’d like to admit, keeping track of symptoms in a diary can just feel overwhelming and like a big burden and like it’s not worth it.

But like you’re saying, when you’re having these conversations with your doctor, if you can go back and say, not only do I have headache four days a month or one day a week, but it’s doing this to me. I’m missing work, I’m not able to travel. So all of which you said is just another subtle reminder why keeping a diary or keeping track of things is important. And not just the days, the times, that kind of stuff – it sounds like, more importantly, the impact can be a key to discussing with your healthcare provider.

Pearlman : Yeah, and I’m all about simplification. And there’s a time and a place to get into all of those details. And, you know, in some in more complicated cases, it’s important to understand all of that to make the right decisions and so forth. But, even if you can get someone to just put an X on a sheet of paper that has a day, this was the day I was impacted. Just so you…it doesn’t have to be complicated, right? If you can…so when you talk to your provider, because that’s the other thing – you go in, and you see them once a year, once every 6 months, or even if you make a specific appointment to talk about headache, being able to recall in the moment is not an easy thing to do, right? So just put an X on a calendar on a day you’re impacted. I was impacted 5 days a month the last 3 months, right? As that can be equally helpful.

O’Brien : I believe in simplification as well. I like to just put a dot on my calendar, on my phone, on the days that I live with migraine, and I have color-coded systems. So any way that it can help people, like you said, spark that conversation with their healthcare provider. So you did mention, in the OVERCOME study, that there were findings that really show that there is a need for more migraine awareness and education. And Eli Lilly has a really cool program; it’s called the Think Talk Treat program. Can you tell us a little bit more about the program – why it was developed and what people living with migraine can get from it?

Pearlman : So Think Talk Treat Migraine is sort of the essence of what we’ve already been talking about. So we had the data from the OVERCOME study, which showed that there was a tremendous amount of unmet need. People who should be on appropriate who weren’t on appropriate treatment. It also dove deeper into why that was. Why did someone not go to a healthcare provider? Why did a healthcare provider not prescribe? Why did someone get prescribed and not take? You know, all the different factors that go into that.

And so we looked at those sort of root causes, so to speak, as to what was leading to that unmet need. And then developed a program to target a couple of those root causes. And we chose to target diagnosis, recognizing that you have migraine and making it easy for a primary care provider to recognize you have migraine. Because again, the vast majority of people with migraine are going to be cared for in primary care; they are cared for in primary care. There’s not enough neurologists and definitely not enough headache specialists to take of everyone with migraine, and we don’t really think that’s necessary.

So using those root causes that we identified, we developed a program called Think Talk Treat Migraine. And we labeled it the 4-1-1 of migraine for those of old enough to use landlines, right? So 4-1-1 was how you got information, right? So 4 if you have headache and any of the 3 associated features – sensitivity to light, sensitivity to noise, nausea, or impact, sensitivity to light, nausea, impact – you have migraine. It’s all it takes to make the diagnose; it’s based on a validated tool called ID Migraine. If you have migraine, you have to ask one question, and that’s how often a month are you impacted by migraine?

And if the answer is 1, then 1 day a month acute treatment, 1 day a week, 4 days a month, preventive treatment. And so it’s a very simple message. And we put that out to patients through a website that we had through social media posting, through search optimization and things, so patients could see that message. And we also gave that simple message to primary care providers, to the primary care provider community with some basic education around it. Because what we wanted to convey was migraine – while it’s a complex neurologic disease – is not complicated for the vast majority of people, right? It’s ask a simple question, ask the right question, get the right answer and start treatment.

And then we wanted to make sure that they were using the same language on impact. So, easy to recognize migraine, and then match the conversation around impact. And that’s the essence of Think Talk Treat Migraine. And obviously, there’s a lot more that goes into it in terms of, you know, making sure it’s the right diagnosis and discussing different treatment options. But at least to spark that conversation and to make it so that patients and providers were interested enough in migraine to learn more. So it’s more of an activation program than an education program.

O’Brien : I love that because you get activated, and then you have the education portion of it, and you’re able to communicate with healthcare professionals. And healthcare professionals can get some education out of it as well. So it’s the activation program, which is really exciting. Well, Dr. Pearlman, as we’re wrapping up here, is there anything else that you want to share either about the OVERCOME study or about Think Talk Treat Migraine that you think people out there should know?

Pearlman : Well I will come back to stigma a bit because I do think that, you know, with advocacy work and working with advocacy organizations, we really can play a role in reducing the stigma of migraine. And if we can nudge that a little bit, I think that will make it easier for people with migraine to speak up and to have the right conversation, right? So I don’t want to let that go – that we have an opportunity to destigmafy/destigmatize migraine. And so we need to take accountability for that and works towards that. So, I think there’s that. And repeat the question again.

O’Brien : Just if there’s anything else that you want to share about the findings. What you’re saying is great. If there’s anything else about the Think Talk Treat program as well.

Pearlman : So I think, you know, obviously, we want to spread that message any way that we can. And, you know, while this is a program that Eli Lilly has developed, it is much more around recognition, diagnosis, and having the right conversations than about specific medications. And so, this is the contents available for others to use and to share and distribute. We have a website, ThinkMigraine.com, that we actually have just recently launched a Spanish language version of the website with some information there because that’s another area that has tremendous unmet need and is underserved in our Spanish-speaking population as well. And so, we think it’s important that we continue to advocate to get this message out and to try and demystify and destigmatize migraine.

O’Brien : Well it’s been a wonderful conversation today. I know I learned quite a bit, and I’d like to thank our guest, Dr. Eric Pearlman, from Eli Lilly, for joining us today. Dr. Pearlman, thanks so much for sharing your knowledge.

Pearlman : Thanks, Molly. Thank you for the opportunity.

O’Brien : We appreciate it. And we appreciate you listening and watching out there. Once again, I’m Molly O’Brien with the Association of Migraine Disorders. We’ll see you next time.

Voice-over : Thank you for tuning into Spotlight on Migraine . For more information on migraine disease, please visit MigraineDisorders.org.

*The contents of this podcast are intended for general informational purposes only and do not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. The speaker does not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.

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Migraine & Genetics Breakthrough

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Do you suffer from migraines? A migraine is a very strong headache that might come with nausea, vomiting and sensitivity to light. Many people suffer from this condition and the symptoms are really intense and might interfere with everyday life. If you want to speak about your breakthrough regarding migraines and genetics you can now do it with this template! It’s perfect to display your data in a very visual way!

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Correlation between migraine and cerebral small vessel disease: A case-control study

Affiliations.

  • 1 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
  • 2 Research Laboratory of Cancer Epigenetics and Genomics, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
  • PMID: 37985464
  • DOI: 10.1002/ejp.2199

Background: Microcirculatory pathology is one of the pathophysiological theories of migraine, which may present as visually subclinical lesions. Image markers of cerebral small vessel disease (CSVD) have been investigated in elderly migraineurs. However, past studies looked at only part of image features, and the conclusions may have been hindered by confounding factors. The relationship between migraine and CSVD signs needs reliable demonstrations.

Methods: We conducted a case-control study by recruiting episodic young migraineurs from a tertiary headache centre, with tension-type headache (TTH) and healthy controls. Distinct image features of microvascular damage and baseline characteristics across groups were assessed, and multivariate linear regression was performed to evaluate the risk factors for image abnormalities in migraineurs.

Results: Forty-eight migraineurs, 32 TTHs and 49 healthy controls were included. The median age was 32 year-old. 58.7% of the participants were female. The Scheltens score and volume of white matter hyperintensities (WMHs) in migraineurs, and the number of Virchow-Robin spaces (VRSs) in both migraineurs and TTHs were different from those in normal controls. No lacunar infarct-like lesions (ILLs) or cerebral microbleeds (CMBs) were found. Age, education level (high level: β = -2.23, lobar WMHs), attack duration (long duration: β = 3.81, lobar WMHs) and attack frequency were independent risk factors for Scheltens score and volume of WMH in migraineurs. Migraine aura (β = -2.389), attack frequency and education level were correlated with the number of VRSs.

Conclusions: Migraine was associated with WMHs and VRSs. Aura, attack duration, attack frequency, age and education level were risk factors for image abnormalities of CVSD in migraineurs.

Significance: This study provides a novel and comprehensive landscape of CSVD MRI features in young migraineurs, and it fills the blank of CMBs and VRSs which received less attention, with more persuasive, more reliable and stronger evidence of the association between CSVD and migraine. Our results also imply some new feature of TTH and the possible pathophysiology of the migraine course as well as new clues for the early management of migraine in terms of visual brain damage.

© 2023 European Pain Federation - EFIC ®.

international journal of trend in scientific

Treating Migraine Ardhavbhedaka with Ayurveda A Single Case Study

Jan 25, 2020

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Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 20 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7 around 1 in 7 people .1 Chronic Migraine affects about 2 of world population2 with female and male ratio 3 1.3 The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or halos around the light, this type of headache is called headache with aura. It is also called as "sick headache because nausea and vomiting occasionally accompany the excruciating pain which lasts for 4 to 5 hours. Ayurveda believes in treating the disease at its root cause from within. The present article is a case report of 27 years old male who visited ENT OPD at SDM college of Ayurveda and Hospital, Hassan, Karnataka with a known case of migraine since 6 years. The patient was treated with Ayurvedic managements both sodhana and shamana chikitsa, under IPD and then OPD basis for 2 months. The patient experienced no attack of migraine even within 2 months of interval. This helps to achieve complete curative and prophylactic management of migraine through Ayurveda. This article may aid a new treatment option among practitioners of new era where there is no permanent cure for migraine. Dr. Shyam Kumar Sah | Dr. Deeraj Bc | Ashwini Mj "Treating Migraine (Ardhavbhedaka) with Ayurveda: A Single Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21556.pdf Paper URL: https://www.ijtsrd.com/medicine/ophthalmology/21556/treating-migraine-ardhavbhedaka-with-ayurveda-a-single-case-study/dr-shyam-kumar-sah<br>

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International Journal of Trend in Scientific Research and Development (IJTSRD) Volume: 3 | Issue: 3 | Mar-Apr 2019 Available Online: www.ijtsrd.com e-ISSN: 2456 - 6470 Treating Migraine (Ardhavbhedaka) with Ayurveda: A Single Case Study Dr. Shyam Kumar Sah1, Dr. Deeraj Bc2, Dr. Ashwini Mj3 1PG Scholar, 2Associate Professor, 3Professor and HOD 1, 2, 3Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India How to cite this paper: Dr. Shyam Kumar Sah | Dr. Deeraj Bc | Ashwini Mj "Treating Migraine (Ardhavbhedaka) with Ayurveda: A Single Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456- 6470, Volume-3 | Issue-3, April 2019, pp. 68-69. http://www.ijtsrd.co m/papers/ijtsrd215 56.pdf Copyright © 2019 by author(s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/ by/4.0) INTRODUCTION The Migraine Research Foundation considers Migraine is the 3rd most prevalent illness and 6th most disabling health illness in the world. Migraine sufferers have a higher chance of having depression, anxiety, sleep disorders, other pain conditions and fatigue.4 It is a leading cause of disability throughout the world. It has a multifactorial background such as genetic, environmental, metabolic, harmonal and pharmacological.5These factors trigger the attacks of migraine vary between patients. However, it presents a common pattern of occurrence with peak incidence in adolescence and peak prevalence in middle age. About two third of the case run in the family.The headaches affectone half of the head and are throbbing and pulsating in nature, and last from 4 to 72 hours.6 Changing hormone levels may also play a role as migraine aaffects more in boys than girls before puberty, and two to three times more in women than men.7 Up to one third of people have an aura typically a short period of visual disturbance that signals that the headache will soon occur.8 It is highly prevalent headache disorder over the past decade having considerable impact on the individual and society. It can involve brain, eye and autonomous nervous system. Migraines are believed to be a neurovascular disorder with evidence supporting its mechanisms starting within the brain and then spreading to the blood vessels.9The neurotransmitter serotonin (5- ABSTRACT Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 20 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7% (around 1 in 7 people).1 Chronic Migraine affects about 2% of world population2 with female and male ratio 3:1.3 The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or halos around the light, this type of headache is called headache with aura. It is also called as “sick headache” because nausea and vomiting occasionally accompany the excruciating pain which lasts for 4 to 5 hours. Ayurveda believes in treating the disease at its root cause from within. The present article is a case report of 27 years old male who visited ENT OPD at SDM college of Ayurveda and Hospital, Hassan, Karnataka with a known case of migraine since 6 years. The patient was treated with Ayurvedic managements: both sodhana and shamana chikitsa, under IPD and then OPD basis for 2 months. The patient experienced no attack of migraine even within 2 months of interval. This helps to achieve complete curative and prophylactic management of migraine through Ayurveda. This article may aid a new treatment option among practitioners of new era where there is no permanent cure for migraine. KEYWORDS: Migraine, Ardhavabhedhaka, Shodhana and Shamana chikitsa IJTSRD21556 hydroxytryptamine) and hormone estrogen play vital role in pain sensitivity of Migraine. Low levels of Serotonin selectively constricts cranial blood vessels and also induces a massive activation of peripheral nerve endings which play a key role in triggering migraine headache. Estrogen mainly affects female of reproductive age group.10 Consent: Informed consent was taken prior to case study. Case report: A 27 year old male patient visited ENT opd on 02/01/2018 of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, with chief complaints of unilateral headache on and off once and some times twice in a month since 6 years. Headache was followed by nausea and sometimes vomiting, too. Headche was alternating means sometime in right side and sometime in left side. The body weight was 57 kgs. Occupationally, he was a software engineer. No significant family history and personale history identified. He consulted many allopathic physicians but got symptomatic relief only. For above said complaints he was admitted (IP- 027476) here on the same day for further management. There was no history of diabetes mellitus or hypertension. His vitals were within normal limits. On general examination, there was no pallor, icterus, clubbing of @ IJTSRD | Unique Paper ID - IJTSRD21556 | Volume – 3 | Issue – 3 | Mar-Apr 2019 Page: 68

International Journal of Trend in Scientific Research and Development (IJTSRD) @ www.ijtsrd.com eISSN: 2456-6470 nails, oedema or lymphadenopathy noted. No CNS abnormalities noted on through examination. Investigations: Routine haematological and urine investigations as well as CT scan of brain were carried out and findings were not of any pathological significance. The visual acuity of both eyes were 6/6, Right eye 6/6 , Left eye 6/6 and near vision N6 as well as IOP 14mm of Hg in both eye were observed before and after treatment. Treatment Protocol: 1st Day: the patient was given amapachanna with chitrakadivati in the dose of 2 tablets and Panchakolaphanta 100ml tid followed by kriyakalpa procedures Sthanika Avagundana with Dhanyaka and Haridra in Triphala kashaya over fronto-maxillary region OD. Rasna choorna was applied over fore head. 2nd Day: Sadhyovireachana with Nimbamritadi Erand taila 60ml followed by Triphala kashaya 100ml was given on empty stomach at 8 a.m. Sips of hot water and Jeera jala were also given. The patient had four vegas of virechana on that day. Sthanika avagundana was given at 4 p.m. 3rd Day: Mukha abhyanga with Asanbilwadi taila followed swedana karma. Marsha nasya with Anu taila, 12-12 drops in each nostril followed by haridra and ghrita dhumapana in the morning on empty stomach. Shirotalam with Brahmi churna, Bala churna and Aswgandha churna in Satapaka taila was applied. Sthanika Avagundana was given in the afternoon. These treatment protocols continued for 7 days along with internal medication like tab. Cephagraine 2 tid, Madiphala Rasayan 2 tsf tid with water and Sirasuladi Vajra Rasa 2 bd after food. Rasna Choorna for sirolepa was given. 10th Day: Patient was discharged and advised to continue tab. Cephagraine 2 tid, Madiphala Rasayan 2 tsf tid with water and Sirasuladi Vajra Rasa 2 bd after food. Rasna Choorna for sirolepa SOS for 20 days as well as to avoid apathya and triggering factors. 1st Follow up: after 20th day patient came to ENT opd with no attacks of migraine. He was advised to continue the same for 1 month. 2nd Follow up: after one month from the date of 1st follow up, he came to ENT opd with no attacks of migraine. He was advised to continue tab. Cephagraine 2 tid and Madiphala Rasayan 2 tsf tid for one month more and follow up next month. But patient did not come for 3rd follow up. therapy were given to the patient for the treatment. Sadhyovirechana with Nimbamritadi Erand taila detoxifies the body and removes the vitiated pitta Doshas from the kosta. Nasya karma with Anu taila was instilled into both nostrils and was expected to strengthen the vital functions of the sense organs by its unique mode of action through Shringataka marma. Sthanika avagundana the special kriyakalpa procedure helped to open the Vatavaha shrotas and lightened the head. The ingredients used for avagundana Dhanyaka, Haridra and Triphala kashaya was supposed to pacify vitiated vata-kapha Doshas. Similarly, Rasna choorna sirolepa was having potent vatahara properties. The internal medications also helped to pacify the vitiated Doshas and brought into the equilibrium state. The combination of both sodhana and shamana therapies were acted synergistically to combat against the vitiated tridoshas in pathology of Ardhavbhedaka. Conclusion: Migraine is an episodic neurovascular disabiling disorder which is closely related to ardhavbhedaka in Ayurveda and characterized by its cardinal feature half sided headache. Ayurveda believes in cleansing the body and pacifying the tridoshas from the roots by using unique treatment modalities such as sodhana and shamana chikitsa. These treatment approaches create a balanced physiology which brings healing the body and mind. This helps to achieve complete treatment as well as control of migraine to the patient. Ayurveda opens new doors for treatment of migraine through holistic approaches and aid a new treatment option among practitioners of new era where there is no permanent cure for migraine References: [1]Steiner TJ et al. Migraine: the seventh disabler. The Journal of Headache and Pain 2013, 14:1 [2]Natoli JL et al. Global prevalence of chronic migraine: a systematic review. Cephalgia. 2010 May; 30 (5): 599- 609 [3]WHO. Atlas of headache disorders and resources in the world 2011. [4] http://migraineresearchfoundation.org/about- migraine/migraine-facts/ [5]WHO. Atlas of headache disorders and resources in the world 2011. [6]https://en.m.wikipedia.org>wiki>Migraine [7]Bartleson JD, Cutrer FM (May 2010). "Migraine update. Diagnosis and treatment". Minn Med. 93 (5): 36– 41. PMID 20572569 [8]Headache Classification International Headache International Classification of Headache Disorders: 2nd edition". Cephalalgia. 24 (Suppl PMID 14979299 [9]Bartleson JD, Cutrer FM (May 2010). "Migraine update. Diagnosis and treatment". Minn Med. 93 (5): 36– 41. PMID 20572569 [10]Hamel, E. (November 2007). "Serotonin and migraine: biology and clinical implications". Cephalalgia: An International Journal of Headache. 27 (11): 1293– 1300. PMID 17970989 [11]Agnivesha. 2011. Charak Samhita revised by Charak and Drudhabala with Ayurveda Dipika Commentary by Chakrapani Datta; Edited by Vaidya Yadavji Trikamji Acharya, published by Chaukhamba Prakashan Varanasi. Results: Significant changes in signs and symptoms were noticed before treatment and after treatment with short course duration of 7 days. On first day, patient had severe right sided headache which reduced on third day. On 10th, he had no headache and was feeling happy. On 1st and 2nd follow up there was no attacks of migraine in between the course of duration. Discussion: Ayurveda believes in treating the disease at its root cause from within. According to clinical features of the patient, the headache was Migraine without aura i.e. common migraine. This type of migraine is very common and does not have any warning signs. Migrain can be closely related to ardhavbhedaka in Ayurveda explained by commentator Chakrapani as Ardhamastaka vedna due to its cardinal feature ‘half sided headache’.11 Sodhana and Shamana both Subcommittee Society of the "The (2004). 1): 9–160. @ IJTSRD | Unique Paper ID - IJTSRD21556 | Volume – 3 | Issue – 3 | Mar-Apr 2019 Page: 69

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Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 30 to 50 years. According to WHO, migraine is the third most common disease in the world with an estimated global prevalence of 14.7 around 1 in 7 people .1 Chronic Migraine affects about 2 of world population2 with female and male ratio 3 1.3 It is a widespread, chronic and intermittently disabling disorder characterized by recurrent headaches with or without aura. The attack gives warning before it strikes black spots or a brilliant zigzag line appears before the eyes or the patient has blurring of vision or has part of his vision blanked out. It is also called as "sick headache because nausea and vomiting occasionally accompany the excruciating pain which lasts for as long as three days. Suppressing migraine pain with NSAIDS and analgesics gives short term relief and the pain can rebound. Dependence on medicines decreases the body's natural pain relief mechanism and long term dependence can damage kidneys, liver or other vital organs. Ayurveda believes in treating the disease at its root cause from within. Therefore, treatments focus on balancing the vitiated Doshas in the digestive and nervous systems. This can be achieved by avoiding triggering factors and prescribing doshic specific diet, stress management, herbal formulas, lifestyle modification, Panchakarma, Kriyakalpa and other holistic modalities to create a balanced physiology. Dr Shyam Kumar Sah | Dr Deeraj BC | Dr Ashwini MJ "Conceptual Study of Migraine in Ayurveda (Ardhavbhedaka)" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-2 | Issue-4 , June 2018, URL: https://www.ijtsrd.com/papers/ijtsrd15633.pdf Paper URL: http://www.ijtsrd.com/medicine/other/15633/conceptual-study-of-migraine-in-ayurveda-ardhavbhedaka/dr-shyam-kumar-sah

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  16. PPT

    Chronic: persistent, lasting. A New Disability • According to WHO, migraine is the 20th leading cause of YLDs, accounting for 1.4% of total global YLDs. • Migraine burden is higher in women • Migraine affects about 11% of the adult population in Western countries • Prevalence is highest between the ages of 25-55.

  17. S5:Ep1

    Hear from Dr. Eric Pearlman, Associate Vice President at Eli Lilly, as we dive into their findings from the OVERCOME study. This study aims to further understand the stigma experienced by people living with migraine, identify barriers to the appropriate treatment, and assess how novel treatment options may influence delivery of migraine care and outcomes.

  18. Migraine Case Study

    1. Migraine Case Study Introduction: Migraine is a chronic disorder of the brain with significant morbidity, as well as personal, familial and socioeconomically impact. It affects about 12 percent of the general population and affects three times more women than men.

  19. Migraine & Genetics Breakthrough

    A migraine is a very strong headache that might come with nausea, vomiting and sensitivity to light. Many people suffer from this condition and the symptoms are really intense and might interfere with everyday life. If you want to speak about your breakthrough regarding migraines and genetics you can now do it with this template! It's perfect ...

  20. PPT

    Migraine without aura (common migraine) • This is an idiopathic, recurring disorder involving attacks that last 4-72 hours. • The headache is typically unilateral, pulsating, of moderate or severe intensity, and is aggravated by normal physical activity. • It is associated with nausea, vomiting, photophobia, and phonophobia.

  21. PPT

    Chronic: persistent, lasting. A New Disability • According to WHO, migraine is the 20th leading cause of YLDs, accounting for 1.4% of total global YLDs. • Migraine burden is higher in women • Migraine affects about 11% of the adult population in Western countries • Prevalence is highest between the ages of 25-55.

  22. Correlation between migraine and cerebral small vessel disease: A case

    Background: Microcirculatory pathology is one of the pathophysiological theories of migraine, which may present as visually subclinical lesions. Image markers of cerebral small vessel disease (CSVD) have been investigated in elderly migraineurs. However, past studies looked at only part of image features, and the conclusions may have been hindered by confounding factors.

  23. Migrane ppt

    Migraine case presentation. Migraine case presentation ... Data from the American Migraine Study II. Headache. 2001;41:646-657. Radat F, Swendsen J. Psychiatric comorbidity in migraine: A review. Cephalalgia. 2004;25:165-178. Lipton RB, Hamelsky SW, Kolodner KB, Steiner TJ, Stewart WF. Migraine, quality of life and depression: A population ...

  24. PPT

    Migraine is one of the most common neurovascular disabling disorders encountered in Shalakya practice. Migraine can be defined as a paroxysmal affection having a sudden onset accompanied by usually unilateral severe headache. In Ayurveda, Migraine is described as Ardhaavabhedhaka which is a major health issue among people of age group 20 to 50 years. According to WHO, migraine is the third ...