Chronic Migraine (CM) Interview Dr. Christine Lay, M.D., FRCP Headache Neurologist Women's College Hospital Centre for Headache Toronto, Ontario

Brent

Overuse of medication is one of the biggest concerns in treating patients with chronic migraine (CM) because patients are at risk of overusing their medications. Is this harmful to their organs?

Dr. Lay

All medications have potential side effects, and some of the medications used to treat headache can negatively affect the kidneys, the stomach and the liver. Other medications sometimes used can cause you to feel sleepy because of the impact on the nervous system. Many of these risks are increased when someone is also having alcohol on a regular basis. However, if you follow your doctor’s recommendations, which is often to limit use of headache acute medications to 2 days per week, these side-effects can be minimized.

Brent

Can CM evolve from occasional, episodic migraine or does it just start one day?

Dr. Lay

More often than not, chronic migraine evolves from episodic migraine, but there are many patients who experience the start of chronic migraine one day, and it never goes away thereafter. Migraine can fluctuate, even without therapy, from episodic to chronic and back again, or even disappear for a period of time. The severity can also fluctuate from bad attacks that leave you unable to function to mild attacks that allow you to carry on with your day.

Brent

Are you aware of any estimates as to how expensive CM is to the Canadian and American healthcare systems?

Dr. Lay

In one published study by Dr. Werner Becker (Calgary) and Dr. Richard Lipton (New York) chronic migraine costs our economy roughly 3 times as much as it does when patients are treated for episodic migraine (EM).

The most expensive costs are medications (including OTC and prescription), physician visits, neurologist/headache specialist visits, other specialist medical providers, emergency room visits, lost time at work and diagnostic testing.

Brent

Why is migraine, especially chronic migraine so hard to diagnose and treat?

Dr. Lay

Many of the patients with chronic migraine (CM) have not been properly diagnosed, which is a result of several factors. First, sometimes patients do not seek care, believing there is nothing that can be done or when other family members have the same type of headache, sufferers feel like it “runs in the family”. Headache is significantly under-taught in medical schools and physicians often graduate knowing more about rare neurologic diseases that they do about headache management, so CM is often under or misdiagnosed as tension headache or sinus headache for example. The universities and the Headache societies are working to change this, to ensure physicians have an appropriate Headache Toolbox to improve diagnosis and medical therapy. Canadian organizations such as Help for Headaches, Migraine Canada, Migraine Quebec and the new Chronic Migraine Facebook online support group and the Canadian Headache Society provide reliable information to patients. Sometimes medications prescribed can worsen headaches, such as opiate drugs. It is important that you as the patient are informed and can work with your doctor to find the right medications for you.

When the headache story makes sense and the neurological exam is normal, which it usually is in primary headache, there is no reason for testing or imaging such as MRIs. When there are worrisome symptoms, or something abnormal on the exam, or perhaps when medications are not working, then testing may be considered.

Brent

If a sufferer or patient has true CM will over-the-counter medicines help?

Dr. Lay

Chronic migraine typically only responds to over-the-counter medications temporarily, and then another migraine attack comes along. Using over-the-counter medications too often can also contribute to medication overuse, which makes the problem worse. CM generally requires acute therapy along with preventative therapy (oral medications, injectable therapies and devices), lifestyle modifications and stress management.

Brent

I heard about a headache diary and its usefulness in a proper diagnosis. If a patient with CM brings a completed headache diary to you, what are you looking for?

Dr. Lay

A headache diary helps us identify the frequency, duration, severity and timing of the pain, what may “trigger” the headache, and various other patterns such as weekend or early week headaches, headaches related to a woman’s menstrual cycle or headaches related to shift work. Diaries are very helpful and they help reduce recall bias – under or over-forgetting your headaches.

Find-a-Headache-Doctor
Click a province on the map above
or the list below:
 
   British Columbia
Alberta

Saskatchewan
Manitoba
Ontario
Quebec 
New Brunswick 
   Nova Scotia 
Prince Edward Island 
Newfoundland / Labrador
Northwest Territories 
Nunavut 
Yukon Territories
       

The book Chronic Daily Headache features
an article reviewed by a Headache Neurologist
entitled "Why Some Headache Patients do
not Improve"!