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      The Patient Perspective

      Kayte first experienced a migraine when she was 18 years old and was diagnosed with chronic migraine at 24. In these videos she talks candidly about how chronic migraine has affected her, and the messages she wants to share with other patients.

      First-hand experience of living
      with chronic migraine

      What would Kayte say to other
      chronic migraine patients?

      Patient case based on a real-life patient. This is Kayte’s personal story, and this will not be the same experience for all patients with chronic migraine.


      Self-care strategies

      Lifestyle changes and the avoidance of triggers can be powerful strategies for managing migraine, independently of or in association with pharmaceutical treatments.5,6

      In order to accurately define the type of migraine, determine an appropriate treatment plan, and judge the response to a particular treatment, it is important for the patient to try to identify any factors that affect or trigger migraine, as well as reporting the frequency and severity of the migraine attacks. It is helpful to advise patients of lifestyle choices and the benefits of keeping a headache diary.5,6


      The following are some of the common triggers for migraine. Keeping a diary can help patients to identify triggering factors.5,7

      • change in the weather
      • high humidity
      • chocolate
      • aged cheese
      • caffeine
      • alcohol
      • additives
      • missed meals
      • dehydration
      • bright lights
      • strong odours
      • loud sounds
      • oral contraceptive
      • menstruation
      • vigorous exercise
      • too much or too little sleep
      • anxiety
      • tension
      • depression
      • shock

      Adhering to the following lifestyle changes can help patients manage their migraines:5,7,8

      <4-5 cups per day

      Aim to go to bed and wake up at the same time every day

      Most adults need about 8 hours sleep a night

      Eat regularly throughout the day

      Do not skip meals

      Aim for at least 30 minutes of moderate intensity exercise, 3 times a week

      Avoid any factors identified as triggering or worsening headache

      It can be beneficial to encourage patients to keep a headache diary, including:5,6,9

      • day/ time of headache
      • duration of headache
      • severity of headache (mild/ moderate/ severe)
      • location of pain (unilateral/ bilateral)
      • type of pain (pulsating/ pressure/ other)
      • other associated symptoms (nausea, photophobia etc)
      • menstruation
      • use of all prescribed or over the counter medications taken to relieve headaches
      • response to pain relief

      Diary responses can be used to monitor the effectiveness of headache interventions and as a basis for clinical consultation.9

      The high frequency of migraine attacks means that medication overuse is common among patients with chronic migraine, estimated at 41-50%.10 Frequent use of painkillers, NSAIDs, triptans and ergots can lead to medication overuse headaches (MOH).10,11 Furthermore, overuse of painkillers may reduce the effectiveness of preventive migraine medications.12

      • Dull constant headache
      • Often present all day, sometimes every day

      Be alert to the possibility of medication overuse headache in people whose headache developed or worsened while they were taking the following drugs for 3 months or more:

      • triptans, opioids, ergots or combination analgesic medications on 10 days per month or more or
      • paracetamol, aspirin or an NSAID, either alone or in any combination, on 15 days per month or more

      Chronic migraine is a complex neurological disease requiring appropriate effective management – including treatment or referrals to improve patient outcomes2,6,13

      CM: chronic migraine; NSAID: non-steroidal anti-inflammatory drug.

      BOTOX® (botulinum toxin type A) is indicated for the prophylaxis of headaches in adults with chronic migraine (headaches on at least 15 days per month of which at least 8 days are with migraine).14

       

      References

      1. Allergan. Data on file. INT/0423/2016
      2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
      3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
      4. Allergan. Data on file. 014
      5. Migraine Trust. Migraine attack triggers. Available at: migrainetrust.org. Accessed April 2022
      6. Weatherall M W. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis 2015;6(3):115-123
      7. NHS. Migraine: causes. Available at: nhs.uk/conditions. Accessed April 2022
      8. Migraine Trust. Migraine and sleep. Available at: migrainetrust.org. Accessed April 2022
      9. National Clinical Guideline Centre (NCGC). Headaches: diagnosis and management of headaches in young people and adults. Chapter 6: Headache diaries for the diagnosis and management of primary headaches and medication overuse headache. Available at: ncbi.nlm.nih.gov. Accessed April 2022
      10. Escher C M, Paracka L et al. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord 2017;10(2):127-135
      11. National Institute for Health and Care Excellence (NICE). CG150: Headaches in over 12s: diagnosis and management. Available at: nice.org.uk. Accessed April 2022
      12. Migraine Trust. Medication-overuse headache. Available at: migrainetrust.org. Accessed April 2022
      13. International Headache Society (IHS). International classification of headache disorders (3rd edition) guidelines. Available at: ihs-headache.org. Accessed April 2022
      14. BOTOX® Summary of Product Characteristics. Available at: medicines.org.uk. Accessed April 2022
       

      Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.

       

      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk

      Adverse events should also be reported to AbbVie on GBPV@abbvie.com 

       

      Date of preparation: April 2022. UK-BCM-220071.