Migraine – Why is it Commonly Misdiagnosed?

0:00 [Music]
0:23 uh welcome everybody to
0:25 um our our our second
0:28 webinar of the month or i guess of the
0:31 fall
0:31 um really happy to have everybody
0:34 joining us
0:35 um my name is wendy gerhart and i am the
0:37 executive director of
0:39 migraine canada i first of all want to
0:42 start off by thanking our sponsors
0:45 um who make it possible for us to
0:48 develop resources and programs
0:50 uh to support the community um a brief
0:53 overview of today’s agenda
0:55 um i’m going to talk a little bit about
0:56 migraine canada and introduce
0:59 those of you who are new to us
1:02 and then christy tate will give her
1:05 presentation
1:06 and then we’ll go into a question and
1:08 answer period
1:11 who’s migraine canada uh we’re a
1:13 national associate association
1:15 supporting all canadians living with
1:17 migraine
1:18 and uh headache disorders we are
1:20 federally registered as a not-for-profit
1:22 corporation
1:23 and we’ll be seeking our charitable
1:25 status uh in the coming months
1:28 uh we are compro compris we are
1:30 comprised of
1:31 a board uh made up of uh
1:34 volunteers who um graciously are
1:37 are donating their time to really grow
1:40 migraine canada into everything that it
1:42 can be
1:44 i am the only staff um and i’m
1:48 i’m thrilled to be a part of this
1:49 community and working really hard to
1:51 grow the organization to meet the needs
1:54 of everybody out there and lastly but
1:58 not least
2:00 volunteers we we rely on volunteers to
2:02 help
2:03 move things forward if you’re interested
2:06 in helping and getting involved in our
2:08 organization please
2:10 email me at the information is all on
2:14 the website
2:15 but would be happy to chat with you
2:16 about opportunities
2:20 our vision and mission so our vision is
2:22 really that canadians living with
2:24 migraine and headache disorders
2:25 are diagnosed treated and supported so
2:28 their quality of life is optimized
2:30 and our mission is to improve the lives
2:32 of canadians with migraine
2:34 and other headache disorders through
2:36 awareness support
2:37 education advocacy and research
2:40 fairly certain you will see those words
2:42 a lot
2:44 in everything that the migraine canada
2:46 does
2:48 and as i just mentioned um those are our
2:50 strategic pillars
2:52 we have five of them and uh everything
2:55 we
2:55 do we um do a stress test against
2:59 each of those to make sure that we are
3:00 actually doing
3:02 um the activities and delivering the
3:04 programs that
3:05 that touch on each of those
3:09 those those words awareness education
3:11 support advocacy and
3:13 research call to action
3:17 for those of you that have not signed
3:18 our petition uh please join our growing
3:21 community
3:21 um you can join it on off of our our
3:24 home page
3:25 migrainecanada.org petition and
3:28 this in addition to growing the
3:31 community
3:32 this also will give you
3:35 give us access to email you with
3:37 upcoming events
3:38 new content to our website new news
3:42 you know new approvals of medications
3:45 of services and that kind of thing so i
3:47 encourage you to join the community and
3:49 and let’s really grow
3:50 migraine and the awareness out to the
3:53 common public
3:54 and with that i’m going to now uh just
3:57 quickly introduce christy who is our
3:59 keynote speaker
4:01 and then turn it over to her so christy
4:03 obtained a bachelor of biological
4:05 science from the university of guelph
4:07 a bachelor of science in nursing from
4:09 the university of toronto and her master
4:11 of nursing and primary health care
4:13 nurse practitioner certificate from
4:15 ryerson university
4:16 she is the director of the headache
4:17 program at the neurology center of
4:20 toronto and a clinician at the toronto
4:22 headache and pain clinic
4:24 outside of clinical care she delivers
4:26 educational programming to health care
4:28 providers
4:29 with an interest in headache and
4:30 migraine management and she also hosts a
4:33 migraine blog
4:34 site and her website is
4:39 www.christiet.com
4:41 and christie’s area of clinical
4:43 expertise is the diagnosis and
4:44 management of headache and concussion
4:46 she uses a holistic approach to patient
4:49 care that integrates behavioral and
4:51 lifestyle changes
4:52 with pharmacological treatments she is
4:54 passionate about approving
4:56 access to quality of care for headache
4:58 and migraine patients
4:59 and with that i will turn the podium
5:03 over
5:03 to christy to share um her presentation
5:08 thanks wendy um okay thanks everybody i
5:11 want to thank everybody for joining me
5:13 on a monday night the clocks went back
5:15 it’s dark
5:16 um so i’m very happy to have all of you
5:18 here this is
5:20 an area that i’m extremely passionate
5:22 about it’s near and dear to my heart
5:24 and i’m very excited to be able to do
5:26 this presentation for migraine canada so
5:28 tonight i’m going to talk about
5:30 the misdiagnosis of migraine
5:34 so just a disclaimer this
5:37 this uh webinar is to provide
5:39 information not medical advice
5:41 uh the information discussed may not
5:42 apply to your own situation
5:44 so if there’s any questions regarding
5:46 treatment then this is definitely
5:47 something that should be discussed with
5:49 your health care provider
5:50 so what are we going to talk about
5:51 tonight so um we’re going to go over
5:54 some of the myths and discuss some of
5:56 the false assumptions
5:57 and in inaccuracies surrounding migraine
6:01 i will look at some common misdiagnoses
6:04 and explore some of the pitfalls in
6:05 diagnosing migraine
6:07 and why it may take so long for a
6:09 migraine sufferer to be properly
6:10 diagnosed
6:12 and then we’ll talk about some of the
6:13 misconceptions so we’ll learn how some
6:15 commonly held beliefs
6:16 may delay treatment or in fact could
6:19 even worsen migraines
6:22 so we’ll start off here with the myths
6:24 so myth number one
6:27 migraines are just bad headaches
6:30 so migraines are in fact a neurological
6:32 condition
6:34 it’s an incredibly complicated process
6:36 and believe it or not despite how long
6:38 we know they’ve been around
6:39 we’re still learning a lot about this
6:41 process so it involves nerves
6:43 blood vessels and different neural
6:45 chemicals
6:46 that are all playing a role in this
6:48 migraine event so the headache the
6:50 actual head pain is really only one part
6:52 of the migraine event
6:54 so there’s a great webinar on migraine
6:56 canada’s site
6:58 by dr elizabeth raru that goes into the
7:00 science of migraine it’s all in your
7:02 brain so i do encourage you to take a
7:03 look at that
7:04 for more details so a migraine is not
7:08 just a headache so the entire migraine
7:12 event
7:12 can last many days the headache phase
7:15 consists of
7:17 numerous symptoms uh aside from just a
7:20 headache and it’s a very
7:22 uh it’s a highly variable event it’s a
7:23 very unique thing for each sufferer
7:26 which is why maybe sometimes people
7:27 don’t identify that they might have
7:29 migraines if it doesn’t fit into
7:31 all of the things that they perceive so
7:34 this
7:34 timeline i think is a nice illustration
7:36 of some of the things that can be going
7:37 on during a migraine
7:39 so there’s a pro drone period this can
7:41 go on for
7:42 hours up to days and this is when
7:44 migraine sufferers might talk about
7:46 uh changes in their their mood they may
7:49 feel fatigued
7:51 uh they might have a little bit of
7:52 increased sensitivity to
7:54 certain things sounds or things in the
7:56 environment
7:58 and then you progress to uh if you’re
8:00 one of one third of migraine sufferers
8:02 that experience an
8:04 aura so it’s not the majority of
8:05 migraine sufferers but the aura phase
8:07 tends to last about five to 16 minutes
8:09 and most or 60 minutes or in
8:11 this is most commonly a visual
8:13 disturbance so sometimes migraine
8:14 sufferers will
8:15 report uh some squiggly lines or bright
8:18 lights
8:18 and then this segways into what we call
8:20 the headache phase so if you see here
8:23 the headache phase typically lasts four
8:25 to up to 72
8:26 hours and this is the most debilitating
8:29 phase so it is when you might experience
8:32 nausea
8:33 vomiting light sound smell sensitivity
8:36 um the the sensation of pain in your
8:38 head
8:39 neck pain and stiffness um so that’s
8:42 really what most people kind of
8:44 identify with as the migraine event and
8:46 then there’s the post drone period so
8:48 this can go on
8:49 in some migraine sufferers for two to
8:52 two days or beyond and it’s kind of
8:54 termed the migraine hangover this is
8:56 when you’re not quite yourself you’re
8:57 feeling a little bit
8:58 fatigued um and you’re and have mood
9:01 changes so
9:02 i like this illustration because it
9:04 shows really how complex this entire
9:06 process is
9:08 um but bear in mind you don’t have to
9:10 follow this timeline
9:11 to suffer from migraines so some
9:13 migraines at first don’t perceive all of
9:14 these things
9:15 so what’s the problem with calling a
9:17 migraine just a headache well it really
9:18 diminishes
9:19 its impact and there’s some really
9:21 astounding things that we know about
9:23 migraines so
9:24 they’re actually the second leading
9:26 cause of years lost to disability in
9:28 people under 50
9:30 world wide so that’s huge
9:33 they can cause missed work school family
9:35 events have a huge
9:37 impact on quality of life and in canada
9:40 alone there was
9:41 a large study done of canadian employees
9:43 with migraine
9:44 and 56 of them had taken sick days
9:47 23 were on short-term disability and 18
9:50 we’re on long-term disability
9:52 um so it really shows the impact it can
9:54 have on people
9:56 so migraine is stigmatized it’s not
9:59 recognized and it’s
10:00 completely invisible this is the
10:02 challenge with a condition like this
10:04 um i think interestingly you know
10:08 we think about the things that are are
10:09 missed when people
10:12 have a migraine things like work but
10:14 rather than missed work migraine
10:15 sufferers endure something called
10:16 presenteeism and this is actually when
10:18 they
10:19 they show up to work events to all kinds
10:22 of things despite suffering with
10:23 symptoms so
10:24 for all the days that uh they may be off
10:27 um there are a lot of days where they’ll
10:29 actually suffer through things and this
10:31 is um
10:32 often how more days are spent than than
10:36 missing
10:36 commitments so i think that sort of
10:40 covers
10:41 why it is is not just a headache and all
10:43 and although a headache is one part it’s
10:45 really so much more complex than that
10:47 so we’re gonna move on to myth number
10:49 two
10:50 migraines are easy to diagnose
10:54 so first of all migraine is incredibly
10:56 common
10:57 so four million canadians are estimated
10:59 to have migraines
11:00 and that prevalence is higher than
11:03 asthma
11:04 diabetes or osteoarthritis which are all
11:06 quite common conditions
11:08 so to put it in a little bit of
11:10 perspective about one in four
11:12 households will have a migraine sufferer
11:14 living in it
11:15 that’s about 15 percent of the
11:17 population
11:19 we do know that women are affected three
11:21 times more than men so quite
11:23 disproportionately
11:24 and about one to two percent of migraine
11:27 sufferers have a headache on more than
11:29 15 days out of
11:30 the month so we refer to this as chronic
11:32 migraine
11:34 and that’s quite a high number uh one or
11:36 two out of a hundred
11:37 so some of these uh pictures just sort
11:39 of illustrate how common that is so
11:41 another interesting thing is it’s common
11:43 in children
11:45 so one in 10 or 10 of children will
11:48 suffer from migraine
11:49 there is a strong correlation certainly
11:51 if one or both parents have migraine
11:54 it increases their likelihood um but
11:58 it it’s not exclusive to adults so this
12:01 is why i think it’s important that we
12:02 we recognize it so how do we diagnose
12:05 migraine
12:07 so this is something that’s done by your
12:09 your health care provider so
12:10 physician or nurse practitioner uh
12:12 they’re gonna do a general health
12:13 history
12:14 uh and a headache history ideally that
12:17 really will go through a lot of details
12:20 uh physical assessment and a
12:21 neurological exam
12:23 which in the case of migraine a
12:24 neurological exam really should be
12:26 normal so we’re not looking for
12:28 um anything in particular we’re actually
12:31 looking for everything to be normal
12:32 that is the case in migraine and what we
12:35 really want to do is ensure there isn’t
12:37 a secondary cause
12:39 for this headache so that means that the
12:42 headache
12:42 a secondary headache is a headache that
12:44 is a symptom for another condition
12:47 whereas migraine is considered a primary
12:50 headache the migraine
12:51 itself is the cause for those those
12:54 headaches
12:56 there’s internationally accepted
12:58 criteria that helps us
12:59 to categorize migraine and then we
13:02 arrive at something called a clinical
13:04 diagnosis so a clinical diagnosis means
13:06 we put all these pieces of the puzzle
13:08 together and it fits and
13:11 then the diagnosis is in keeping with a
13:13 migraine so there isn’t one particular
13:15 test that we we read and
13:16 tells us it’s migraine so it seems
13:19 pretty straightforward
13:20 all of these things but still migraines
13:23 are incredibly under-diagnosed and
13:26 they’re under-treated
13:29 so there’s something going on here where
13:31 we’re kind of missing this so we know
13:33 that there are
13:34 a lot of gaps in migraine care and i
13:36 think it’s important to understand them
13:38 from
13:38 all perspectives of the players that are
13:40 involved in migraine diagnosis so
13:43 um we see her on the left people with
13:45 migraines so they may just not
13:47 suspect that the the headaches or the
13:49 symptoms they have
13:50 are migraines at all uh there’s a lot of
13:52 stigma
13:53 and there could be a lack of empathy
13:55 potentially from a healthcare provider
13:57 that
13:57 they just don’t feel heard or recognize
14:00 that this is something significant
14:02 there could be poor access to health
14:04 care many people don’t have a primary
14:06 health care provider
14:07 or they just may not seek care there
14:10 could be a perception
14:11 of lack of options particularly if maybe
14:14 they’ve tried something in the past
14:15 it hasn’t worked or there’s been not a
14:17 good effect from it
14:19 uh there’s also could be a perception of
14:21 normalcy that this is just
14:23 these are their headaches and this is
14:24 what they live with um
14:26 misdiagnosis could be a cause and
14:29 there’s a self-blame which i think is
14:30 always something important
14:32 in migraine because i hear this a lot
14:35 that people
14:36 think well i’m not sleeping well or i
14:38 should drink more or i should do this
14:39 and that’s really uh
14:41 a self blame that is uh needs to be kind
14:45 of
14:45 dispelled and taken away i think from
14:46 migraine sufferers so then we have
14:49 healthcare providers on the other hand
14:50 so we do as healthcare providers often
14:53 focus on secondary headaches so
14:54 secondary headaches again are those
14:56 things where something else is causing
14:57 the headache and
14:58 and we don’t we certainly don’t want to
15:00 miss something worrisome
15:02 or emergent that needs to be addressed
15:04 we have a poor understanding often
15:06 of the impact that these migraines might
15:08 have
15:09 on on people living with them so we
15:11 don’t feel the same kind of urgency to
15:13 address them
15:14 really in healthcare there is not a lot
15:15 of education
15:17 on the very very complex nuances of
15:19 managing migraine so there’s a lot
15:21 that goes into managing them and i
15:24 usually say this is kind of a
15:26 a journey it’s a marathon in in the
15:29 relationship you
15:30 build with a migraine sufferer and how
15:31 you’re managing them so we don’t have a
15:33 lot of education
15:35 dedicated to that in either med school
15:36 or nurse practitioner programs
15:38 time constraints always a big issue um
15:41 missed or misdiagnoses and we may just
15:43 fail to capture the frequency of
15:44 patients headaches so
15:45 that’s a lot going on there but really
15:47 what is the result
15:49 um so two-thirds of migraine sufferers
15:51 don’t ever consult a healthcare provider
15:53 for their headaches
15:54 and 40 of migraine sufferers just aren’t
15:56 diagnosed
15:58 as a result proper treatment isn’t
16:00 offered and this leads to a lot of i
16:02 think unnecessary disability with
16:04 migraine sufferers
16:05 so although the diagnosis piece
16:09 um is not it should not be that
16:12 complicated we’re still missing the mark
16:14 in a lot of ways
16:15 so bring this to myth number three
16:18 mri is needed to find the cause of my
16:21 migraines
16:24 so are mris or ct scans needed to
16:26 diagnose migraines
16:28 uh in short no uh it’s not something
16:30 that we need to diagnose them
16:32 so a healthcare provider may order one
16:34 of these tests to assess for
16:35 another cause of headaches so if there
16:37 is a concern that this doesn’t fit with
16:39 all of those things
16:40 uh the exam is not normal or it doesn’t
16:42 really fit criteria for a migraine
16:43 then an mri can be helpful so if this is
16:46 the case though why not just
16:48 scan everybody and make you know
16:50 everyone feel easy
16:51 so what is the harm in in scanning
16:53 everyone so there are some things
16:55 cet scans certainly expose patients to
16:58 radiation
17:00 there are things called incidental
17:02 findings so these are discoveries that
17:04 are made
17:04 on images that are unrelated to the
17:07 reason that the test was ordered so
17:09 we just find them and as our our ability
17:11 to do these tests
17:12 improves as the technology improves it’s
17:14 more and more common that we just find
17:16 these little unusual things
17:19 in different people’s scans so then what
17:22 happens so these can result
17:23 in potentially additional testing
17:26 other referrals and they can be a really
17:29 significant source of anxiety
17:32 focusing on some of these incidental
17:34 findings
17:35 can further delay treatment of migraines
17:38 and interestingly there’s a study that
17:40 looks at the reassurance that
17:42 say a normal mri gives a patient and
17:45 it’s often lost over time
17:47 so if the the disabling headaches and
17:50 migraines continue
17:52 then any of that reassurance that was
17:54 developed
17:56 after about a year is gone there’s of
17:59 course a cost to the health care system
18:00 so these are resources that um you know
18:03 we have to be mindful
18:04 if there’s really not a necessity to
18:06 using them and i think that sometimes
18:08 this goes back to the myth that there
18:11 must be some other cause for migraine
18:13 disability since they are just headaches
18:15 so i think
18:16 um even in the process of getting
18:19 diagnosed with
18:21 migraines people think but a migraine is
18:23 just a headache so why do i have all
18:25 these other things there must be
18:26 something else that’s going
18:28 on when i i think there just needs to be
18:30 a lot more education
18:32 that all of those things really do fit
18:34 with migraine and it’s not just a
18:35 headache
18:37 so we do have a lot of data actually
18:38 that shows that uh how often are our
18:41 mris found to be abnormal
18:43 and in somebody who meets criteria for
18:46 migraine and has a normal exam
18:48 an abnormal mri is very unlikely so it’s
18:51 not different than just the general
18:53 population
18:54 so it really isn’t a test um that is
18:57 necessary in most cases
18:58 so this brings us to our our
18:59 misdiagnosis
19:02 so misdiagnosis one i have
19:05 really bad tension headaches so we’re
19:08 going to meet anne
19:09 so and this is ann she’s 29 years old
19:13 she has had headaches since she was a
19:15 teenager they became more frequent when
19:17 she was in university
19:19 she notices that she has headaches more
19:20 when she’s worried or she’s stressed
19:23 she feels the pain it wraps right around
19:25 her forehead and to her neck
19:27 she uses over-the-counter medication so
19:28 things like ibuprofen acetaminophen
19:31 they help a little bit but she usually
19:32 needs to rest in the dark room once they
19:34 get really severe
19:36 she’s tried massage and acupuncture
19:37 meditation
19:39 all kinds of things to relax and it just
19:41 really doesn’t help her enough
19:42 so this is the story so migraines are
19:45 very commonly
19:46 misdiagnosed as tension headaches uh and
19:49 so this is a nice little
19:50 illustration here of some of the common
19:52 symptoms uh that are present in either
19:54 tension or migraine headache and how
19:56 they can kind of get
19:58 uh mixed up so both sided head pain
20:01 bilateral head pain we say so intention
20:03 headache yes this is the kind of head
20:05 pain you have it wraps around
20:06 but actually in migraine about 40 of
20:09 people will also have pain on both sides
20:11 of their head so i think we often hear
20:13 about that one-sided head pain but it’s
20:15 not always the case
20:16 uh neck pain so we think neck and that’s
20:19 where tension and stress is so
20:21 certainly goes along with attention
20:22 headache but still
20:24 about 70 of migraine sufferers will also
20:26 have neck pain so that doesn’t always
20:28 sort of tease the two out
20:30 light sensitivity very very common in
20:32 migraine
20:33 it can happen with tension headaches
20:35 sometimes people have a little bit and
20:36 they’re a bit bothered by light
20:38 nausea so this is not a feature of
20:40 tension headache so anytime somebody has
20:42 a little bit of
20:43 nausea aversion to eating this this
20:46 doesn’t go along with tension headaches
20:47 but it’s very common in migraine
20:49 and then i i think sometimes the most um
20:53 telling difference between tension and
20:55 migraine is how it impacts your activity
20:58 so a tension headache really does not
21:00 limit your activity whereas a migraine
21:02 certainly does uh at least at some
21:04 points so if we kind of go back to ann’s
21:07 story
21:08 she would have these headaches and they
21:09 would get to a point where she would
21:11 need to lay down
21:12 it was just too much so this is a
21:13 feature that goes along with migraines
21:16 and and not tension headaches so uh
21:19 colleagues that work in a headache all
21:23 the time developed this
21:24 screening tool so this is not meant to
21:26 be a tool for diagnosis but it
21:29 definitely can help screen and maybe
21:32 um tease out some of those migraines
21:35 that are maybe mistaken as tension
21:36 headaches so the questions are simply in
21:38 the last three months
21:39 when you have had a headache did you
21:41 have any of the following did you feel
21:42 nauseated or sick
21:43 did light bother you did your headache
21:45 limit your ability to work study or play
21:48 and and a yes to two or more of those
21:50 questions
21:51 means that this could have been a
21:52 migraine so i think sometimes you know
21:55 as migraine sufferers
21:56 these are important things to be aware
21:58 of because it helps you communicate
22:00 to your healthcare provider as well and
22:03 for healthcare providers you know it’s
22:04 good for us to
22:05 to recognize some of these tools so we
22:07 can sort of tease out the bottom
22:09 and get to the bottom of these things so
22:11 often
22:12 migraines just misdiagnosed as tension
22:15 headache
22:16 misdiagnosis number two
22:19 my headaches come from my neck
22:23 so the relationship between neck pain
22:27 and migraine so
22:28 this this is a complicated one so
22:31 can migraines cause neck pain can neck
22:33 pain trigger migraines
22:34 can neck pain and jaw pain be related
22:36 and can jaw pain trigger migraines
22:38 the answer is yes to all of these things
22:42 uh so how do we untangle some of this
22:46 so i’ll tell you a story this is a very
22:48 common story so
22:49 this is matthew he’s 45 years old he
22:52 started having
22:53 regular headaches in his 30s when he
22:55 started a new job
22:56 it was high stress he had to spend a lot
22:59 of time
23:00 leaning forward and he was reviewing
23:01 paperwork so he always has tension in
23:03 his neck and his shoulders and he would
23:05 develop a severe headache a few times a
23:07 week
23:08 he’s had years of massage and
23:10 acupuncture and physiotherapy and a
23:12 personal trainer and these therapies
23:14 haven’t eliminated
23:15 his cervicogenic headaches is what they
23:17 have been called
23:20 so i think first it’s important to
23:21 understand what’s going on here
23:23 so your head and your neck sensory
23:26 networks are linked
23:27 uh so this means that pain in one area
23:30 can be felt or referred to another
23:32 area so if you look here at this picture
23:34 there’s the area in the head
23:36 these are nerves that are kind of
23:37 interconnecting everything the jaw area
23:39 and the back of the head
23:40 so migraine sufferers commonly have jaw
23:43 pain
23:44 and neck pain however sometimes the
23:46 migraine diagnosis
23:48 is completely missed so some of the the
23:51 diagnosis and
23:52 maybe some of you have kind of heard
23:53 this or been labeled with this
23:56 um that are made instead of migraine
23:58 could be cervicogenic which just means
24:00 neck originating headache tension
24:03 headaches
24:04 occipital neuralgia which is uh
24:06 irritation of the the occipital nerves
24:08 at the back of your head
24:09 or tmd which is kind of a broad umbrella
24:12 turn
24:13 temporomandibular dysfunction um of
24:16 the jaw pain so you have your tmj joint
24:18 there but
24:19 um so all of these things sometimes are
24:23 what migraines end up being labeled as
24:25 so
24:26 how do we understand the difference of
24:28 what’s going on here um so it’s
24:30 important to remember
24:31 that about 70 of migraine sufferers will
24:33 experience some neck pain and
24:35 symptoms as part of their their migraine
24:38 uh poor posture shoulder tension
24:41 especially
24:41 you know all of us sitting in front of
24:43 our computers maybe from our makeshift
24:45 home offices
24:46 uh can certainly be a trigger for a
24:49 migraine
24:50 jaw pain from clenching and grinding
24:52 this can be a
24:53 kind of a stress response but it can
24:55 also be associated with neck pain and it
24:57 can trigger migraines
24:58 uh so what do we do i don’t think that
25:00 i’ve really untangled this kind of
25:02 mess yet so i think it’s important to
25:04 remember that
25:06 we recognize that this is an
25:08 interconnected process so
25:10 certainly exercise physiotherapy can
25:12 help with postural triggers
25:14 jaw problems may need to be assessed and
25:17 addressed
25:18 you really do need a proper assessment
25:19 of your head and neck but
25:21 ultimately the migraines need to be
25:23 treated so
25:24 in cases where the headaches are all
25:26 coming from the neck i think
25:28 a lot of times those of us who who work
25:30 with headaches all the time see people
25:32 that spend a lot of time thinking
25:34 if i take care of the neck the head pain
25:36 will go away but really truly if if it
25:38 was just the neck then that would
25:40 resolve all of the issues so
25:42 the migraines can’t be neglected in this
25:44 and and a lot of times treating them
25:46 effectively will improve the neck pain
25:48 as well
25:49 so that brings us to our third
25:51 misdiagnosis
25:52 i have chronic sinus headaches
25:56 so this is margaret she’s 41 years old
26:00 she has had frequent headaches her
26:02 entire life
26:03 she notices that they’re associated with
26:05 weather and season changes and she
26:07 describes pain around her sinuses
26:09 her eyes become watery and sensitive to
26:11 light during these episodes
26:12 she takes cold and sinus medications and
26:15 nasal sprays on a regular basis
26:17 she’s even seen ear nose and throat
26:19 specialist but she hasn’t had any relief
26:21 so margaret tells you that she’s got
26:23 chronic sinusitis and she knows that her
26:25 headaches will improve if she can just
26:26 clean up
26:27 clear up her sinus issues so migraines
26:30 are
26:30 commonly misdiagnosed as sinus headaches
26:33 so research has shown
26:35 that 75 of headaches thought to be sinus
26:39 headaches are in fact
26:40 migraine they meet criteria for migraine
26:42 so how
26:43 are we confusing these things so in
26:45 migraine
26:46 it’s actually very common to have pain
26:49 over the sinus areas and it can be a
26:51 very throbbing pain
26:53 and actually tearing and nasal
26:55 congestion
26:56 can be quite common during migraine
26:58 attacks as well
27:00 another thing with migraines is that
27:01 they can be triggered by
27:03 weather changes so you know this kind of
27:05 goes along with
27:06 you know is it my allergies is something
27:08 going on um with my sinuses
27:10 and it’s a common time to trigger
27:12 migraines so
27:14 why is this important it’s it’s
27:15 important because migraine and sinus
27:17 infections are treated completely
27:19 differently
27:21 so a lot of times in the case of
27:24 a sinus headache or sinusitis
27:26 misdiagnosis
27:27 patients may have or headache sufferers
27:30 may have
27:31 lots of courses of antibiotics a lot of
27:34 nasal sprays and
27:35 this goes on and on and on and it
27:37 doesn’t always address the cause
27:39 typically in the case of sinusitis
27:40 you’re going to have other things the
27:42 discharge will be
27:44 a lot more discolored
27:47 you might have a decreased sense of
27:49 smell and other things that go along
27:50 with being more acutely unwell
27:53 so a good thing to be kind of mindful of
27:56 so
27:56 segwaying into the misconceptions
28:01 so misconception number one
28:04 i have regular headaches plus migraines
28:08 so separating headaches can sometimes
28:12 miss a diagnosis of chronic migraine
28:15 so in people with migraine they very
28:18 very commonly will talk about their most
28:20 severe
28:20 or disabling headaches and oftentimes
28:23 there’s some
28:24 other milder type headache that they
28:26 have on other days that
28:28 you know probably isn’t as um you know
28:31 significant and they’re quite fine with
28:32 so
28:33 what ends up happening is that when
28:36 you know we’re talking about the
28:37 frequency of headaches
28:39 people migraine may only talk about
28:41 those really really disabling episodes
28:43 but
28:45 what we’re trying to look at is whether
28:46 or not these are chronic migraines so
28:48 this simply means that headaches
28:50 are present on 15 days or more per month
28:53 and they don’t all
28:54 need to be migraine type headaches so
28:57 people with migraine
28:58 can be really prone to other types of
28:59 headache so we now believe
29:02 that even those milder headaches between
29:03 the severe migraines are part of the
29:05 entire migraine process
29:08 and sometimes what can happen is
29:10 somebody may have
29:11 a few days of the severe migraines and
29:13 then a lot more of the milder headaches
29:15 but over time they can
29:16 transition so you might start to have
29:19 more frequent more severe episodes
29:21 so it’s good to kind of intervene and
29:23 address this and get them taken care of
29:25 earlier
29:26 so how can you kind of sort this out and
29:28 and what can you do so you can track
29:30 your headaches and track
29:31 all of them so there’s a fabulous tool
29:34 made by migraine canada the canadian
29:36 migraine tracker this is something that
29:38 i definitely recommend
29:40 uh for everyone to use it uses a very
29:42 simple scale
29:44 zero being no headache one two or three
29:46 being
29:47 mild moderate or severe in terms of its
29:49 impact on your function
29:51 you can track as much or even as little
29:53 information as you like so
29:55 how many headache days and how often
29:57 you’re using your your medication to
29:59 treat them
29:59 and this is an invaluable tool both for
30:02 your own
30:03 kind of knowledge of migraines but also
30:05 to communicate
30:06 with your healthcare provider so i do
30:10 recommend that
30:13 misconception number two
30:16 over-the-counter medication
30:18 is safe to use daily for my migraines
30:22 so we’re going to meet another gentleman
30:24 here and this is lawrence
30:26 he’s 36 years old and was diagnosed with
30:29 migraines in his 20s
30:30 he used to get migraines about twice a
30:32 month and he was
30:34 prescribed a tryptin so it’s a
30:36 prescriptive medication to treat
30:37 migraines
30:38 uh and over the last 10 years his
30:40 migraines have become more frequent so
30:42 he uses different combinations of
30:43 medications including sumatriptan
30:45 tylenol 3
30:46 ibuprofen at least five days out of the
30:48 week so all of these medications are
30:50 becoming less effective
30:52 at treating his headaches
30:55 so this is a really common story
30:58 especially in migraine sufferers that
31:00 have chronic or very high frequency
31:02 number of headaches so a medication
31:04 overuse headache is actually
31:06 a headache that is caused by taking
31:09 those acute medications too often so
31:11 acute medications
31:12 are the medications that you take when
31:15 you have
31:16 a migraine or a headache event and you
31:17 want them to work quickly they’ll work
31:19 within an hour or two
31:20 so when you use them more than two days
31:22 out of the week you’re at risk for a
31:24 medication overuse headache
31:26 so about 50 of chronic migraine
31:29 sufferers
31:30 actually experience medication overuse
31:33 and how do we know that this is causing
31:35 a worse headache or or adding on to this
31:38 so research shows that when medication
31:41 overuse
31:42 is stopped about 60 to 70 percent of
31:45 people
31:46 will have headache improvement so the
31:49 takeaway message
31:50 from this is that if you need to treat
31:52 your headaches or your migraines on two
31:54 or more days out of the week
31:55 you should really speak to your
31:56 healthcare provider so often this means
31:58 that some kind of preventative treatment
32:00 is needed
32:01 and there’s a really great post as well
32:03 on on migraine canada
32:05 for medication overuse so if if this is
32:08 something that
32:09 um you are not familiar with or you
32:11 think you’re kind of verging on that
32:13 it’s a it’s a great post that talks
32:14 about really what’s happening here so
32:16 you end up with kind of this
32:18 rebounding effect to your headaches uh
32:21 and they kind of
32:22 you need more medication because they’re
32:24 more often but when you take it
32:26 the headaches kind of get worse so
32:29 although over-the-counter medications
32:31 can be quite safe if you’re taking them
32:33 you know as as directed and within
32:36 typical limits
32:37 there it’s very tricky when it comes to
32:39 migraine sufferers who
32:41 whose brains are just a lot more
32:42 sensitive to these things
32:45 and misconception number three
32:48 there’s nothing more that can be done
32:50 for my migraines
32:52 so this actually is a really exciting
32:55 time in migraine
32:56 care and i think that it’s
33:01 a great time for people to be able to
33:03 understand their options so if you
33:05 experience headaches of any kind
33:08 migraines if a loved one or you know
33:10 somebody who has migraines which given
33:11 how common they are it’s probably
33:13 the case um visit migraine canada
33:16 there’s a wealth of information there
33:18 and migraine management really involves
33:20 so much more than medication
33:21 so i kind of put this uh circle up here
33:24 so there’s acute treatments these are
33:25 the things that you take when you have a
33:27 migraine there’s a lot of preventative
33:28 treatments
33:29 these can come in the form of medication
33:31 and supplements and and there’s a lot of
33:32 other things that can be done
33:34 and then there’s lifestyle and behaviors
33:36 as well and that plays a role
33:38 so new options are becoming available
33:40 all the time
33:42 we’ve made a lot of really interesting
33:44 advances in terms of our understanding
33:45 of migraine there’s new medications that
33:47 have come to market and there’s a few
33:48 more that are coming shortly
33:51 um and then how do you kind of find
33:54 a healthcare partner to navigate this
33:57 journey with you
33:58 so i think that communication is really
34:01 important
34:01 so something like tracking your
34:03 migraines and using canadian migraine
34:05 tracker
34:06 as well as your medication use can
34:08 really help
34:09 to better communicate with your
34:11 healthcare provider what’s going on
34:13 and really help them to maybe understand
34:16 because you do need
34:17 a bit of a partner on this journey that
34:19 can untangle some of the things that are
34:20 going on
34:22 um and that brings us to the end of our
34:25 talk tonight
34:26 thanks everybody have a great night
34:34 [Music]