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Defining the Complicated Migraine |
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BY MAURY BREECHER
Contributing Writer |
SCOTTSDALE, ARIZ. (ECCC)—
The definition or diagnosis of “complicated headache” depends on
the medical specialty of the treating physicians, said Dr.
Frederick Taylor on February 18 in a presentation at a Headache
Research Summit presented by the Diamond Headache Clinic
Research and Educational Foundation.
Headache specialists think that migraines with neurological
symptoms and signs are complicated. However, other practitioners
consider migraine complicated when it is refractory,
intractable, or incorrigible (with or with symptoms), reported
Dr. Taylor, the director of the Headache Clinic & Research
Center at Park Nicollet Health Services in Minneapolis.
“Atypical headache is often not atypical,” he said. “Atypicals,
like aura without headache, are less common in the general
population but occur more frequently with aging, and such cases
are commonly found in doctor’s waiting rooms.”
According to Dr. Taylor, complicated headaches are most often
chronic migraines. And what makes migraine complicated?
“Chronic migraines may be refractory, intractable, or
incorrigible with or without neurological symptoms,” said Dr.
Taylor. “Refractory headache is associated with DSM-IV Axis I
and II.”
He recommended that physicians who treat headache patients but
who are not headache specialists should familiarize themselves
with the ICID-II, the International Classification of Headache
Disorders (Cephalalgia 2004;8(Supp1): S24-S26).
According to the ICHD, the complications of migraine include
chronic migraine, migraine-triggered seizures, migrainous
infarction, and persistent aura without infarction.
Dr. Taylor said 99% of migraine attacks include visual phenomena
such as aura, which is described as sparks or scintillations.
Auras develop gradually, taking 5 minutes or more to develop,
and can last from 5 to 60 minutes, he said. Patients may report
seeing zig-zag or unilateral lines.
“It has been very well documented that female migraineurs with
aura are at increased risk for cardiovascular problems and
stroke, so that means we need to help them optimize their other
risk factors,” said Dr. Taylor.
He pointed out that there is complete disagreement about the
treatment of migraine with aura. Some physicians prescribe
ß-blockers, but he advises against it.
“Avoid ß-blockers when treating migraineurs with aura,” said Dr.
Taylor. “It’s not overwhelming evidence, but there are seven
cases in the literature showing an association of stroke when
migraineurs with aura take ß-blockers.”
Dr. Taylor also encouraged physicians to try to change their
patients’ mindset from, “Doctor, what are you going to do for
me?” to one where patients get involved in their own care.
“We need to make the patients the star of the medical team,
responsible for making proper decisions. When they are the
stars, we end up being the coaches as well as medical care
providers,” he concluded.
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| Copyright 2008 Elsevier Custom Conference Coverage. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the copyright owner. No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, through negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, the Publisher recommends that independent verification of diagnoses and drug dosages should be made. Opinions expressed in this publication are those of the original authors and do not necessarily reflect those of the Publisher, the sponsor, or the editors. Elsevier assumes no liability for any material published herein. |
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