Chronic Migraine, Meds & Supplements, Treatment

Inadequately Treated Episodic Migraine Three Times More Likely to Progress to Chronic

People who have episodic migraine that is not adequately treated are three times more likely to progress to chronic migraine than those who have an effective treatment for episodic migraine, according to a recent study. In Keep Episodic Migraine From Progressing to Chronic on, I beg everyone with episodic migraine to see a doctor and also dispel some myths and misunderstandings about migraine treatment. Episodic migraine is bad enough, but chronic migraine is hell. If you have episodic migraine that’s not well-managed, please, please seek better treatment — no one should have to live with the misery of chronic migraine.

What I don’t mention in that post is how close the topic is to my own heart. My 16-year-old niece has had chronic daily headache since she was 11 and has episodic migraine attacks all her life, which have gotten more frequent as she’s gotten older. Whenever I see news about episodic migraine progressing to chronic — or chronic migraine worsening over time — I wonder how my niece’s migraine will progress. Everything I know about this illness points to the likelihood of her symptoms worsening without effective intervention. The thought breaks my heart.

Imagining my bright, driven, kind niece as sick as I have been makes me weep. I’m hopeful that her early diagnosis and the advances of migraine treatment in the last 20 years will mean she never has to endure what I have. I’d like my experience to be a cautionary tale that leads her and her parents to treat her migraines aggressively before they spiral out of control and become even harder to corral. There’s no guarantee her migraine trajectory will be the same as mine, but there’s also no guarantee it won’t. I’m afraid the odds aren’t in her favor.

Coping, Resources

Mindfulness: An Amazing Tool for Coping With Migraine

“[T]echniques based on the Buddhist teaching of mindfulness have reliably been the most effective, helpful coping strategies I’ve used in my 25 years with chronic migraine. While plenty of people approach Buddhism as a religion, I think of it more as psychology; a collection of wise insights to help people live their fullest lives.”

Migraine & Mindfulness — “Bruce Almighty,” my favorite of the posts I’ve written for Migraine and Headache Awareness Month is now up on No matter what your religious or spiritual bent is, mindfulness is an amazing tool, not only for coping with migraine, but with all of life’s stresses. To make this wonderful technique accessible to everyone, I focus on a secular approach to mindfulness in the beginning of the post, then include links to other incredible leaders who are more religious in their teachings.

Patient Education, Resources

Online Tool to Assess What Kind of Headaches You Have

Migraine, tension-type, sinus, cluster. . . . You know what your headache feels like and the other symptoms you have. Seems like finding a diagnosis would be easy, but it can be quite complicated. Consider these factors:

Headache Central, an educational site sponsored by the Michigan Headache Treatment Network, has a tool to help classify your headaches in medical terms. The online program asks questions about your headaches, determining which questions to ask based on your previous responses. After you’ve answered all the questions, you’re given a page with your responses and possible diagnoses summarized in a doctor-friendly format to print and take to your next appointment.

The program is not intended for you to diagnose yourself but to provide your doctor with a more complete view of what you’re experiencing. Of course, many readers will use the information to guide further online research. Arriving at your doctor’s office well-informed is helpful; so is being open to what they have to say. Think of the headache classification tool a starting point from which your doc can ask you relevant questions (and vice versa) to flesh out your diagnosis and find the appropriate treatment for you.

FYI: The program doesn’t work in Firefox.

Doctors, Treatment

Empathy and Shared Experience Between Doctor & Patient

Can a doctor who has a headache disorder understand — and treat — your illness better than one who doesn’t? Is shared experience necessary for empathy?

“How could I possibly understand or help her, she seemed to be asking, if I had not personally experienced her pain?

“Her question caught me by surprise and made me pause. O.K., I’ll admit it. I’m a cheerful guy who’s never really tasted clinical depression. But along the way I think I’ve successfully treated many severely depressed patients.

“Is shared experience really necessary for a physician to understand or treat a patient? I wonder. After all, who would argue that a cardiologist would be more competent if he had had his own heart attack, or an oncologist more effective if he had had a brush with cancer?

“Of course, a patient might feel more comfortable with a physician who has had personal experience with his medical illness, but that alone wouldn’t guarantee understanding, much less good treatment.”


Why Stimulate the Occipital Nerve?

News reports have lauded trigeminal, peripheral and supraorbital nerve stimulation, but there hasn’t been much coverage of occipital nerve stimulation. This isn’t an endorsement of one type over another, but I talk about ONS because that’s what I have. When I have a grasp on the other options, I’ll write about them.

The occipital nerve is targeted because it is a sort of gatekeeper that refers migraine pain to other nerves. Dr. David Dodick of the Mayo Clinic in Scottsdale explains, “The occipital and trigeminal nerves converge. These nerves connect with all of the pain-sensitive structures in the skull. [S]timulating the occipital nerve inhibits activity in the trigeminal nerve.” (This quote is from an an article that was on OUCH‘s old website, which is no longer available. Even though the article focuses on occipital stimulation for cluster headaches, the information applies to migraines.)

From what I’ve learned – and what the quote from Dr. Dodick above indicates, it appears that the occipital nerve connects to all other nerves, therefore is the widest-reaching option. I’m by no means a definitive source on this. At the very least, if you’re considering nerve stimulation, it’s a good idea to research all the possible types and work with your doctor to determine the best for your pain.