Improving knowledge of migraine and its treatment

Migraines are a common and potentially disabling syndrome that often involves much more that just a severe headache. Due to the often severe pain and associated symptoms, effective and safe treatment of migraine is essential. Numerous management options exist, and it is important that doctors are made aware of these and are kept up to date with any new advances in migraine treatment. The AURA education program seeks to improve general practitioners’ knowledge of migraines and the options for both acute and prophylactic treatment.

Migraine is a syndrome that affects at least 12% of the population, and up to 20% of women. The most common symptom is a severe one-sided throbbing headache, but migraines are often also associated with nausea and vomiting, auras, sensitivity to light and sound, and fatigue.¹

The symptoms of migraine are extremely varied. Not all patients experience prodromal symptoms (such as auras); a small minority will have only limited pain but severe prodromal symptoms.² While there are significant genetic factors that make a person susceptible to migraines, many patients also have specific triggers that will bring about a migraine. These can include stress, tiredness, certain foods (such as cheese or red wine) and hormonal factors (such as menstruation).³

Nearly all migraine sufferers find that migraines significantly reduce their ability to function at work and in social situations.⁴ The World Health Organisation has ranked migraine as the 12th most important cause of disability in the world. It is estimated that migraines cost Australia more then $720 million each year.⁵

The management of migraines is, however, difficult, due to the fact that every patient will have different symptoms and will respond differently to treatment. For this reason, patients need an individualised plan that involves avoidance of triggers, acute relief and possibly prophylaxis if the migraines occur frequently. The medications available for acute relief include NSAIDs, triptans, prochlorperazine and opioid analgesics. For prophylaxis, the options include topiramate, propranolol, pizotifen, amitriptyline and even botox.^2,6

Although migraine patients often self-medicate or seek complementary therapy, many patients with severe or frequent migraines turn to their general practitioners for advice and treatment. To help general practitioners keep up to date with all the new advances in migraine treatment, including evidence based prophylaxis treatments, a new program called AURA (An Update on migRaine prophylAxis) is being run.

The AURA program is an interactive GP workshop on the management of frequent migraine. It takes place over dinner and includes both a presentation and an interactive discussion session. The presentation runs for approximately 90 minutes and is granted 3 RACGP Category 2 CPD* points.

The areas covered in the session include:

• Highlighting the impact of migraine in Australia
• Defining migraine and correctly diagnosing migraine in patients
• Prevention of migraine by avoiding triggers 
• Treating acute migraine
• Managing frequently recurring migraine (Prophylaxis of migraine)

Developed in consultation with general practitioners and local neurologists, AURA provides an opportunity to:

• Discuss migraine with a neurologist
• Gain practical advice on migraine diagnosis
• Discuss and evaluate appropriate management options for frequent migraine
• Review case studies
• Share your ideas and experience with colleagues

Dr Janet Keys-Brown of the Faculty of Medicine, Nursing and Health Sciences at Monash University in Melbourne believes that "migraine is an important and relevant topic for GPs, given the extremely high prevalence of the condition in the community, and the strong evidence that treatment/prevention are sub-optimal." Dr Keys-Brown has had some involvement with development of the AURA workshop and believes that it should meet the needs of GPs very well. "It is clear, up-to-date and informative but not bogged down with technical/specialist detail. I imagine it will prove to be useful and popular with participants."

The AURA educational event begins 1st June 2008.

References:

1. Lipton RB, et al. Migraine prevalence, disease burden, and the need for preventative therapy. Neurology 2007; 68: 343-49.
2. Hankey G, Wardlaw J. Clinical Neurology. Demos Medical Publishing, United Kingdom, 2002.
3. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 16th Edition. McGraw-Hill. 2001.
4. Goadsby PJ.  Recent advances in the diagnosis and management of migraine.  BMJ 2006; 332: 25-9.
5. Alexander L. Prevalence and cost of headache. Headache Australia. Available from url: www.headacheaustralia.org.au/what_is_headache/prevalence_and_cost_of_headache
6. Stark RJ, Valenti L, Miller GC. Management of migrain in Australian general practice. MJA 2007; 187: 142-46.

* RACGP has yet to confirm points.