EVALUATION AND PROPHYLAXIS

TREATMENT OF THE ADULT PATIENT

WITH MIGRAINE

dr. Indarwati Setyaningsih, Sp.S(K)

Department of Neurology Faculty of Medicine

Universitas Gadjah Mada
Yogyakarta, 2020
Overview

Evaluation Medication

Non-
Prophylaxis
Pharmacological
Treatment
Treatment
 EVALUATION

DIAGNOSIS
• Medical history, symptoms and physical and
neurological examination
• If became severe, test to rule out condition unusual,
complex or suddenly other causes for pain include
– MRI, CT scan : help diagnosis tumors, strokes,
bleeding in the brain, infection and other brain
condition
Evaluasi

• Headache diary merupakan suatu gold

standard evaluasi serangan, frekuensi, durasi,
beratnya serangan, disabilitas, dan respon
obat
Migraine Diary
Migraine Diary
Migraine Diary
MEDICATION
Treatment

• Migraine treatment is aimed at stopping

symptoms and preventing future attacks.
• Medications used to combat migraines fall
into two broad categories:
– Pain-relieving medications: also known as acute
or abortive treatment  designed to stop
symptoms.
– Preventive medications: drugs taken regularly,
often daily  reduce the severity or frequency of
Migraine. Mayoclinic. org

migraines.
Treatment Goal
 ACUTE TREATMENT

Successful abortive therapy :

• pain-free status in 2 hrs post therapy
• pain-free status lasts atleast 24 hrs
post therapy
• better intensity (mod to mild or severe to
mod)
Acute Migraine Treatment
Acute Migraine Treatment
Acute Migraine Treatment

Becker, W.J. 2015. Acute Migraine

Treatment in Adults. Headache, 55:778-93.
Medication
Medication
Non-Pharmacological Treatments
Non-Pharmacological Treatments

RELAXATION TRAINING :
Progressive Muscle Relaxation (PMR) and meditation or
passive relaxation

CBT :
The mixture between cognitive therapy and behavioral
therapy.
To identify the most important thought, emotion, and
behaviour to decide the best reaction.
Point: How the patients think about certain situation
affecting how they feel emotionally & physically, and
changing their behavior the key of
Non-Pharmacological Treatments

BIO FEEDBACK
A technique where the person receives extra feedback about the state
that their body is in. It’s then the person’s job to use the feedback they
get to make changes in their own body.
8-10 session @30-45 minute
Includes :
 Conditioning
 Feed back
 Intrumentasi
 Behavior modification
 Adaptation
Migraine Prophylaxis
AAFP, 2019
General Principles for Instituting Preventive Therapy

• Start the chosen drug at a low dose and increase it

slowly until therapeutic effects develop, the ceiling
dose is reached, or adverse events become
intolerable.
• Consider comorbidity and coexistent illnesses in drug
choice (cardiovascular, psychiatric, neurologic,
gastrointestinal diseases or others).
• Avoid exacerbating, overused, and contraindicated
drugs (because of coexistent or comorbid illnesses).
Silberstein, S.D., 2015. Preventive Migrain Treatment. Continuum, 21(4):973-89
General Principles for Instituting Preventive Therapy

• Give each treatment an adequate trial. A full

therapeutic trial may take 2 to 6 months before the
maximal response to a treatment is evident.
• Set realistic goals. Success is defined as a 50%
reduction in attack frequency or headache days, a
significant decrease in attack duration, or an
improved response to acute medication.
• Reevaluate therapy; migraine may improve or
remit independent of treatment.
Silberstein, S.D., 2015. Preventive Migrain Treatment. Continuum, 21(4):973-89
General Principles for Instituting Preventive Therapy

• Be sure that a woman of childbearing age is aware of

any possible risks and avoid preventive drugs if at all
possible in anticipation of and during pregnancy.
• To maximize compliance, involve patients in their
care.
• Set realistic expectations regarding adverse events.

Silberstein, S.D., 2015. Preventive Migrain Treatment. Continuum, 21(4):973-89

 Guidelines for stopping preventive therapy

Guidelines for stopping preventive therapy:

• The patient develops intolerable adverse events
or a severe drug reaction.
• The drug does not demonstrate even partial
efficacy after 2 months of therapy and disorders
such as acute medication overuse have been
eliminated.
• The patient has shown significant benefit. If the
headaches are well controlled for at least 6
months, slowly taper and, if possible, discontinue
the drug.
Silberstein, S.D., 2015. Preventive Migrain Treatment. Continuum, 21(4):973-89
10 Natural Way To Reduce Migraine Symptom

• Avoid hot dog

• Apply lavender oil
• Try accupuntur
• Look for feverfew
• Apply peppermint oil
• Go to ginger
• Sign up to Yoga
• Try biofeedback
• Add magnesium in your diet
• Book a massage
What food are good for migraine

• Orange,Yellow and green vegetable

• Rice especially brown rice
• Dried food cooked fruit, cherries and
crainberies
 Technology :
Polymer Matrix
Hydrophilic
TAHAP-TAHAP PELEPASAN OBAT
• Lebih nyaman dengan
dosis 1 kali sehari
• Efikasi lebih baik
• Dapat ditoleransi
dengan baik
 RINGKASAN…..1
• Migren salah satu nyeri kepala primer
• Penegakan diagnosis dengan anamnesis,
pemeriksaan fisik, pemeriksaan neurologis,
pemeriksaan penunjang utk mengeksklusi adanya
kelainan lain di otak penyebab nyeri kepala
• Terapi bisa berupa acute treatment serta
prophilaksis
• Depakote ER merupakan salah satu obat untuk
prophilaksis migren yg direkomendasi AAN, EFNS,
US Headache Consortium
 RINGKASAN …..2
• Depakote ER merupakan obat first line
prophilaksis migren
• Depakote aman, ditoleransi dengan baik, dosis
tunggal
TERIMA KASIH