Event 4: Evaluation Treatment Response

Follow Up Visit 1: Part 1

Test Your Knowledge

Joe notes that Sumatriptan isn’t always helpful for his headaches. He also thinks it makes him tired. His friend takes hydrocodone for his headaches and Joe wonders if this might work for him.

True or false: Is hydrocodone an appropriate alternative medication?

Incorrect

Correct

Follow Up Visit 1: Part 2

Headache Spectrum

Headaches evolve along a spectrum with migraine as most severe.

Chart showing migraine evolution — Migraine evolution

Follow Up Visit 2

Stress

Stress is the most commonly reported trigger of headache attacks.

Multiple Categories of Migraine Triggers

Dietary Items

aged cheeses (tyramine)
alcohol (tyramine & sulfates; dehydration)
caffeine withdrawal
artificial sweeteners (aspartame)
processed meats (nitrates, MSG)

Chronobiological

oversleeping
napping
too little sleep

Bright Light, Odors

perfume
smog
cigarettes
flashing lights or screens

Hormonal

menarche
menstruation
menopause
birth control pills
pregnancy

Physical

exercising too much
exercising in heat

Stress Let Down

vacation
weekend

Self-Care Techniques

Self-care techniques are effective in reducing stress.

Take a break
Exercise
Smile and laugh
Get social support
Meditate

Source: American Psychological Association

Mental Health Evaluation

A mental health evaluation may be needed if stress is excessive.

Excessive stress
Depression and anxiety
Worsening headaches

When to Consider a Mental Health Evaluation

Consider a mental health evaluation if any of the following are experienced more days than not:

Feeling little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying

Source: Kroenke et al. Psychosomatics 2009;50:613-621.