Headache Neurologist's Interviews
Dr. Werner J. Becker, MD, FRCPC Neuroscience Professor (retired), Calgary Alberta Interview: Dr. Werner Becker
What Self Care Strategy (ie: not completing a headache diary, living an erratic lifestyle, not following a doctor's advice), etc., do you see most frequently in your headache practice?
Poor stress management is observed from many headache patients. Stress-reduction appears to be practiced the least and we know that stress seems to have a significant impact on a patient’s inability to cope with their migraine. Research suggests that stress is the number one trigger for migraines.
We know that approximately 80% of migraine patients seek help from their family physicians. We also know from expert Headache Neurologists, Doctors Saper and Lay, that physicians are under-trained in medical school.
In regards to patients not having a complete understanding of their headaches and what is “likely” going on - do you think it is family physicians being poorly trained, or patients not practicing self-care, or a bit of both?
Both - the family doctor and the patient do not invest the time to learn about headache syndromes, especially migraine, and to understand the patient’s headache problem as well as possible. 1
Chronic Migraine (CM), Interview
Dr. Christine Lay, M.D., FRCP. Headache Neurologist, Women's College Hospital for Headache, Toronto, Ontario
Overuse of medication is one of the biggest concerns in treating patients with chronic migraine (CM) because patients are at risk of overusing their medications. Is this harmful to their organs?
All medications have potential side effects, and some of the medications used to treat headache can negatively affect the kidneys, the stomach and the liver. Other medications sometimes used can cause you to feel sleepy because of the impact on the nervous system. Many of these risks are increased when someone is also having alcohol on a regular basis. However, if you follow your doctor’s recommendations, which is often to limit use of headache acute medications to 2 days per week, these side-effects can be minimized.
Can CM evolve from occasional, episodic migraine or does it just start one day?
More often than not, chronic migraine evolves from episodic migraine, but there are many patients who experience the start of chronic migraine one day, and it never goes away thereafter. Migraine can fluctuate, even without therapy, from episodic to chronic and back again, or even disappear for a period of time. The severity can also fluctuate from bad attacks that leave you unable to function to mild attacks that allow you to carry on with your day. 2
Poster (updated 2017) 3
Medical edits courtesy of Dr. Paul E. Cooper MD, FRCPC, FAAN (London), Dr. Christine Lay, MD. FRCP (Toronto) and Dr. Elizabeth Leroux, MD, FRCPC (Montreal) and Irene Worthington, B.Sc.Phm (co-author of Canadian acute and prophylactic migraine guidelines). Pharmacist (retired) Sunnybrook Hospital, Toronto, Ontario
Poster (formerly Chronic Daily Headache) Medical edits courtesy of Dr. Werner J. Becker, MD, FRCPC Neuroscience Professor (retired) Calgary, Alberta 4
- 1. Self-care Interview, Dr. Werner Becker, MD, FRCPC Navigating Toward Better Headache Care (2018)
- 2. Chronic Migraine interview, Dr. Christine Lay, MD. FRCP Headache Neurologist, Women's College Hospital for Headache, Toronto, Ontario
- 3. Headache Types poster (updated 2017) - Dr. Paul Cooper, MD, FRCPC, FAAN , Dr. Christine Lay, MD. FRCP , Dr. Elizabeth Leroux, MD, FRCPC . Irene Worthington (pharmacist) B.Sc.Phm. (co-author of Canadian acute and prophylactic migraine guidelines). Pharmacist (retired) Sunnybrook Hospital, Toronto, Ontario
- 4. Chronic Headaches poster, Dr. Werner J. Becker, MD, FRCPC Neuroscience Professor (retired) Calgary, Alberta