Is It a Migraine? Risk Factors and Diagnostic Categories
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. List three types of migraine 2. Describe risk factors associated with chronic migraine
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from April 10 2018 through 07/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Migraine is a complex neurologic disorder including both moderate to severe headache along with a variety of neurologic and systemic symptoms. Common symptoms include hypersensitivity to light and sound, cutaneous pain sensitization, and GI symptoms.
Headache symptoms are often described as follows
Aggravated by physical activity or head movement (90%)
Aura may include
Flashes of light | Partial loss of vision | Parasthesias | Vertigo | Ataxia | Diplopia
Symptoms are typically bilateral, sequential (visual, then sensory) and recurrent in nature
Migraine with aura (with at least two attacks fulﬁlling the two following criteria)
One or more of the following fully reversible aura symptoms
Speech and/or language
At least three of the following six characteristics
At least one aura symptom spreads gradually over ≥5 minutes
≥2 aura symptom in succession
Each individual aura symptom lasts 5–60 minutes
≥1 aura symptom is unilateral
≥1 aura symptom is positive for scintillations and pins and needles
Aura is accompanied, or followed within 60 minutes, by headache
Note: Not better accounted for by another diagnosis
Migraine without aura (at least 5 attacks fulfilling the following criteria)
Headache lasting 4-72 hours (untreated or successfully treated)
Headache has at least two of the following characteristics
Unilateral | Pulsating | Moderate/severe intensity | Aggravated by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)
≥ 8 days meet diagnostic criteria for migraine with or without aura
Not better accounted for by another diagnosis
WHO lists migraine as the third most prevalent medical condition in the world. Migraine may not always present with typical symptoms and can be bilateral, mild, non-throbbing, with facial pain and hence confused with tension or sinus headache. It may be preceded by prodromal symptoms hours or days before headache. Symptoms can include fatigue, neck stiffness and impaired concentration. Postdromal symptoms occur up to 24 hours after headache may include weakness, fatigue, somnolence, photophobia, impaired concentration, irritability and nausea.
Most prevalent ages are between 25-55 years
In women, the annual and lifetime prevalence are 18% and 33%
A minority (<10%) of women have attacks of migraine in association with most of their menstrual cycles
Usually without aura
Tend to be longer and accompanied by more severe nausea
8% of the migraine population has chronic migraine
Risk factors for chronic migraine
Overuse of acute medications
Inadequate treatment of acute attack
Allodynia (perception of pain when non-painful stimuli are applied to the skin)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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