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Guide to living well with<br />
I “ took<br />
control of<br />
<strong>my</strong> <strong>Chronic</strong><br />
<strong>Migraine</strong>!<strong>”</strong><br />
Former CNN journalist<br />
Yasmina Ykelenstam<br />
persevered until she found<br />
her path to relief<br />
Don’t put<br />
up with<br />
migraines—<br />
prevent<br />
them!<br />
37 ways<br />
to take<br />
charge!<br />
£ ID your triggers<br />
£ Tune into<br />
symptoms ASAP<br />
£ Treat promptly<br />
£ Be prepared
Guide to living well with<br />
<strong>Migraine</strong><br />
headaches<br />
Good communication with<br />
her care team was key for<br />
Kate McCombs to conquer<br />
her migraines.<br />
10<br />
18<br />
“It worked! I was so happy!<strong>”</strong><br />
says ex-CNN journalist<br />
Yasmina Ykelenstam of a<br />
treatment that helps prevent<br />
her <strong>Chronic</strong> <strong>Migraine</strong>.<br />
New hope<br />
3 Live your best life—<br />
even with migraine!<br />
Why your chances of getting rid of<br />
migraine pain are better than ever<br />
The basics<br />
4 What’s causing your head pain?<br />
Learn the different types of headache<br />
5 The four stages of migraine<br />
6 Steer clear of your triggers<br />
You & your care team<br />
7 Your weekly journal<br />
Track your symptoms to learn your triggers<br />
8 Your healthcare team<br />
9 How medications can help<br />
Real inspiration<br />
10 “I’m conquering <strong>Chronic</strong> <strong>Migraine</strong>!<strong>”</strong><br />
Former CNN journalist Yasmina Ykelenstam<br />
refused to stop looking for a solution to<br />
near constant distress<br />
16 <strong>”</strong>What I’ve learned about migraine<strong>”</strong><br />
Celebs share how they stop the pain<br />
18 “How I took control...<strong>”</strong><br />
How migraine sufferers make every day easier<br />
Feel your best<br />
21 Q&A<br />
Your questions answered by a migraine expert<br />
22 <strong>Migraine</strong>-proof your home<br />
Make your home a safe zone!<br />
24 Questions for your next exam<br />
24 Resources you need now<br />
>> Find these articles and more at<br />
HealthMonitor.com/<strong>Migraine</strong><br />
Reviewed by<br />
Health Monitor’s<br />
migraine experts:<br />
Roger K. Cady, MD—<br />
founder and medical director<br />
of the Headache Care Center in<br />
Springfield, MO. He is the<br />
Associate Executive Chairman of the<br />
National Headache Foundation.<br />
Stephen D. Silberstein, MD—<br />
professor of neurology and director<br />
of the Jefferson Headache Center<br />
at Thomas Jefferson University in<br />
Philadelphia. He is a Fellow of the<br />
American Headache Society and the<br />
American Acade<strong>my</strong> of Neurology.<br />
Editor-in-Chief, Maria Lissandrello<br />
Project Editor, Lindsay Bosslett<br />
Creative Director, John Angelini<br />
Art Director, Jennifer Webber<br />
Production and Project<br />
Management Director,<br />
Kimberly H. Vivas<br />
Account Executive,<br />
Christina Nelson<br />
Alliances and Partnerships<br />
Director, Marc Jensen<br />
Vice President, Human Resources<br />
and Customer Service,<br />
Renee Mormando<br />
Chief Financial Officer,<br />
Ding Yu<br />
Senior Vice President,<br />
Dave Dolton<br />
Senior Vice President,<br />
New Products, Technology<br />
and Strategy, Alex Dong<br />
President, Kenneth Freirich<br />
Chief Executive Officer,<br />
Eric Jensen<br />
Health Monitor Network is the nation’s leading<br />
multimedia patient-education company, with<br />
publications, websites and mobile apps. For more<br />
information, contact: Health Monitor Network,<br />
135 Chestnut Ridge Road, 2nd Floor, Montvale,<br />
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healthmonitor.com; www.healthmonitor.com<br />
©2015 Data Centrum Communications, Inc.<br />
This publication is not intended to provide<br />
advice on personal medical matters or to<br />
substitute for consultation with a physician.<br />
The NHF aims to raise awareness<br />
of headache; support research; and<br />
educate the public about it.<br />
The AHMA<br />
exists to E.A.S.E.<br />
the burden of<br />
<strong>Migraine</strong> and other<br />
Headache Disorders through Education,<br />
Awareness, Support and Engagement.<br />
The editorial content of this publication has been<br />
reviewed for accuracy by the National Headache<br />
Foundation (NHF) and the American Headache &<br />
<strong>Migraine</strong> Association (AHMA). This review does<br />
not constitute an endorsement or expression of<br />
opinion by NHF, AHMA or the reviewing healthcare<br />
provider(s) regarding any advertised product or<br />
service or point of view mentioned or advertised.<br />
t<br />
hese days, Patrice R.<br />
Valentine spends time<br />
having fun with friends<br />
and pursues her passions,<br />
including launching a new business.<br />
But it wasn’t always like that. “At<br />
<strong>my</strong> worst, I would have a migraine<br />
that would last for days. Often,<br />
I’d get them two or three times a<br />
month. It was keeping me from<br />
doing <strong>my</strong> job and living <strong>my</strong><br />
life.<strong>”</strong> How did she find relief? “I<br />
refused to give up!<strong>”</strong> she says. “My<br />
doctor and I tried everything, and<br />
finally a treatment came out that<br />
made all the difference.<strong>”</strong> Patrice<br />
even experienced a silver lining:<br />
“By tracking <strong>my</strong> symptoms I also<br />
learned that stress was a trigger for<br />
me—so I quit <strong>my</strong> job to pursue <strong>my</strong><br />
own business. <strong>Migraine</strong>s actually<br />
changed <strong>my</strong> life for the better!<strong>”</strong><br />
Focus on prevention<br />
With today’s treatments, days spent<br />
lying down in dark rooms may be a<br />
thing of the past. Whether you suffer<br />
from episodic migraines (the kind<br />
that occur on fewer than 15 days per<br />
month) or <strong>Chronic</strong> <strong>Migraine</strong> (which<br />
strikes on 15 or more days per month<br />
for at least three months), partnering<br />
with your healthcare team like Patrice<br />
did is key. It’s the best way to take<br />
advantage of the latest learning.<br />
For example, the newest emphasis<br />
is on preventing migraines. In fact the<br />
American Acade<strong>my</strong> of Neurology<br />
has identified nearly a dozen effective<br />
medications that can help do just that.<br />
What’s more, nearly 40% of<br />
patients could benefit from such<br />
preventive therapies, says Stephen D.<br />
Silberstein, MD, professor of<br />
neurology and director of the<br />
Jefferson Headache Center at Thomas<br />
Jefferson University in Philadelphia.<br />
Experts also have a deeper understanding<br />
of what triggers migraines<br />
and how to find faster relief. A pivotal<br />
finding: Treating a migraine quickly<br />
helps the medication work better.<br />
What you can do<br />
If you’re one of the nearly 30<br />
million Americans who suffer from<br />
migraine, it’s time to take a stand.<br />
Start by learning about your<br />
headaches—what type you have<br />
and what triggers them—and<br />
new hope<br />
Live your best life—<br />
even with migraines!<br />
exploring all your treatment<br />
options. That’s where this guide<br />
comes in handy. Get comfortable in<br />
your favorite armchair and read on.<br />
You’ll get tips and real-life<br />
inspiration, which will help you<br />
turn the tables on migraine, just<br />
like Patrice. “I definitely encourage<br />
people to work closely with their<br />
doctors,<strong>”</strong> she says. “You never<br />
know what options might be out<br />
there—or what might be causing<br />
your migraines without your realizing<br />
it. You don’t have to just accept<br />
the pain and discomfort as a part<br />
of your life—get out there and do<br />
something about it!<strong>”</strong><br />
HealthMonitor 3
the basiCS<br />
What’s causing<br />
your headache?<br />
The<br />
the basiCS<br />
4 stages of migraine<br />
If you have migraines you’re familiar with the pain, the nausea and the vomiting. But that<br />
describes only the headache stage of migraine. There are three others, and tuning into them<br />
can help you get more effective treatment. Consider: Treating at the very first sign can help<br />
stave off a full-blown migraine or limit your symptoms. To learn more, read on.<br />
ot really sure? You’re<br />
not alone. Many people<br />
mistake migraines for<br />
sinus infections; it’s easy to confuse<br />
tension and cluster headaches;<br />
and you may not realize there’s a<br />
difference between episodic and<br />
<strong>Chronic</strong> <strong>Migraine</strong>. Yet it’s important<br />
to get to the bottom of your head<br />
pain. That’s because identifying the<br />
type of headache you have can help<br />
your healthcare provider pinpoint<br />
the best treatment for you. To find<br />
out exactly what’s ailing you, read on.<br />
Tension-type: The most<br />
common headache, tension-type<br />
headaches usually cause only mild<br />
to moderate pain. The discomfort<br />
typically begins in the forehead,<br />
temples or the back of your head<br />
or neck. It creates a band-like<br />
sensation around your head, or<br />
a feeling of pressure in head and<br />
neck muscles. The headaches<br />
often occur after feeling stressed,<br />
anxious, fatigued or angry.<br />
Sinus: A study found that 86%<br />
of people who thought they were<br />
having a sinus headache were<br />
actually suffering a migraine—so it’s<br />
important to know the difference.<br />
Sinus headaches typically cause<br />
throbbing pain and a feeling of<br />
pressure around your eyes, cheeks<br />
and forehead. The pain will usually<br />
worsen if you bend or lie down.<br />
They develop when your sinuses<br />
become swollen, usually due to<br />
4 HealthMonitor<br />
<strong>Migraine</strong> or chronic migraine?<br />
<strong>Migraine</strong>: <strong>Migraine</strong> often<br />
begins as a dull ache that develops<br />
into a throbbing and pulsating pain,<br />
often near the temples, as well as the<br />
front or back of one or both sides of<br />
the head. The pain is often accompanied<br />
by nausea, vomiting, and/or<br />
sensitivity to light and noise. Some<br />
may see “aura<strong>”</strong> (see page 5 to learn<br />
more) before the headache strikes.<br />
<strong>Migraine</strong> checklist<br />
Many of the symptoms of a<br />
migraine are unique to that type of<br />
headache. If you’re experiencing<br />
at least two of the symptoms at<br />
right—either before or during your<br />
headache—let your healthcare<br />
provider know.<br />
allergies or a sinus infection. Your<br />
sinuses will often be blocked, so<br />
you may not be able to breathe well<br />
through your nose, and your sense of<br />
taste or smell may be diminished. If<br />
the cause is an infection, you’ll likely<br />
have a low fever, and may have green<br />
or yellow nasal discharge, a sore<br />
throat, soreness in your jaw or teeth,<br />
a cough, and/or fatigue.<br />
Rebound: This type of<br />
headache occurs if you take acute<br />
pain relievers too often (twice a week<br />
or more for several weeks) or use<br />
more than the recommended dosage.<br />
Typically, as soon as the medication<br />
<strong>Chronic</strong> <strong>Migraine</strong>:<br />
With <strong>Chronic</strong> <strong>Migraine</strong>, you can feel<br />
as though you’re never free from your<br />
headaches at all, and while pain medications<br />
may lessen your symptoms,<br />
they never go away completely. Your<br />
care team may diagnose you with<br />
<strong>Chronic</strong> <strong>Migraine</strong> if you have 15 or<br />
more migraine days a month, each<br />
episode lasting four hours or more.<br />
◦ Blurred vision<br />
◦ Dizziness<br />
◦ Fatigue/<br />
sleepiness<br />
◦ Nausea<br />
◦ Sensitivity to<br />
light<br />
◦ Sensitivity to<br />
sound<br />
◦ Vomiting<br />
◦ Lightheadedness/<br />
feeling faint<br />
◦ Sweating or<br />
cold hands<br />
◦ Diarrhea<br />
◦ Other:<br />
____________<br />
wears off, the headache comes back.<br />
You may also experience neck pain,<br />
irritability, difficulty concentrating and<br />
depression.<br />
Cluster: Cluster headaches come<br />
in groups and typically strike without<br />
warning. The head pain, which is<br />
severe, often occurs on only one side of<br />
the head, and may cause the eye to tear<br />
and turn bloodshot, and your nose to<br />
run on the same side. They often begin<br />
in the middle of the night and may last<br />
for weeks or months. Their cause is<br />
not completely known, but researchers<br />
believe they may be the result of a<br />
chemical reaction in the brain.<br />
1 Prodromal (early warning)<br />
• When it happens: Several hours to up to two days<br />
in advance.<br />
• Frequency: About 60% of those with migraines will<br />
experience this phase.<br />
• Possible symptoms: Anxiety, unexplained energy or<br />
feelings of euphoria, irritability, difficulty concentrating,<br />
food cravings, sensitivity to smells or noise, fatigue<br />
with frequent yawning<br />
• What to do: Take the pain reliever your doctor<br />
recommended or prescribed. Doing so right now can<br />
help you avoid a full-on migraine. This is also a good<br />
time to think about possible triggers—for example,<br />
ask yourself what you’ve eaten or had to drink, how<br />
stressed you are and how much sleep you’ve had.<br />
2<br />
Aura phase<br />
(pre-migraine)<br />
• When it happens: About an hour before to right<br />
when the headache strikes.<br />
• Frequency: About 20% of those with migraines<br />
experience this phase, but not necessarily every time.<br />
• Possible symptoms: Changes in vision, such as<br />
flickering, shimmering or flashing lights, tunnel vision,<br />
difficulty focusing, spots of vision loss or zigzag lines<br />
that cross your line of sight; skin sensations, such as<br />
numbness in your extremities or feelings of tingling or<br />
“pins and needles<strong>”</strong> in the face or hands; trouble speaking,<br />
writing or understanding words; muscle weakness<br />
• What to do: Immediately take a pain reliever or the<br />
medication you’ve been prescribed for your migraine.<br />
Make sure you have your migraine tool kit (see page<br />
23) handy and avoid any triggers.<br />
4<br />
3<br />
1<br />
2<br />
Phases of a migraine<br />
1. Prodromal: 24-48 hours<br />
2. Aura phase: 1 hour<br />
3. Headache phase: 4-72 hours<br />
4. Postdromal: 24-48 hours<br />
3<br />
4<br />
Headache phase (during migraine)<br />
• When it happens: This is when the actual headache<br />
strikes; it can last for hours up to several days.<br />
• Frequency: 100% if the migraine is untreated.<br />
• Possible symptoms: Throbbing or pulsing<br />
pain ranging from mild to severe, often on one side<br />
but sometimes both sides of the head; sensitivity<br />
to light, sounds and sometimes smells; nausea<br />
and vomiting; blurred vision; light-headedness<br />
and/or fainting<br />
• What to do: Immediately take a pain reliever or<br />
medication you’ve been prescribed for your migraine.<br />
Relax in a cool, dark, quiet setting.<br />
Postdromal<br />
(after headache)<br />
• When it happens: After the attack phase has subsided,<br />
and lasting for a few hours up to two days.<br />
• Frequency: Most people who experience the attack<br />
phase will experience some form of postdromal phase.<br />
• Possible symptoms: Extreme fatigue,<br />
sluggishness, confusion, irritability, head pain if<br />
you move too quickly or bend over<br />
• What to do: If you’ve been taking acute pain relievers,<br />
start to cut back so you avoid a rebound headache. Continue<br />
to rest and avoid stress or other common triggers.<br />
HealthMonitor 5
the basiCS<br />
you & your care team<br />
Steer clear of<br />
your triggers!<br />
one of the best ways to rein in<br />
your migraines? Avoid<br />
having them in the first<br />
place! One strategy: Zeroing in<br />
on—and avoiding—your triggers,<br />
the culprits that spark the chemical<br />
reactions resulting in migraine. The<br />
thing is, triggers are different for<br />
everyone, and sometimes a combination<br />
is to blame. To learn what sets<br />
off your migraines, see the list below,<br />
and use the journal on the next page<br />
to track your migraines.<br />
Food/food additives.<br />
While food triggers tend to be<br />
unique for each individual, there are<br />
some that are more common. Here<br />
are some of the more likely ones,<br />
according to the National Headache<br />
Foundation and American<br />
Headache Society:<br />
• Aged cheeses (such as blue cheese<br />
and Cheddar)<br />
• Processed meats with nitrates or<br />
nitrites (such as bacon and hot dogs)<br />
• Monosodium glutamate (MSG)<br />
(often found in soy sauce, meat<br />
tenderizers and seasoned salts)<br />
• Artificial sweeteners<br />
• Alcohol (particularly red wine)<br />
• Coffee, tea and other sources<br />
of caffeine<br />
Eyestrain. Particularly from<br />
staring too long at a computer screen,<br />
or attempting to read too-small text or<br />
reading in low light.<br />
Dehydration. Thirst can spark a<br />
migraine; stay hydrated by drinking<br />
plenty of water throughout the day.<br />
Odors. Perfume and/or certain<br />
scented cleaning products can<br />
trigger a headache.<br />
Food temperature. Very hot<br />
(such as hot soup or coffee) and very<br />
cold (such as ice cream) foods can<br />
trigger a migraine in some.<br />
Skipping a meal. <strong>Migraine</strong><br />
sufferers’ bodies crave predictability.<br />
Glare. Nearly 90% of migraine<br />
sufferers are sensitive to light. In<br />
a study in Nature Neuroscience,<br />
researchers found a pathway in the<br />
brain that links the visual system to<br />
that which produces head pain.<br />
Changes in your routine.<br />
<strong>Migraine</strong> sufferers are sensitive to<br />
schedule changes, such as sleeping<br />
too much or too little.<br />
Hormone changes. Sixty<br />
percent of women who suffer<br />
from migraines do so when<br />
estrogen levels drop (such as<br />
before menstruation).<br />
Stress. Everyday hassles like<br />
running late for an appointment<br />
or working long hours to meet a<br />
deadline can cause nerve irritation<br />
and inflammation. Experiencing<br />
“letdown<strong>”</strong> after stress can have the<br />
same effect. “[The migraine] doesn’t<br />
happen when you finish your<br />
deadline, but it can happen the next<br />
day,<strong>”</strong> says Stephen D. Silberstein,<br />
MD, professor of neurology and<br />
director of the Jefferson Headache<br />
Center at Thomas Jefferson<br />
University in Philadelphia.<br />
Intense exercise. It sparks<br />
the release of nitric oxide—a<br />
chemical that can cause nerve<br />
irritation—into the bloodstream.<br />
Cigarette smoke. It can<br />
cause nerve irritation.<br />
A change in<br />
temperature.<br />
Going from either<br />
warm air to cold (such<br />
as being out on a warm<br />
summer day and going<br />
into an air conditioned<br />
room) or vice versa, can<br />
spark a migraine.<br />
A change in<br />
pressure. Changes in barometric<br />
pressure can alter your body’s<br />
chemical balance.<br />
Use this diary to pinpoint your<br />
triggers—and find out how well<br />
your treatments are working.<br />
Your weekly migraine journal<br />
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY<br />
DATES<br />
What I ate before<br />
<strong>my</strong> headache<br />
How much I slept the<br />
night before<br />
What activities I did that day<br />
What the weather was like<br />
(include temperature, humidity<br />
and barometric pressure)<br />
Rate the severity of your pain<br />
(0 = no pain, 10 = severe pain)<br />
Describe the type of pain<br />
(throbbing, band-like) and its<br />
location (in the temples, etc.)<br />
Note any other symptoms<br />
(nausea, aura, etc.)<br />
Treatments (and doses)<br />
Note how long it took<br />
for you to get relief<br />
6 Guide to Living Well with <strong>Migraine</strong> Headaches<br />
HealthMonitor 7
you & your care team<br />
Your healthcare team<br />
As challenging as it may be to battle migraine, remember that you’re not alone. There’s a<br />
whole team of healthcare providers in your corner. Here is a look at the experts who can<br />
help you develop the best strategy for overcoming your pain:<br />
• A neurologist specializes in<br />
disorders of the brain and nervous<br />
system. Look for one who is boardcertified<br />
in pain or headache medicine.<br />
• A board-certified internist<br />
or family physician with a<br />
background in pain management<br />
and/or headache medicine can<br />
diagnose and treat migraine.<br />
• A physical therapist can teach<br />
exercises to reduce neck tension, which<br />
is common among migraine patients.<br />
He or she may also teach or recommend<br />
other physical activities, such as yoga,<br />
that have been proven to ease symptoms.<br />
We can change<br />
the course of<br />
We can change<br />
this the disorder course of<br />
this disorder<br />
so little can do so much<br />
so little can do so much<br />
• A nurse practitioner (NP)<br />
or physician assistant (PA)<br />
can diagnose and treat migraine.<br />
• A psychologist or<br />
neuropsychologist can help<br />
you learn to better manage stress,<br />
which often triggers migraine,<br />
and can teach you biofeedback<br />
methods. A psychologist can also<br />
help you cope with depression<br />
and/or anxiety.<br />
• A sleep disorder specialist<br />
can diagnose sleeping conditions,<br />
such as sleep apnea, that may be<br />
contributing to your migraines.<br />
After 7,000 years of enduring and searching for relief from migraine, there’s still<br />
no cure. Still worse, for the 3rd most common disorder on the planet and the 4th<br />
most disabling among women worldwide, we’ve had only one class of medication<br />
developed and approved for the treatment of migraine over the last half-century!<br />
While we know more today than ever before about the brain chemistry and circuits<br />
involved, we are still far from safer and more effective treatments.<br />
Yet we have the brain trust – so many talented doctors and scientists across the United<br />
After States 7,000 and years around of enduring the world and searching – who know for relief the path from migraine, forward and there’s know still how to get this<br />
no done. cure. Still What’s worse, missing for the 3rd is enough most common money disorder to do the on the job. planet and the 4th<br />
most disabling among women worldwide, we’ve had only one class of medication<br />
developed and approved for the treatment of migraine over the last half-century!<br />
As a nation, we allocate a pittance to migraine research – less than 1/20th of 1% of<br />
While we know more today than ever before about the brain chemistry and circuits<br />
involved, the budget we are still of the far from National safer and Institutes more effective of Health treatments. – or about $16 million a year. Given<br />
the prevalence and magnitude of migraine, $260 million would be right. Industry and<br />
Yet the we have voluntary the brain sector trust – simply so many cannot talented make doctors up and the scientists difference. across the The United task before us now<br />
States needs and a around kick-start! the world – who know the path forward and know how to get this<br />
done. What’s missing is enough money to do the job.<br />
As a That’s nation, why we the allocate American a pittance <strong>Migraine</strong> to migraine Foundation research and – less Mrs. than Cindy 1/20th McCain of 1% of are partnering<br />
the in budget 2013 of to the launch National the Institutes 36 of MILLION Health – or MIGRAINE about $16 million CAMPAIGN, a year. Given a national public<br />
the mobilization prevalence and and magnitude education of migraine, campaign $260 to million increase would our be right. nation’s Industry research and investment in<br />
the migraine voluntary sector and raise simply public cannot visibility make up for the this difference. enormously The task disabling before us disorder now that affects<br />
needs<br />
more<br />
a kick-start!<br />
than 36 million Americans.<br />
That’s why the American <strong>Migraine</strong> Foundation and Mrs. Cindy McCain are partnering<br />
in 2013 to launch the 36 MILLION MIGRAINE CAMPAIGN, a national public<br />
mobilization and education campaign to increase our nation’s research investment in<br />
migraine and raise public visibility for this enormously disabling disorder that affects<br />
more than 36 million Americans.<br />
Join us and make the difference<br />
us and make the difference<br />
Join us and make the difference<br />
To learn more, visit us at www.American<strong>Migraine</strong>Foundation.org<br />
How medications<br />
can help<br />
Great news: Your chances of getting life-changing<br />
relief from migraines are better than ever, thanks to<br />
a growing number of treatment options, including<br />
proven ways to prevent migraines, according to the latest<br />
guidelines from the American Acade<strong>my</strong> of Neurology.<br />
preventive<br />
acute<br />
Preventive therapies calm your hypersensitive nervous<br />
system so you experience fewer flare-ups. When<br />
a migraine does occur, it is usually less intense. Of<br />
course, during an episode, you can still turn to acute<br />
medications to help ease the pain quickly. Ask your<br />
healthcare provider about the medications in the chart<br />
below to find the right approach for you.<br />
Medication How it is given How it works<br />
Antiepileptic (divalproex sodium,<br />
sodium valproate, topiramate)<br />
Antidepressant<br />
(amitriptyline, venlafaxine)<br />
Beta-blocker<br />
(metoprolol, propranolol, timolol)<br />
Nonsteroidal anti-inflammatory<br />
drug (NSAID) (fenoprofen,<br />
ibuprofen, ketoprofen, naproxen)<br />
Onabotulinum toxin A<br />
(a purified organic product;<br />
for <strong>Chronic</strong> <strong>Migraine</strong> only)<br />
Triptan<br />
(frovatriptan for short-term<br />
prevention of menstrual migraines)<br />
Antinausea (metoclopramide,<br />
prochlorperazine)<br />
Dihydroergotamine<br />
(DHE)<br />
Nonsteroidal anti-inflammatory<br />
drug (NSAID) (acetaminophen,<br />
diclofenac, ibuprofen, naproxen)<br />
Triptan/NSAID combination<br />
(sumatriptan and naproxen sodium)<br />
Triptan (almotriptan, frovatriptan,<br />
naratriptan, sumatriptan)<br />
Pill or syrup<br />
Pill<br />
Pill or injection<br />
Pill, oral solution,<br />
injection<br />
Injection<br />
(in a few locations)<br />
Injection, nasal spray,<br />
pill<br />
Pill, liquid,<br />
suppository<br />
Injection or nasal spray<br />
Pill, oral solution,<br />
injection<br />
Pill<br />
Injection, nasal spray, pill<br />
Stabilizes nerve cells in the brain, making<br />
them less easily activated<br />
Boosts levels of the brain chemical serotonin,<br />
which helps calm the nervous system<br />
Blocks the release of stress hormones like adrenaline<br />
and epinephrine, which can trigger migraines<br />
Relieves inflammation and pain. These<br />
medications are often prescribed on a short-term<br />
basis to women with menstrual migraines and<br />
patients who are suffering from other types of<br />
pain, such as back and/or neck<br />
Quiets hyperactive nerve cells; blocks muscle<br />
contractions in the head, neck and face; and blocks<br />
the release of inflammatory chemicals associated<br />
with migraine pain<br />
Prevents nerves on the surface of the brain<br />
from transmitting pain signals, reduces<br />
inflammation and shrinks swollen blood vessels<br />
Relieves nausea and migraine pain<br />
Blocks pain, reduces inflammation and<br />
shrinks swollen blood vessels<br />
Relieves inflammation and pain<br />
you & your care team<br />
Relieves inflammation, blocks pain and shrinks<br />
swollen blood vessels<br />
Prevents nerves on the surface of the brain<br />
from transmitting pain signals, reduces<br />
inflammation and shrinks swollen blood vessels<br />
HealthMonitor 9
eal inspiration<br />
“I’m conquering<br />
<strong>Chronic</strong> <strong>Migraine</strong>!<strong>”</strong><br />
When faced with a seemingly insurmountable problem—say,<br />
managing <strong>Chronic</strong> <strong>Migraine</strong> in the middle of a war zone—<br />
former CNN journalist Yasmina Ykelenstam knows she has<br />
what it takes to prevail. by Lindsay Bosslett<br />
there is no ‘can’t’ in <strong>my</strong><br />
vocabulary,<strong>”</strong> says Yasmina<br />
Ykelenstam, currently<br />
Yasmina covering a<br />
on one of her nowfrequent<br />
lengthy trips abroad. “Be it<br />
story in downtown<br />
Beirut in 2008.<br />
chartering private helicopters to airlift<br />
equipment, bribing ship captains to<br />
stow us away or finagling team visas to Libya on two<br />
hours’ notice during the Gaddafi years—I’ve done it all.<strong>”</strong><br />
However, her can-do attitude doesn’t mean finding<br />
her path to migraine relief was easy.<br />
“When they were at their worst I found <strong>my</strong>self<br />
banging <strong>my</strong> head against a wall to try and alleviate<br />
the incredible pain,<strong>”</strong> she remembers.<br />
“I explored all <strong>my</strong> options<strong>”</strong><br />
Yasmina was first diagnosed with migraines by “Dr.<br />
Mom,<strong>”</strong> and a headache specialist confirmed it. Then<br />
began the journey to find relief.<br />
“I have tried every migraine medication on the<br />
market: prescription NSAIDs, acetaminophen,<br />
triptans, biofeedback therapy, homeopathic remedies,<br />
meditation, stress reduction, physiotherapy—you<br />
name it.<strong>”</strong> Some would work only for a short time,<br />
some had terrible side effects and none could seem to<br />
really slow down the migraine onslaught.<br />
“The migraines progressed over time. They were<br />
daily at times, or lasted for weeks, in some cases<br />
months,<strong>”</strong> she says. “Eventually <strong>my</strong> doctor told me I didn’t<br />
just have migraines—I had <strong>Chronic</strong> <strong>Migraine</strong> [defined<br />
by 15 or more migraine days a month, each lasting four<br />
hours or more]. You truly haven’t experienced hell until<br />
you’ve had a migraine last for six months. It felt like I<br />
was never not in pain.<strong>”</strong><br />
The migraines became so bad, eventually Yasmina<br />
was afraid to leave her house—let alone travel the<br />
globe to cover news stories. “I was scared in case I<br />
began a migraine and wasn’t able to make it home to<br />
somewhere dark,<strong>”</strong> she says. “And there’s little worse in<br />
life than bouncing around in a Humvee or a military<br />
helicopter while flying though hostile territory in war<br />
zones in that kind of condition.<strong>”</strong><br />
“My answer was out there!<strong>”</strong><br />
Yasmina eventually left her job at CNN to concentrate<br />
on her health. After finding a headache specialist she<br />
could really connect with, she told him how many<br />
treatments she had tried and failed to find relief with. He<br />
convinced her to try an injectable medication that would<br />
prevent her head pain. “It worked! I was so happy,<strong>”</strong> she<br />
says. But as a journalist, Yasmina still felt she needed to<br />
investigate the cause of her migraines.<br />
Yasmina decided to try to see if anything she ate<br />
sparked a migraine. She wrote down any offender foods<br />
and shared the list with her doctor, who finally gave her<br />
an answer: Yasmina had a histamine intolerance.<br />
Histamine is produced by the immune system in<br />
response to foreign invaders entering the body. But in<br />
Yasmina, her histamine response was being triggered<br />
by different foods and cosmetics, causing constant<br />
body-wide inflammation and <strong>Chronic</strong> <strong>Migraine</strong>.<br />
“Now I had a treatment and I knew <strong>my</strong> trigger,<strong>”</strong> she<br />
says. “Thanks to that, for the first time in <strong>my</strong> life I was<br />
finally free of migraines—I couldn’t believe it!<strong>”</strong><br />
Now Yasmina devotes her time to educating others<br />
with migraines to pursue treatment and learn their<br />
triggers. She’s even started her own food blog—<br />
thelowhistaminechef.com—where she features low<br />
,<br />
10 Guide to Living Well with <strong>Migraine</strong> Headaches<br />
HealthMonitor 11
eal inspiration<br />
histamine–reactive recipes and other products.<br />
“I have more than 60,000 readers monthly, so I know<br />
I’m really reaching people,<strong>”</strong> Yasmina says. “I’m just glad<br />
I can help others like I was to finally find relief!<strong>”</strong><br />
Here are some other ways Yasmina learned to control<br />
her <strong>Chronic</strong> <strong>Migraine</strong>—maybe they can work for you!<br />
Give new treatments a fair shake. “Follow what your<br />
doctor says and don’t give up [on a new treatment] if<br />
it doesn’t work right away,<strong>”</strong> Yasmina says, adding that<br />
with treatments like the injections and even dietary<br />
changes, it can take weeks to see relief.<br />
Keep a food journal! “Start a food diary right away!<strong>”</strong><br />
Yasmina emphasizes. “Write down a list of all potential<br />
triggers, then cross them off once you encounter them<br />
and don’t get a migraine.<strong>”</strong> Yasmina used her food diary<br />
to learn she had to eliminate fermented foods, smoked<br />
meats and fish, most alcohols, most vinegars and any<br />
packaged foods with dye and preservatives.<br />
Stay upbeat! “My positive outlook remained because<br />
I knew one day, if I kept trying, I’d take control,<strong>”</strong><br />
Yasmina says. “You have to have faith in yourself, and<br />
don’t feel guilty or like you failed if you need to take<br />
medication.<strong>”</strong><br />
Find others who understand. “Sharing what I have<br />
learned on <strong>my</strong> blog has inspired readers to share<br />
their own stories of recovery with me,<strong>”</strong> Yasmina says.<br />
“Above all, I’m thankful for that and finding this<br />
community of people. We all can help each other, and<br />
there’s no better motivator than helping others.<strong>”</strong><br />
Are you a candidate for<br />
preventive therapies?<br />
It’s possible to short-circuit migraines<br />
before they start with preventive therapies.<br />
These medications are designed to reduce<br />
the frequency and severity of attacks. You<br />
might benefit if you fall into any of the<br />
following categories:<br />
• You aren’t getting relief from acute<br />
medications or you can’t tolerate them.<br />
• Your migraines strike more than once a week<br />
or you need to take headache-relieving<br />
meds more than a few times per week.<br />
• You’re getting complicated forms of<br />
migraine (with aura).<br />
• Your migraines are interfering with your<br />
daily routine.<br />
IMPORTANT SAFETY INFORMATION (Continued)<br />
Do not take BOTOX ® (onabotulinumtoxinA) if you:<br />
are allergic to any of the ingredients in BOTOX ® (see<br />
Medication Guide for ingredients); had an allergic reaction<br />
to any other botulinum toxin product such as Myobloc ®<br />
(rimabotulinumtoxinB), Dysport ® (abobotulinumtoxinA), or<br />
Xeomin ® (incobotulinumtoxinA); have a skin infection at the<br />
planned injection site.<br />
The dose of BOTOX ® is not the same as, or comparable to,<br />
another botulinum toxin product.<br />
Serious and/or immediate allergic reactions have been<br />
reported. These reactions include itching, rash, red itchy<br />
welts, wheezing, asthma symptoms, or dizziness or feeling<br />
faint. Tell your doctor or get medical help right away if you<br />
experience any such symptoms; further injection of BOTOX ®<br />
should be discontinued.<br />
Tell your doctor about all your muscle or nerve conditions<br />
such as a<strong>my</strong>otrophic lateral sclerosis (ALS or Lou Gehrig’s<br />
disease), <strong>my</strong>asthenia gravis, or Lambert-Eaton syndrome,<br />
as you may be at increased risk of serious side effects<br />
including severe dysphagia (difficulty swallowing) and<br />
respiratory compromise (difficulty breathing) from typical<br />
doses of BOTOX ® .<br />
Tell your doctor about all your medical conditions,<br />
including if you: have or have had bleeding problems; have<br />
plans to have surgery; had surgery on your face; weakness<br />
of forehead muscles, such as trouble raising your eyebrows;<br />
drooping eyelids; any other abnormal facial change; are<br />
pregnant or plan to become pregnant (it is not known if<br />
BOTOX ® can harm your unborn baby); are breastfeeding or<br />
plan to breastfeed (it is not known if BOTOX ® passes into<br />
breast milk).<br />
Tell your doctor about all the medicines you take, including<br />
prescription and non-prescription medicines, vitamins, and<br />
herbal products. Using BOTOX ® with certain other<br />
medicines may cause serious side effects. Do not start any<br />
new medicines until you have told your doctor that you<br />
have received BOTOX ® in the past.<br />
Especially tell your doctor if you: have received any other<br />
botulinum toxin product in the last 4 months; have received<br />
injections of botulinum toxin such as Myobloc ® , Dysport ® ,<br />
or Xeomin ® in the past (be sure your doctor knows exactly<br />
which product you received); have recently received an<br />
antibiotic by injection; take muscle relaxants; take an allergy<br />
or cold medicine; take a sleep medicine; take anti-platelets<br />
(aspirin-like products) or anti-coagulants (blood thinners).<br />
Other side effects of BOTOX ® include: dry mouth, discomfort<br />
or pain at the injection site, tiredness, headache, neck pain,<br />
and eye problems: double vision, blurred vision, decreased<br />
eyesight, drooping eyelids, swelling of your eyelids, and<br />
dry eyes.<br />
For more information refer to the Medication Guide or talk<br />
with your doctor.<br />
You are encouraged to report negative side effects of<br />
prescription drugs to the FDA. Visit www.fda.gov/medwatch or<br />
call 1-800-FDA-1088.<br />
Please refer to full Medication Guide including Boxed<br />
Warning on the following pages.<br />
For adults with <strong>Chronic</strong> <strong>Migraine</strong>,<br />
15 or more headache days a month,<br />
each lasting 4 hours or more,<br />
BOTOX ® is the first and only preventive treatment<br />
proven to reduce headache days every month.<br />
BOTOX ® is the only FDA-approved, preventive treatment that is<br />
injected by a doctor every 3 months for people with <strong>Chronic</strong> <strong>Migraine</strong>.<br />
BOTOX ® prevents up to 9 headache days a month, versus up to 7 days<br />
for placebo. BOTOX ® is not approved for adults with migraine who<br />
have 14 or fewer headache days a month.<br />
IMPORTANT SAFETY INFORMATION<br />
BOTOX ® may cause serious side effects that can be life<br />
threatening. Call your doctor or get medical help right away if<br />
you have any of these problems any time (hours to weeks) after<br />
injection of BOTOX ® :<br />
• Problems swallowing, speaking, or breathing, due to weakening<br />
of associated muscles, can be severe and result in loss of life. You<br />
are at the highest risk if these problems are pre-existing before<br />
injection. Swallowing problems may last for several months.<br />
FOR ADULTS WITH<br />
CHRONIC MIGRAINE<br />
injection<br />
Find a headache specialist near you at<br />
Botox<strong>Chronic</strong><strong>Migraine</strong>.com<br />
BOTOX ® is a prescription medicine that is injected to prevent headaches in adults with <strong>Chronic</strong> <strong>Migraine</strong> who have 15 or more days<br />
each month with headache lasting 4 or more hours each day in people 18 years or older. It is not known whether BOTOX ® is safe<br />
or effective to prevent headaches in patients with migraine who have 14 or fewer headache days each month (episodic migraine).<br />
• Spread of toxin effects. The effect of botulinum toxin may affect<br />
areas away from the injection site and cause serious symptoms<br />
including: loss of strength and all-over muscle weakness, double<br />
vision, blurred vision and drooping eyelids, hoarseness or change<br />
or loss of voice (dysphonia), trouble saying words clearly<br />
(dysarthria), loss of bladder control, trouble breathing, trouble<br />
swallowing. If this happens, do not drive a car, operate<br />
machinery, or do other dangerous activities.<br />
There has not been a confirmed serious case of spread of toxin<br />
effect away from the injection site when BOTOX ® has been used at<br />
the recommended dose to treat <strong>Chronic</strong> <strong>Migraine</strong>.<br />
Please see additional Important Safety Information on adjacent page.<br />
12 Guide to Living Well with <strong>Migraine</strong> Headaches<br />
injection<br />
© 2014 Allergan, Inc., Irvine, CA 92612. ® marks owned by Allergan, Inc. Dysport is a registered trademark of Ipsen Biopharm Limited Company.<br />
Myobloc is a registered trademark of Solstice Neurosciences, Inc. Xeomin is a registered trademark of Merz Pharma GmbH & Co KGaA. APC43DI14
MEDICATION GUIDE<br />
BOTOX ®<br />
BOTOX ® Cosmetic<br />
(Boe-tox)<br />
(onabotulinumtoxinA)<br />
for Injection<br />
Read the Medication Guide that comes<br />
with BOTOX or BOTOX Cosmetic before<br />
you start using it and each time it is given<br />
to you. There may be new information.<br />
This information does not take the place of<br />
talking with your doctor about your medical<br />
condition or your treatment. You should<br />
share this information with your family<br />
members and caregivers.<br />
What is the most important information<br />
I should know about BOTOX and<br />
BOTOX Cosmetic?<br />
BOTOX and BOTOX Cosmetic may cause<br />
serious side effects that can be life<br />
threatening, including:<br />
• Problems breathing or swallowing<br />
• Spread of toxin effects<br />
These problems can happen hours, days,<br />
to weeks after an injection of BOTOX or<br />
BOTOX Cosmetic. Call your doctor or get<br />
medical help right away if you have any of<br />
these problems after treatment with BOTOX<br />
or BOTOX Cosmetic:<br />
1. Problems swallowing, speaking, or<br />
breathing. These problems can happen<br />
hours, days, to weeks after an injection of<br />
BOTOX or BOTOX Cosmetic usually because<br />
the muscles that you use to breathe and<br />
swallow can become weak after the injection.<br />
Death can happen as a complication if you<br />
have severe problems with swallowing or<br />
breathing after treatment with BOTOX or<br />
BOTOX Cosmetic.<br />
• People with certain breathing problems may<br />
need to use muscles in their neck to help<br />
them breathe. These people may be at greater<br />
risk for serious breathing problems with<br />
BOTOX or BOTOX Cosmetic.<br />
• Swallowing problems may last for several<br />
months. People who cannot swallow well<br />
may need a feeding tube to receive food and<br />
water. If swallowing problems are severe,<br />
food or liquids may go into your lungs.<br />
People who already have swallowing or<br />
breathing problems before receiving BOTOX<br />
or BOTOX Cosmetic have the highest risk of<br />
getting these problems.<br />
2. Spread of toxin effects. In some cases,<br />
the effect of botulinum toxin may affect areas<br />
of the body away from the injection site and<br />
cause symptoms of a serious condition called<br />
botulism. The symptoms of botulism include:<br />
• loss of strength and muscle weakness<br />
all over the body<br />
• double vision<br />
• blurred vision and drooping eyelids<br />
• hoarseness or change or loss of voice<br />
(dysphonia)<br />
• trouble saying words clearly (dysarthria)<br />
• loss of bladder control<br />
• trouble breathing<br />
• trouble swallowing<br />
These symptoms can happen hours, days, to<br />
weeks after you receive an injection of BOTOX<br />
or BOTOX Cosmetic.<br />
These problems could make it unsafe for you<br />
to drive a car or do other dangerous activities.<br />
See “What should I avoid while receiving<br />
BOTOX or BOTOX Cosmetic?<strong>”</strong><br />
There has not been a confirmed serious case<br />
of spread of toxin effect away from<br />
the injection site when BOTOX has been<br />
used at the recommended dose to treat<br />
chronic migraine, severe underarm sweating,<br />
blepharospasm, or strabismus, or when<br />
BOTOX Cosmetic has been used at the<br />
recommended dose to treat frown lines and/<br />
or crow’s feet lines.<br />
What are BOTOX and BOTOX Cosmetic?<br />
BOTOX is a prescription medicine that is<br />
injected into muscles and used:<br />
• to treat overactive bladder symptoms such<br />
as a strong need to urinate with leaking or<br />
wetting accidents (urge urinary incontinence),<br />
a strong need to urinate right away<br />
(urgency), and urinating often (frequency)<br />
in adults when another type of medicine<br />
(anticholinergic) does not work well enough<br />
or cannot be taken.<br />
• to treat leakage of urine (incontinence)<br />
in adults with overactive bladder due to<br />
neurologic disease when another type of<br />
medicine (anticholinergic) does not work well<br />
enough or cannot be taken.<br />
• to prevent headaches in adults with chronic<br />
migraine who have 15 or more days each<br />
month with headache lasting 4 or more hours<br />
each day.<br />
• to treat increased muscle stiffness in elbow,<br />
wrist, and finger muscles in adults with upper<br />
limb spasticity.<br />
• to treat the abnormal head position and<br />
neck pain that happens with cervical dystonia<br />
(CD) in adults.<br />
• to treat certain types of eye muscle<br />
problems (strabismus) or abnormal<br />
spasm of the eyelids (blepharospasm)<br />
in people 12 years and older.<br />
BOTOX is also injected into the skin to treat<br />
the symptoms of severe underarm sweating<br />
(severe primary axillary hyperhidrosis) when<br />
medicines used on the skin (topical) do not<br />
work well enough.<br />
BOTOX Cosmetic is a prescription medicine<br />
that is injected into muscles and used to<br />
improve the look of moderate to severe<br />
frown lines between the eyebrows (glabellar<br />
lines) in adults for a short period of time<br />
(temporary).<br />
BOTOX Cosmetic is a prescription medicine<br />
that is injected into the area around the side<br />
of the eyes to improve the look of crow’s<br />
feet lines in adults for a short period of time<br />
(temporary).<br />
You may receive treatment for frown lines and<br />
crow’s feet lines at the same time.<br />
It is not known whether BOTOX is safe or<br />
effective in people younger than:<br />
• 18 years of age for treatment of urinary<br />
incontinence<br />
• 18 years of age for treatment of chronic<br />
migraine<br />
• 18 years of age for treatment of spasticity<br />
• 16 years of age for treatment of cervical<br />
dystonia<br />
• 18 years of age for treatment of<br />
hyperhidrosis<br />
• 12 years of age for treatment of strabismus<br />
or blepharospasm<br />
BOTOX Cosmetic is not recommended for<br />
use in children younger than 18 years of age.<br />
It is not known whether BOTOX and<br />
BOTOX Cosmetic are safe or effective to<br />
prevent headaches in people with migraine<br />
who have 14 or fewer headache days each<br />
month (episodic migraine).<br />
It is not known whether BOTOX and<br />
BOTOX Cosmetic are safe or effective for<br />
other types of muscle spasms or for severe<br />
sweating anywhere other than your armpits.<br />
Who should not take BOTOX or<br />
BOTOX Cosmetic?<br />
Do not take BOTOX or BOTOX Cosmetic<br />
if you:<br />
• are allergic to any of the ingredients in<br />
BOTOX or BOTOX Cosmetic. See the end of<br />
this Medication Guide for a list of ingredients<br />
in BOTOX and BOTOX Cosmetic.<br />
• had an allergic reaction to any other<br />
botulinum toxin product such as Myobloc ® ,<br />
Dysport ® , or Xeomin ®<br />
• have a skin infection at the planned injection<br />
site<br />
• are being treated for urinary incontinence<br />
and have a urinary tract infection (UTI)<br />
• are being treated for urinary incontinence<br />
and find that you cannot empty your bladder<br />
on your own (only applies to people who are<br />
not routinely catheterizing)<br />
What should I tell <strong>my</strong> doctor before taking<br />
BOTOX or BOTOX Cosmetic?<br />
Tell your doctor about all your medical<br />
conditions, including if you:<br />
• have a disease that affects your muscles and<br />
nerves (such as a<strong>my</strong>otrophic lateral sclerosis<br />
[ALS or Lou Gehrig’s disease], <strong>my</strong>asthenia<br />
gravis or Lambert-Eaton syndrome). See<br />
“What is the most important information I<br />
should know about BOTOX and<br />
BOTOX Cosmetic?<strong>”</strong><br />
• have allergies to any botulinum toxin<br />
product<br />
• had any side effect from any botulinum<br />
toxin product in the past<br />
• have or have had a breathing problem,<br />
such as asthma or emphysema<br />
• have or have had swallowing problems<br />
• have or have had bleeding problems<br />
• have plans to have surgery<br />
• had surgery on your face<br />
• have weakness of your forehead<br />
muscles, such as trouble raising your<br />
eyebrows<br />
• have drooping eyelids<br />
• have any other change in the way your<br />
face normally looks<br />
• have symptoms of a urinary tract<br />
infection (UTI) and are being treated for<br />
urinary incontinence. Symptoms of a<br />
urinary tract infection may include pain or<br />
burning with urination, frequent urination,<br />
or fever.<br />
• have problems emptying your bladder<br />
on your own and are being treated for<br />
urinary incontinence<br />
• are pregnant or plan to become<br />
pregnant. It is not known if BOTOX or<br />
BOTOX Cosmetic can harm your unborn<br />
baby.<br />
• are breast-feeding or plan to breastfeed.<br />
It is not known if BOTOX or BOTOX<br />
Cosmetic passes into breast milk.<br />
Tell your doctor about all the medicines<br />
you take, including prescription and<br />
nonprescription medicines, vitamins<br />
and herbal products. Using BOTOX or<br />
BOTOX Cosmetic with certain other<br />
medicines may cause serious side effects.<br />
Do not start any new medicines until<br />
you have told your doctor that you have<br />
received BOTOX or BOTOX Cosmetic in<br />
the past.<br />
Especially tell your doctor if you:<br />
• have received any other botulinum toxin<br />
product in the last four months<br />
• have received injections of<br />
botulinum toxin, such as Myobloc ®<br />
(rimabotulinumtoxinB), Dysport ®<br />
(abobotulinumtoxinA), or Xeomin ®<br />
(incobotulinumtoxinA) in the past. Be sure<br />
your doctor knows exactly which product<br />
you received.<br />
• have recently received an antibiotic by<br />
injection<br />
• take muscle relaxants<br />
• take an allergy or cold medicine<br />
• take a sleep medicine<br />
• take anti-platelets (aspirin-like products)<br />
and/or anti-coagulants (blood thinners)<br />
Ask your doctor if you are not sure if your<br />
medicine is one that is listed above.<br />
Know the medicines you take. Keep a list<br />
of your medicines with you to show your<br />
doctor and pharmacist each time you get<br />
a new medicine.<br />
How should I take BOTOX or<br />
BOTOX Cosmetic?<br />
• BOTOX or BOTOX Cosmetic is an<br />
injection that your doctor will give you.<br />
• BOTOX is injected into your affected<br />
muscles, skin, or bladder.<br />
• BOTOX Cosmetic is injected into your<br />
affected muscles.<br />
• Your doctor may change your dose of<br />
BOTOX or BOTOX Cosmetic, until you and<br />
your doctor find the best dose for you.<br />
• Your doctor will tell you how often<br />
you will receive your dose of BOTOX<br />
or BOTOX Cosmetic injections.<br />
What should I avoid while taking BOTOX<br />
or BOTOX Cosmetic?<br />
BOTOX and BOTOX Cosmetic may<br />
cause loss of strength or general muscle<br />
weakness, or vision problems within<br />
hours to weeks of taking BOTOX or<br />
BOTOX Cosmetic. If this happens, do not<br />
drive a car, operate machinery, or<br />
do other dangerous activities. See<br />
“What is the most important information<br />
I should know about BOTOX and<br />
BOTOX Cosmetic?<strong>”</strong><br />
What are the possible side effects of<br />
BOTOX and BOTOX Cosmetic?<br />
BOTOX and BOTOX Cosmetic can cause<br />
serious side effects. See “What is the<br />
most important information I should know<br />
about BOTOX and BOTOX Cosmetic?<strong>”</strong><br />
Other side effects of BOTOX and BOTOX<br />
Cosmetic include:<br />
• dry mouth<br />
• discomfort or pain at the injection site<br />
• tiredness<br />
• headache<br />
• neck pain<br />
• eye problems: double vision, blurred<br />
vision, decreased eyesight, drooping<br />
eyelids, swelling of your eyelids, and dry<br />
eyes.<br />
• urinary tract infection in people being<br />
treated for urinary incontinence<br />
• painful urination in people being treated<br />
for urinary incontinence<br />
• inability to empty your bladder on your<br />
own and are being treated for urinary<br />
incontinence. If you have difficulty fully<br />
emptying your bladder after getting<br />
BOTOX, you may need to use disposable<br />
self-catheters to empty your bladder up to<br />
a few times each day until your bladder is<br />
able to start emptying again.<br />
• allergic reactions. Symptoms of an<br />
allergic reaction to BOTOX or BOTOX<br />
Cosmetic may include: itching, rash, red<br />
itchy welts, wheezing, asthma symptoms,<br />
or dizziness or feeling faint. Tell your<br />
doctor or get medical help right away<br />
if you are wheezing or have asthma<br />
symptoms, or if you become dizzy or faint.<br />
Tell your doctor if you have any side effect<br />
that bothers you or that does not go away.<br />
These are not all the possible side effects<br />
of BOTOX and BOTOX Cosmetic. For<br />
more information, ask your doctor or<br />
pharmacist.<br />
Call your doctor for medical advice about<br />
side effects. You may report side effects to<br />
FDA at 1-800-FDA-1088.<br />
General information about BOTOX and<br />
BOTOX Cosmetic:<br />
Medicines are sometimes prescribed<br />
for purposes other than those listed in a<br />
Medication Guide.<br />
This Medication Guide summarizes the<br />
most important information about BOTOX<br />
and BOTOX Cosmetic. If you would like<br />
more information, talk with your doctor.<br />
You can ask your doctor or pharmacist<br />
for information about BOTOX and BOTOX<br />
Cosmetic that is written for healthcare<br />
professionals.<br />
What are the ingredients in BOTOX and<br />
BOTOX Cosmetic?<br />
Active ingredient: botulinum toxin type A<br />
Inactive ingredients: human albumin and<br />
sodium chloride<br />
Revised: 08/2015<br />
This Medication Guide has been approved<br />
by the U.S. Food and Drug Administration.<br />
Manufactured by: Allergan<br />
Pharmaceuticals Ireland a subsidiary of:<br />
Allergan, Inc.<br />
2525 Dupont Dr.<br />
Irvine, CA 92612<br />
© 2015 Allergan, Inc. All rights reserved.<br />
®<br />
marks owned by Allergan, Inc.<br />
Patented. See: www.allergan.com/<br />
products/patent_notices<br />
Myobloc ® is a registered trademark of<br />
Solstice Neurosciences, Inc.<br />
Dysport ® is a registered trademark of Ipsen<br />
Biopharm Limited Company.<br />
Xeomin ® is a registered trademark of Merz<br />
Pharma GmbH & Co KGaA.<br />
®<br />
Based on 72511US14<br />
APC25LG15
eal inspiration<br />
“What I’ve learned<br />
about migraine<strong>”</strong><br />
Fight back!<br />
“<strong>Migraine</strong>s are the worst! … [I tell<br />
<strong>my</strong> migraine] ‘We are about to go<br />
to blows! #IWin’<strong>”</strong><br />
—Tweeted by reality star Khloé<br />
Kardashian, who eventually<br />
learned her migraines were<br />
triggered by stress.<br />
Treat quickly!<br />
“[When a migraine is about<br />
to strike] I’m nauseated…I get<br />
this light disruption thing.<strong>”</strong><br />
—Comedian and actor Russell<br />
Brand, who was interrupted<br />
in the middle of a standup<br />
routine by signs of a migraine,<br />
but was able to continue<br />
after taking medication.<br />
Enlist friends!<br />
“[<strong>Migraine</strong>s] once made me pass<br />
out on stage. Fortunately, the<br />
boys in <strong>my</strong> band have learned to<br />
tell when it’s coming. They just<br />
take me by the elbow and help<br />
me sit until it passes.<strong>”</strong><br />
—Loretta Lynn, as written in her<br />
memoir Coal Miner’s Daughter.<br />
Get back in<br />
the game!<br />
“Once I decided to seek<br />
professional help for <strong>my</strong><br />
migraine attacks, I learned<br />
that there are effective<br />
treatments that enable me<br />
to ‘get back in the game,’<br />
and I now want to help other<br />
sufferers do the same.<strong>”</strong><br />
—Terrell Davis, player for the<br />
NFL’s Denver Broncos
eal inspiration<br />
“ How I took control<br />
of <strong>my</strong> migraines...<strong>”</strong><br />
These five patients feared they’d never find relief from their<br />
debilitating headaches. Today, they’re working closely with<br />
their healthcare providers and thriving. Here are their tips for<br />
taking back control from migraine. by Lindsay Bosslett<br />
“Managing migraines isn’t about finding one big<br />
answer—it’s a bunch of tiny pieces,<strong>”</strong> says Kate.<br />
“But as long as you keep communicating with<br />
your care team, you won’t have to feel lost.<strong>”</strong><br />
Be patient.<br />
“It is going to take time to find<br />
what works for you,<strong>”</strong> says Kate<br />
McCombs, 30, from New York<br />
City. “Managing migraines isn’t<br />
about finding one big answer—it’s a<br />
bunch of tiny pieces. You may have<br />
many triggers and may have to find<br />
many different ways to avoid them.<br />
You may need more than one<br />
medication or to switch meds at<br />
one point like I did. You may need<br />
to visit more than one doctor. But<br />
as long as you keep trying and keep<br />
finding a way to communicate, you<br />
won’t have to feel lost.<strong>”</strong><br />
Become nutritional<br />
label savvy.<br />
“Once I learned I was allergic to MSG<br />
[monosodium glutamate] and that<br />
it was likely triggering migraines for<br />
me, I was able to cut it out of <strong>my</strong> diet,<strong>”</strong><br />
says Lisa Rosen, 47, Little Falls, NJ,<br />
who has had migraines since her early<br />
teens. “But sometimes it was in food<br />
and I didn’t even know.<strong>”</strong> Food labels<br />
can have some sneaky names for<br />
MSG on labels. If it’s a trigger for you,<br />
avoid anything with the following<br />
listed in its ingredients: the words<br />
Are you doing<br />
all you can to …<br />
PREVENT MIGRAINES?<br />
Today’s treatments can help<br />
fend off migraines—in fact, up<br />
to 40% of migraine sufferers<br />
can benefit from preventive<br />
treatment, studies show. Ask if<br />
you are a candidate.<br />
nip THEM IN THE BUD?<br />
Preventive treatment not right<br />
for you? Then try to identify<br />
your body’s earliest warning<br />
signs of migraine—the sooner<br />
you take an acute medication,<br />
the better it can work to halt<br />
or lessen symptoms.<br />
“Once I discovered MSG was causing <strong>my</strong> migraines I was finally able to cut it<br />
out of <strong>my</strong> diet,<strong>”</strong> Lisa says. “I realized sometimes it hides under different names,<br />
too. But I learned what to avoid, and now I rarely get migraines at all!<strong>”</strong><br />
glutamic or glutamate; textured or<br />
hydrolyzed proteins; yeast extract;<br />
anything labeled as protein-fortified,<br />
ultra-pasteurized, fermented or<br />
enzyme-modified; ajinomoto.<br />
Make sleep<br />
a priority.<br />
“I noticed that I tended to get<br />
migraines on Tuesdays and<br />
Saturdays,<strong>”</strong> says Andrea Stephenson,<br />
46, from Solon, OH, who started<br />
getting migraines six years ago. “I<br />
realized that Tuesdays were after two<br />
nights of going to bed late and getting<br />
up early, and on Saturdays I tended<br />
to sleep in to make up for what I lost<br />
during the week. When I started<br />
getting seven to eight hours sleep<br />
regularly, that helped a lot.<strong>”</strong><br />
Learn your triggers.<br />
“We all have different triggers for<br />
migraines, so just avoiding the<br />
things commonly listed may not<br />
work for you,<strong>”</strong> says Sarah Farver,<br />
48, from Fort Worth, TX, whose<br />
migraines became chronic while<br />
she was in college. “I make sure<br />
to write down when something<br />
uncommon—like lifting a 50-lb.<br />
bag of dog food—triggers one for<br />
me. If I know them, I can avoid<br />
them. Or at least be prepared to<br />
treat very early if I know I’ll be<br />
forced to encounter one.<strong>”</strong><br />
Plan ahead.<br />
“Planning ahead can help avoid<br />
unpleasant surprises and scheduling<br />
messes that trigger migraines,<strong>”</strong><br />
says life-long migraine sufferer<br />
Teri Robert, 60, from Washington,<br />
WV, author of Living Well with<br />
<strong>Migraine</strong> Disease and Headaches<br />
and chairperson at the American<br />
Headache <strong>Migraine</strong> Association.<br />
“Make lists—the last thing you need<br />
is for a migraine to be coming on<br />
as you’re getting ready to travel and<br />
end up forgetting half of what you<br />
need.<strong>”</strong> Teri also recommends making<br />
a migraine kit and keeping it handy<br />
in the car or plane—see page 23 for<br />
what to include.<br />
18 Guide to Living Well with <strong>Migraine</strong> Headaches
eal inspiration<br />
“I know now I have to make sleep a priority,<strong>”</strong><br />
says Andrea. “Sticking to a regular schedule<br />
is essential.<strong>”</strong><br />
Develop your<br />
voice. Kate credits her ability to<br />
communicate clearly with helping her<br />
find relief for her migraines. “The fact<br />
that I can talk openly and honestly<br />
with <strong>my</strong> husband has been a key in<br />
our marriage while managing this<br />
condition,<strong>”</strong> she says. “It’s important<br />
for me to be able to ask <strong>my</strong> friends<br />
to accommodate <strong>my</strong> needs without<br />
alienating them, and to tell <strong>my</strong><br />
doctors what I’m going through<br />
and have them take me seriously.<br />
<strong>Migraine</strong>s are so individual—you<br />
have to be able to say what’s going on<br />
with you specifically. My voice has<br />
been <strong>my</strong> most important ally.<strong>”</strong><br />
Learn your<br />
symptoms. “My migraines<br />
often start with a dull ache in <strong>my</strong><br />
forehead that moves backward,<strong>”</strong><br />
Andrea says. “I often become irritable<br />
and sometimes smells and sounds will<br />
bother me. A sure sign is when I start<br />
20 Guide to Living Well with <strong>Migraine</strong> Headaches<br />
to feel nauseated. The key is taking<br />
<strong>my</strong> medication as soon as I notice<br />
these early symptoms—the earlier the<br />
better, and sometimes I can fend off a<br />
migraine all together.<strong>”</strong><br />
Choose happiness.<br />
“I think everyone has aspects of their<br />
lives that they have to deal with and<br />
work around,<strong>”</strong> Sarah says. “For me,<br />
migraines are just one of those things.<br />
But because of them, I chose to<br />
pursue a fabulous job where I can<br />
work from home now and spend<br />
more time with <strong>my</strong> kids. Happiness<br />
is a choice and choosing to be<br />
thankful for every breath we’re given<br />
is not something to take lightly.<strong>”</strong><br />
Give acupuncture<br />
a try. “My migraines have been<br />
much more rare ever since trying<br />
acupuncture a few years ago,<strong>”</strong> Lisa<br />
says. Acupuncture involves placing<br />
thin, painless needles in different<br />
parts of the body that are associated<br />
with acupoints. And a recent study<br />
published in the Archives of Internal<br />
Medicine did find acupuncture to be<br />
helpful in chronic pain conditions—<br />
just be sure to visit a certified<br />
practitioner; find one at nccaom.org.<br />
Be open to change.<br />
“My migraines started around when I<br />
hit puberty,<strong>”</strong> Kate says. “Because they<br />
were related to <strong>my</strong> menstrual cycle,<br />
they were pretty regular and easier<br />
to plan for. I was able to be treated<br />
by <strong>my</strong> regular doctor for years.<strong>”</strong> All<br />
that changed about a year ago, when<br />
without explanation the migraines<br />
began coming more frequently and<br />
lasting longer. “I knew I needed to try<br />
something different—even though<br />
<strong>my</strong> old treatments had worked for<br />
a long time. That’s when I went to<br />
see a neurologist. He prescribed<br />
an injectable medication, as well as<br />
something I can take daily. It’s<br />
made it so I can work again.<strong>”</strong><br />
Dump the guilt!<br />
“Always take care of yourself,<strong>”</strong> Teri<br />
emphasizes. “We all tend to try to<br />
adapt our schedules to fit with those<br />
of others. If it’s going to trigger a<br />
migraine, just don’t do it—and don’t<br />
feel guilty!<strong>”</strong><br />
“I choose happiness,<strong>”</strong><br />
Sarah says. “Everyone<br />
deals with something;<br />
at least migraines I<br />
can manage!<strong>”</strong><br />
QA &<br />
AM I HAVING CHRONIC MIGRAINE?<br />
I seem to have headaches all the time—I feel<br />
Q like I’m taking pain meds every day, and the pain<br />
never stops. Could I be having <strong>Chronic</strong> <strong>Migraine</strong>?<br />
A<br />
Possibly. You could have <strong>Chronic</strong> <strong>Migraine</strong> if<br />
you suffer 15 or more headaches a month, each<br />
lasting four hours or more. However, taking too many acute<br />
painkillers—medications used to treat the sudden onset of<br />
pain—can also have a rebound effect. Once the medication<br />
wears off, the headache will return. This can happen if you<br />
take more than the recommended dosage, or if you take<br />
the drug too often. Luckily, you don’t have to go off painkillers<br />
cold turkey. If frequent migraines see you turning<br />
to acute painkillers too often, ask your doctor if preventive<br />
medications might be an option for you.<br />
a world without headachE<br />
Our expert:<br />
Stephen D. Silberstein,<br />
MD—professor of neurology<br />
and director of the Jefferson<br />
Headache Center at Thomas Jefferson<br />
University in Philadelphia<br />
AURA—EXPLAINED!<br />
Q<br />
Why do I get aura before a migraine?<br />
Do they mean I get worse migraines than<br />
other people?<br />
A<br />
Auras—which are known to occur in only about<br />
20% of migraines—can include flashes of light,<br />
blind spots, wavy lines or tingling in your hands or face.<br />
Experts suspect the cause is an electrical or chemical<br />
wave that crosses the part of your brain that controls<br />
your sense of vision. In any case, experiencing an aura<br />
has no effect at all on the severity of your migraine. If<br />
anything, consider it a warning that gives you a chance<br />
to take action: Take your meds and find your way to a<br />
cool, dark, quiet place to help fend off or at least lessen<br />
the impact of the headache.<br />
(CAQ)<br />
The National Headache Foundation’s<br />
Certificate of Added Qualification<br />
1 2 3 4 5<br />
Establish Stimulate Serve enhance<br />
a credentialing body physicians’ interest in as an alternative or the ability of patients<br />
for physicians treating headache and its addition to board to identify those<br />
headache and thus management<br />
certification in<br />
physicians with<br />
facilitate patient care.<br />
headache medicine expertise and interest<br />
from the United in headache.<br />
Council of Subspecialties<br />
(UCNS) certification<br />
which requires a<br />
1-year fellowship in<br />
headache medicine<br />
at a qualified center.<br />
Recognize<br />
physicians with an<br />
advanced level of<br />
experience in headache<br />
management.<br />
For more information<br />
[ ]<br />
visit headaches.org/CAQ<br />
[ ]<br />
call (888) NHF-5552
feel your best<br />
<strong>Migraine</strong>-proof your home<br />
Just a few simple changes can turn your<br />
home into a fortress against migraines—and<br />
a refuge to rest in, in case one does strike!<br />
IN THE BEDROOM<br />
Go for thick curtains. Your bedroom can be the<br />
ideal migraine retreat. Thick or “black-out<strong>”</strong> curtains on the<br />
windows will help keep the room dark and cool, and can even<br />
help dampen outside sounds.<br />
Get an air purifier. Dust and dander can be a<br />
trigger for many. You can find free-standing air purifiers for as<br />
low as $40 in home-improvement and electronics stores. Be sure<br />
to change the filter in your furnace, as well, and have your vents<br />
and ducts professionally cleaned once every 3-5 years.<br />
Consider a humidifier or dehumidifier.<br />
Aim for a healthy 35% to 50% humidity inside at all times—that<br />
can mean using a humidifier in winter and a dehumidifier in<br />
summer. Bonus: Maintaining a normal humidity level has been<br />
shown to reduce your likelihood of getting sick!<br />
IN THE KITCHEN<br />
Stop drawers from slamming. When you’re in the midst of a migraine, any noise can<br />
cause a bolt of pain. Pick up little rubber drawer stoppers (or you can make your own by cutting up pencil<br />
erasers!) at a hardware store—they attach to the inside of drawers or cabinet doors and muffle the noise made<br />
when closing them.<br />
Take care with cleaning products. Scented products are a huge migraine trigger for<br />
some. Look for products labeled “perfume-free<strong>”</strong> or “fragrance-free,<strong>”</strong> and be wary of ones that say “all-natural,<strong>”</strong><br />
as these still might have scents that can cause problems. It’s also best to avoid scented detergents, body<br />
products, candles and air fresheners.<br />
Deactivate your fridge light. In the midst of a migraine, you’ll still need to eat and drink<br />
(it’s especially important to stay hydrated!). But the fridge light can exacerbate your migraine. Solution? Simply<br />
remove the bulb and keep a small flashlight nearby—the smaller light beam will help you find the food you<br />
need, and won’t be as problematic for your migraine.<br />
22 Guide to Living Well with <strong>Migraine</strong> Headaches<br />
Your migraine tool kit<br />
If you suffer from<br />
migraines, create<br />
a personalized<br />
migraine kit, which<br />
can come to your<br />
aid if a severe<br />
headache strikes<br />
unexpectedly.<br />
Here’s a list of<br />
what it could<br />
include:<br />
A cold<br />
compress or<br />
pack, which<br />
can help your<br />
throbbing head.<br />
THROUGHOUT<br />
Seal up windows and doors.<br />
A sudden shift in temperature—like you’d experience near<br />
a drafty window—can spark a migraine. Closing up drafts<br />
(either with caulk, insulation or draft guards) will not only<br />
keep the temperature in your house more steady, it will<br />
also help lower your heating and cooling bill.<br />
Change to these light bulbs... Lowwattage<br />
incandescent bulbs, which produce a warm, steady<br />
stream of light. Bright and/or flickering lights—such as<br />
from halogen or fluorescent bulbs—are more likely to<br />
trigger a migraine.<br />
Decorate with care. Paints and carpets that<br />
contain “volatile organic compounds<strong>”</strong> (VOCs) can trigger<br />
or worsen migraines. The compounds get released into the<br />
air over time, and can cause irritation and inflammation<br />
throughout your body. Look for paints that are VOC-free,<br />
such as Benjamin Moore Natura or Low & Zero, and<br />
carpet manufacturers rated as “Green Label<strong>”</strong> by The<br />
Carpet and Rug Institute at carpet-rug.org.<br />
An eye mask<br />
to shield your<br />
eyes from light.<br />
A bottle<br />
of water<br />
Dehydration<br />
can lead to<br />
headaches.<br />
You’ll also<br />
need water<br />
to take your<br />
migraine<br />
medication.<br />
A small<br />
pillow, which<br />
could come in<br />
handy for<br />
resting.<br />
Medication<br />
can treat a<br />
headache ASAP.
you & your care team<br />
9 questions<br />
Good communication is the key to<br />
effective treatment for your migraine.<br />
Get started by asking these questions.<br />
for your next exam<br />
1. Could <strong>my</strong> headache be a migraine?________________________________________________________________________<br />
2. Could I have <strong>Chronic</strong> <strong>Migraine</strong>?____________________________________________________________________________<br />
3. What’s the best way to identify <strong>my</strong> triggers?_________________________________________________________________<br />
4. What are <strong>my</strong> treatment options?___________________________________________________________________________<br />
5. Could I benefit from preventive therapies?__________________________________________________________________<br />
6. How long should I wait to assess if the preventive therapy is working to stop <strong>my</strong> headaches?______________________<br />
7. Should I expect any side effects from <strong>my</strong> treatment(s)? _______________________________________________________<br />
8. How can I tell when a migraine is coming on, and at what point should I start taking acute medication?____________<br />
________________________________________________________________________________________________________<br />
9. When should I come back to see you?_______________________________________________________________________<br />
Resources you need... Looking for more info on migraines? Hoping to connect<br />
with others who understand you? These organizations offer the answers you want and the support you need,<br />
and you can visit them all with a click by logging on to HealthMonitor.com/<strong>Migraine</strong>Resources<br />
This anonymous online health<br />
community is a safe, comforting<br />
place to join and meet others with migraine headaches like<br />
you.. You can share, learn and help others, while keeping your<br />
identity completely confidential. Join the conversation at<br />
HealthKeep.com and download the app in the iTunes Store.<br />
If you have <strong>Chronic</strong> <strong>Migraine</strong>,<br />
don’t live a maybe life. Visit<br />
My<strong>Chronic</strong><strong>Migraine</strong>.com to learn<br />
about treatment options, get inspired by real-life stories,<br />
track your headaches/migraines and find a Headache<br />
Specialist near you.<br />
The AHMA exists to E.A.S.E. the<br />
burden of <strong>Migraine</strong> and other Headache<br />
Disorders through Education, Awareness,<br />
Support, and Engagement.<br />
The National Headache Foundation<br />
enhances the health of those with<br />
migraine by providing educational and<br />
informational resources, supporting headache research<br />
and advocating for the understanding of headache as a<br />
legitimate neurobiological disease.<br />
The American <strong>Migraine</strong><br />
Foundation (AMF) supports<br />
innovative research and education that will lead to<br />
improvement in the lives of those who suffer from migraine<br />
and other related disorders.<br />
The American <strong>Chronic</strong> Pain<br />
Association (ACPA) facilitates<br />
peer support and education for people with chronic<br />
pain and their families so that they may live a fuller life.<br />
ACPA also raises awareness of issues associated with<br />
chronic pain.<br />
NATIONAL FIBROMYALGIA & CHRONIC<br />
PAIN ASSOCIATION. <strong>Migraine</strong>s and<br />
chronic pain are a challenge to manage.<br />
Join the National Fibro<strong>my</strong>algia & <strong>Chronic</strong> Pain Association<br />
(NFMCPA) at FMCPaware.org for education, research<br />
information and important advocacy programs to improve<br />
your healthcare and protect your access to care.<br />
24 Guide to Living Well with <strong>Migraine</strong> Headaches