Interventions for Migraine

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to mothers/families on migraine headache, prevention measures Community Health worker training on migraine, prevention, recognition and management at the community level	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including, irregular or skipped meals; irregular or too little sleep a stressful lifestyle; excessive caffeine consumption lack of exercise; obesity Encourage patients to participate actively in their treatment and to employ self-management principles including. self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others		Recognition of features suggestive of migraine in pregnant women such as both sided severe headache, with nausea and that interferes with normal activities Supportive therapy to pregnant women with migraine including; advice on adequate rest adequate sleep Hydration Avoiding skipping meals Reducing caffeine intake Sleep hygiene—(Avoid bright lights, enough sleep) Regular exercise Relaxation therapy/massage Relieve headache using paracetamol Referral to a health facility for further management of pregnant woman with worsening migraine headache	Relaxation therapy e.g massage therapy to relive migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Primary Care
	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including; irregular or skipped meals irregular or too little sleep a stressful lifestyle excessive caffeine consumption lack of exercise obesity Encourage patients to participate actively in their treatment and to employ self-management principles including; self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others		physical and neurologic examination to help make a diagnosis Non-pharmacological (Non -drug) measures/management of migraine in pregnant women including; Hydration advice on regular meals Reducing caffeine intake Sleep hygiene— (Avoid bright lights, enough sleep), Regular exercise, Relaxation therapy, Pharmacological/drug management of migraine in pregnant women with first line analgesisc such as paracetamol use of anti-emetics if there is history of vomiting Blood pressure monitoring Monitor for any features of migraine headaches due to underlying conditions such as e.g. due to pre-eclampsia Follow up and support to patients to ensure optimum treatment is achieved Referral of the pregnant women to hospital for Management of any underlying conditions that may be causing migraine e.g. pre-eclampsia		Counselling and patient education on use and adherence to the medication according to the prescription
Referral Facility: General
Education and to mothers/families on migraine headache, prevention measures Health worker training on migraine, prevention, recognition and management	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including irregular or skipped meals irregular or too little sleep a stressful lifestyle excessive caffeine consumption lack of exercise obesity Encourage patients to participate actively in their treatment and to employ self-management principles including; self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others Using acute and prophylactic medication appropriately		History, and physical and neurologic examination to help make a diagnosis Non-pharmacological (Non -drug) measures /management of migraine in pregnant women including ; Hydration regular meals advice on Reduction of caffeine intake Sleep hygiene —(Avoid bright lights, enough sleep) Regular exercise Relaxation therapy, Pharmacological/drug management of migraine in pregnant women with first line analgesisc such as; paracetamol use of anti-emetics if there is history of vomiting Migraine prophylaxis Blood pressure monitoring Monitor and manage any secondary causes of headaches in pregnant women such as pre-eclampsia and cerebral venous thrombosis, sub arachnoid haemorrhage, space occupying lesions Provide alternatives to Hormonal contraception for women who may experience onset or aggravation of migraine after starting them. Follow up and support to patients to ensure optimum treatment is achieved	Physiotherapy services as a way of relieving migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Referral Facility: Specialist
Education and to mothers/families on migraine headache, prevention measures Health worker training on migraine, prevention, recognition and management	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including; irregular or skipped meals irregular or too little sleep a stressful lifestyle excessive caffeine consumption lack of exercise obesity Encourage patients to participate actively in their treatment and to employ self-management principles including; self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others Using acute and prophylactic medication appropriately		physical and neurologic examination to help make a diagnosis Non-pharmacological (Non -drug) measures /management of migraine in pregnant women including; Hydration regular meals advice on Reduction of caffeine intake Sleep hygiene —(Avoid bright lights, enough sleep) Regular exercise Relaxation therapy, Pharmacological/drug management of migraine in pregnant women with first line analgesisc such as; paracetamol use of anti-emetics if there is history of vomiting Migraine prophylaxis Blood pressure monitoring Provide alternatives to Hormonal contraception for women who may experience onset or aggravation of migraine after starting them. Monitor and manage any secondary causes of headaches in pregnant women such as pre-eclampsia and cerebral venous thrombosis, sub arachnoid haemorrhage, space occupying lesions Follow up and support to patients to ensure optimum treatment is achieved	Physiotherapy services as a way of relieving migraine	Counselling and patient education on use and adherence to the medication according to the prescription

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to Parents/families on migraine headache, prevention measures among the under 5s Community Health worker training on migraine, prevention , recognition and management at the community level	Advice to parents on lifestyle factors that the child need to avoid or the migraine triggers to reduce the frequency of attacks including; irregular or skipped meals irregular or too little sleep a stressful lifestyle lack of exercise obesity Encourage parents of the under 5 patients to participate actively in their treatment and to employ management principles including; Monitoring the child to identify factors influencing migraine Managing migraine triggers effectively Pacing activity to avoid triggering or exacerbating migraine Ensure the child has a lifestyle that does not worsen migraine Ensure the child relaxes enough Ensure the child has good sleep hygiene Help the child to develop stress management skills Using acute and prophylactic medication on the child appropriately		Recognition of features suggestive of migraine headache in children including; Complaints of Pain on the forehead or on both right and left sides of the head; Headache Vomiting irritability gastrointestinal disturbance sensitivity to light and/to sound Supportive therapy for the child with migraine headache through; Ensuring adequate rest/sleep, regular meals, help the child to exercise Give adequate fluids especially if the child is vomiting Use of painkillers such as ibuprofen Monitor for any features of worsening of the condition of the child with migraine Referrer to a health facility for further management	Relaxation therapy e.g massage therapy to relive migraine	Counselling and education to parents/families on use and adherence to the medication for the child according to the prescription
Primary Care
Basic explanations information to parents/families on migraine headache, prevention measures and treatment. Health worker training on migraine, prevention , diagnosis and management	Advice to parents on lifestyle factors that the child need to avoid or the migraine triggers to reduce the frequency of attacks including, Irregular or skipped meals, Irregular or too little sleep, A stressful lifestyle, lack of exercise obesity Encourage parents of the under 5 patients to participate actively in their treatment and to employ management principles including; Monitoring the child to identify factors influencing migraine Managing migraine triggers effectively Pacing activity to avoid triggering or exacerbating migraine Ensure the child has a lifestyle that does not worsen migraine Ensure the child relaxes enough Ensure the child has good sleep hygiene Help the child to develop stress management skills Using acute and prophylactic medication on the child appropriately		Physical and neurologic examination to help in the diagnosis Identification of features of migraine in children including shorter-lasting headaches attacks, commonly bilateral and less usually pulsating headache; gastrointestinal disturbance Monitor for any features of migraine headaches due to underlying conditions such as headache with projectile vomiting that may be due to intracranial space-occupying lesion, new headache in a patient with a history of cancer, HIV infection or immunodeficiency Referral of the child to hospital for Management of any underlying conditions that may be causing migraine e.g. cancer, space occupying lesions Use of non-drug treatment (non- pharmacologic therapy for migraine in children through bed rest; relaxation therapy; adequate fluids (hydration) physiotherapy Use of drug therapy -analgesics (ibuprofen) in children with migraine, anti-emetics when vomiting is present	Relaxation therapy e.g massage therapy to relive migraine	Counselling and advice to parents on use and to ensure adherence to the medication for the child according to the prescription
Referral Facility: General
Basic explanations information to parents/families on migraine headache, prevention measures and treatment. Health worker training on migraine, prevention , diagnosis and management	Advice to parents on lifestyle factors that the child need to avoid or the migraine triggers to reduce the frequency of attacks including; irregular or skipped meals irregular or too little sleep a stressful lifestyle lack of exercise obesity Encourage parents of the under 5 patients to participate actively in their treatment and to employ management principles including; monitoring the child to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine ensure the child has a lifestyle that does not worsen migraine ensure the child relaxes enough ensure the child has good sleep hygiene help the child to develop stress management skills using acute and prophylactic medication on the child appropriately		Physical and neurologic examination to help in the diagnosis Identification of features of migraine in children including shorter-lasting headaches attacks, commonly bilateral and less usually pulsating headache, gastrointestinal disturbance Use of drug therapy -analgesics (ibuprofen) in children with migraine, anti-emetics when vomiting is present Use of non-drug treatment (non- pharmacologic therapy for migraine in children through bed rest, relaxation therapy, physiotherapy Management of any underlying conditions that may be causing migraine in under 5 e.g. . cancer, space occupying lesions Monitor for any features of migraine headaches due to underlying conditions such as; headache projectile vomiting that may be due to intracranial space-occupying lesion, new headache in a patient with a history of cancer, HIV infection or immunodeficiency Follow up to ensure optimum treatment is achieved	Physiotherapy services as a way of relieving migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Referral Facility: Specialist
Basic explanations information to parents/families on migraine headache, prevention measures and treatment. Health worker training on migraine, prevention , diagnosis and management	Advice to parents on lifestyle factors that the child need to avoid or the migraine triggers to reduce the frequency of attacks including; irregular or skipped meals irregular or too little sleep a stressful lifestyle lack of exercise obesity Encourage parents of the under 5 patients to participate actively in their treatment and to employ management principles including; monitoring the child to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine ensure the child has a lifestyle that does not worsen migraine ensure the child relaxes enough ensure the child has good sleep hygiene help the child to develop stress management skills using acute and prophylactic medication on the child appropriately		Physical and neurologic examination to help in the diagnosis Identification of features of migraine in children including shorter-lasting headaches attacks, commonly bilateral and less usually pulsating headache, gastrointestinal disturbance Use of non-drug treatment (non- pharmacologic therapy for migraine in children through bed rest, relaxation therapy, physiotherapy Use of drug therapy -analgesics (ibuprofen) in children with migraine, anti-emetics when vomiting is present Management of any underlying conditions that may be causing migraine in under 5 e.g. . cancer, space occupying lesions Monitor for any features of migraine headaches due to underlying conditions such as ,headache projectile vomiting that may be due to intracranial space-occupying lesion, new headache in a patient with a history of cancer, HIV infection or immunodeficiency * Follow up to ensure optimum treatment is achieved	Physiotherapy services as a way of relieving migraine	Counselling and patient education on use and adherence to the medication according to the prescription

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to school age children/families on migraine headache, prevention measures Community Health worker training on migraine, prevention , recognition and management at the community level	Advice to parents and the school age children on lifestyle factors that the child need to avoid or the migraine triggers to reduce the frequency of attacks including, irregular or skipped meals, irregular or too little sleep, astressful lifestyle, lack of exercise, obesity Encourage parents and the school age child to participate actively in their treatment and to employ management principles including. Monitoring the child to identify factors influencing migraine Managing migraine triggers effectively Pacing activity to avoid triggering or exacerbating migraine Ensure the child has a lifestyle that does not worsen migraine Ensure the child relaxes enough Ensure the child has good sleep hygiene Help the child to develop stress management skills Using acute and prophylactic medication on the child		Recognition/Identification of features suggestive of migraine I headache in children including: Complaints of Headache (usually on both right and left side of the head or the front), Vomiting irritability gastrointestinal disturbance sensitivity to light and/sound Supportive therapy for the child with migraine headache through Ensuring adequate rest/sleep, regular meals help the child to exercise Give adequate fluids especially if the child is vomiting Use of painkillers such as ibuprofen/paracetamol Monitor for any features of worsening of the condition of the child with migraine and referrer to a health facility for further management.	Relaxation therapy e.g massage therapy to relive migraine	Counselling and patient/parents/families education on use and adherence to the medication for the child according to the prescription
Primary Care

Referral Facility: General

Referral Facility: Specialist

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to communities on headache prevention measures Community awareness on healthy behaviours Including; getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking plenty of water, management of stress, practicing relaxation techniques	Lifestyle modifications, Avoidance of triggers Healthy coping mechanisms	Recognition of migraine signs and symptoms	Analgesics for mild headaches Identify warning features of serious headaches Referral to higher levels of serious headaches	Relaxation therapy e.g massage therapy to relive migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Primary Care
Patient education on healthy behaviours; getting plenty of sleep, staying physically active, avoiding alcohol	Lifestyle modifications Guidance on avoidance of headache triggers Healthy coping mechanisms	History Physical examination	Nonsteroidal anti-inflammatory drugs Non-pharmacologic Therapy: lifestyle changes to reduce stress and improve relaxation Referral to higher levels of serious headaches	Physical therapy	Counselling and patient education on use and adherence to the medication according to the prescription
Referral Facility: General
Patient education on healthy behaviours; getting plenty of sleep, staying physically active, avoiding alcohol	Guidance on avoidance of headache triggers	History Physical examination POUND Mnemonic for Diagnosis	Nonsteroidal anti-inflammatory drugs Triptans Dopamine antagonist Antiemetic Non-pharmacologic therapy: lifestyle changes to reduce stress and improve relaxation	Physical therapy	Counselling and patient education on use and adherence to the medication according to the prescription
Referral Facility: Specialist
Patient education on healthy behaviours; getting plenty of sleep, staying physically active, avoiding alcohol	Guidance on avoidance of headache triggers	History Physical examination POUND Mnemonic for Diagnosis	Nonsteroidal anti-inflammatory drugs Triptans Dopamine antagonist Antiemetic Non-pharmacologic Therapy	Physical therapy	Counselling and patient education on use and adherence to the medication according to the prescription

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to communities on headache prevention measures Community awareness on healthy behaviours Including; getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking plenty of water, management of stress, practicing relaxation techniques	Lifestyle modifications, Avoidance of triggers Healthy coping mechanisms	Recognition of migraine signs and symptoms	Analgesics for mild headaches Identify warning features of serious headaches Referral to higher levels of serious headaches	Relaxation therapy e.g massage therapy to relive migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Primary Care
Lifestyle modifications Guidance on avoidance of headache triggers Healthy coping mechanisms		History Physical examination	Nonsteroidal anti-inflammatory drugs Non-pharmacologic Therapy: lifestyle changes to reduce stress and improve relaxation Referral to higher levels of serious headaches	Physical therapy
Referral Facility: General
Patient education on healthy behaviours; getting plenty of sleep, staying physically active, avoiding alcohol	Guidance on avoidance of headache triggers Preventive medications such as beta-blockers, anti-depressants	History Physical examination POUND Mnemonic for Diagnosis	Nonsteroidal anti-inflammatory drugs Triptans Dopamine antagonist antiemetic Non-pharmacologic Therapy: lifestyle changes to reduce stress and improve relaxation	Physical therapy
Referral Facility: Specialist
Patient education on healthy behaviours; getting plenty of sleep, staying physically active, avoiding alcohol	Guidance on avoidance of headache triggers Preventive medications such as beta-blockers, anti-depressants	History Physical examination POUND Mnemonic for Diagnosis	Nonsteroidal anti-inflammatory drugs Triptans Dopamine antagonist Antiemetic drugs Non-pharmacologic Therapy	Physical therapy

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education and awareness creation/information to the elderly on migraine headache, prevention measures Community Health worker training on migraine, prevention , recognition and management at the community level	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including, Irregular or skipped meals, Irregular or too little sleep, A stressful lifestyle, Excessive caffeine consumption, Lack of exercise, Obesity Encourage patients to participate actively in their treatment and to employ self-management principles including; self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others		Identify features of migraine in elderly including headache with nausea; light sensitivity, patients with recurrent moderate or severe headaches, bilateral (on both sides) headache that interferes with patient activities; Supportive therapy such as ensuring the patient has adequate rest, adequate sleep; regular meals Give pain relieving medicines such as paracetamol/ibuprofen Use nondrug therapies such as relaxation therapies, physiotherapy/massage Monitoring for any indication of worsening of the condition Referral of elderly with worsening migraine to a health facility for further management	Relaxation therapy e.g massage therapy to relive migraine	Counselling and patient education on use and adherence to the medication according to the prescription
Primary Care
	Advice on lifestyle factors to avoid and specific migraine triggers to reduce the frequency of attacks including, irregular or skipped meals, irregular or too little sleep, a stressful lifestyle, excessive caffeine consumption, lack of exercise, obesity Encourage patients to participate actively in their treatment and to employ self-management principles including; self-monitoring to identify factors influencing migraine managing migraine triggers effectively pacing activity to avoid triggering or exacerbating migraine maintaining a lifestyle that does not worsen migraine practicing relaxation techniques maintaining good sleep hygiene developing stress management skills improving communication skills to talk effectively about pain with family and others
Referral Facility: General

Referral Facility: Specialist