New Perspectives on Migraine Comorbidities:Themes from the DayThemes from the Day

Rebecca Erwin Wells, MD, MPHWake Forest Baptist Medical Center

Assistant Professor Wake Forest Baptist Health

@RebeccaWellsMD

Assistant Professor, Wake Forest Baptist HealthAssociate Research Director, Wake Forest Center for Integrative Medicine

rewells@wakehealth.edu

Disclosures• Research Funding Sources:

• American Pain Society• NIH funded K23 award AT008406‐01A1 (NCCIH)

Factors Associated with Migraineg• Insomnia• ObesityAb• Abuse

• Cognitive Impairmentg p

Impact on MigraineInsomniaObesityImpact on Migraine

• Increase likelihood of chronification

ObesityAbuseC iti• Increase likelihood of chronification

• Worsen migraine‐related disabilityCognition

• Poorer response to headache treatment

When to consider evaluation?InsomniaObesityWhen to consider evaluation? ObesityAbuseC iti• On every new headache patient

• Patients refractory to typical treatments

Cognition

Patients refractory to typical treatments

Medications: Circle those you have been on

Awareness & IntentionInsomniaObesity

• Screen

ObesityAbuseC iti

• DiagnoseT t t l

Cognition

• Treatment plan• Refer as needed

Tools & Strategies can be Simple• Insomnia

– 3 Brief (30 min) sessions3 Brief (30 min) sessions

• Obesity/Inactivity/Sedentary behavior– Starting point, set goals, develop plan, address barriers

• Ab se/Cognition• Abuse/Cognition– Screen/Diagnosis can target eval/referralPh i f f l i– Phrasing of referral so important

Profound Potential Benefit for MigrainePLUSPLUS:

• Enduring effects over time (insomnia)• Improve other health factors (obesity)T t h l i l ll b i ( b )• Target psychological well‐being (abuse)

• Address patient frustrations (cognition)p ( g )

***Affect disability******Affect disability***

Fascinating work aheadg

• CogniphobiaCogniphobia• Poor cognition affects treatment decisions• Treating obesity:  is benefit from exercise or weight loss?weight loss?

Ultimate GoalsInsomniaObesity

• Evaluate/screen

ObesityAbuseCognition

• AddressC t t t t l

Cognition

• Create treatment plan

So many questionsInsomniaObesityy q

• Chicken or the egg?

yAbuseCognition

• How maintain benefit over time?• Effect on migraine if only target co‐morbidity?

Cognition

Effect on migraine if only target co morbidity?• Effect equal to drugs?

ff f l d– Effect of Rx plus drugs?• Appropriate Control group

Additional Ideas, Questions?, QRebecca Erwin Wells, MD, MPH

ll @ k h lth drewells@wakehealth.edu@RebeccaWellsMD