More on migraine and headache – Alberta Pain Conference

Dr. William Kingston presented the Conundrum of Managing Migraine with Comorbidities.

More than 10% of people in Canada have had migraines. (I’ve had migraines when I was premenopausal and they were so painful it started my journey to healing and drove me to help my patients manage their own pain). We must not forget the stress of pregnancy and postpartum depression. Hormones and other factors are a huge load on women.

There are groups with migraines who have metabolic problems, diseases like diabetes, hypertension, dyslipidemia, hypothyroidism. There were also groups of people who suffered from anxiety, fibromyalgia, and depression. There was another group who had no co-morbities.

Choosing medications to manage migraine can be incorporated in the medications used to treat conditions like hypertension. There are safer pain medications to choose from when looking at complex patients.

He mentioned prochlorperazine for patients with resistant migraine and Gabapentin.

He spoke about the vicious cycle that results when patients suffer from migraine and depression – two separate but intersecting conditions. Treating migraine can improve your mood. Depression can often present without the typical low mood. There are other presentations of depression. Venlafaxine could be a good drug to try.

Cognitive behaviour therapy can be helpful – Kelty provides free online CBT. Other On-line resources.

PTSD is also important to address if this is present.

When everything does nothing, there may be something – I think searching for hidden trauma, hidden stress, is worthwhile. Step 1 – Rate your pain has links to forms assessing for depression or high adverse child events. Please check in with yourself for hidden triggers and consult your health care professional.

Have a great day


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