Migraine Management in Primary Care: 5 SEEDS for Success
Five migraine management essentials for PCPs and headache patients are summarized with the mnemonic SEEDS.
Lifestyle modification counseling is as essential to migraine management as pharmacologic intervention. A recent review in the Cleveland Clinic Journal of Medicine underscores the important role of the primary care physician in offering headache patients behavioral guidance.
The authors identify 5 key lifestyle areas, summarized by the mnemonic SEEDS: sleep, exercise, eat, diary, and stress. The short slide show below is adapted from the review’s Advice to Patients with Migraine: SEEDS for Success.
The content is very patient-friendly and may be useful as talking points with your next migraine patient.
"The number needed to treat by initiating routine lifestyle behaviors including sleep, diet, and exercise is 2, indicating that every other person could benefit from this type of intervention."
Woldeamanuel & Cowan RP. J Neurol. 2016.
SLEEP. Sleep comorbidities such as apnea and insomnia as well as poor sleep itself are associated with migraine. Stimulus control therapy, outlined above, focuses on using cues to initiate sleep while sleep restriction, which aims for sleep efficiency of 90%, is designed to increase the amount of time spent in bed that is spent asleep. A wide range of behavioral strategies are also useful.
EXERCISE. Migraine has been linked to limited physical activity and a sedentary lifestyle; what is not clear, however, is whether migraineurs are less likely to exercise in order to avoid a headache or if a sedentary lifestyle increases risk for migraine. While the association remains to be identified, the most important message for headache patients is that even minimal activity is better than none at all.
EAT. Most patients believe that some foods are directly responsible for triggering migraines and it is probably true although the evidence is limited. A number of elimination diets (eg, gluten-free, low-glycemic, tyramine-free) have been studied for their imapct on migraine, but overall results in this area are inconsistent. As a foundation for migraine prevention, routine meals and optimal hydration are recommended.
EAT [Caffeine].Patient Care editors added this entry on caffeine specifically because it is known to have both positive and negative impacts on migraine. For related content on caffeine and migraine, please see:
DIARY. Diary use is associated with improved physician-patient communication; as far as type of record keeping, go with whatever patient is most likely to complete. A first-appointment diary can be mailed ahead to obtain detailed background and a first look at patterns/trends. Tracking categories in any diary must include: headache frequency, duration, intensity, analgesic use, headache impact on function, absenteeism, potential triggers (including menses).
STRESS. Stress/anxiety are both associated with migraine and may cause avoidance & hypervigilance of perceived triggers. Evidence-based techniques for stress management translate well to migraine, eg, cognitive behavioral therapy has been shown to decrease catastrophizing, migraine disability, headache severity, and frequency and studies support the use of mindfulness to improve migraine intensity, frequency disability, self efficacy, and quality of life. Review authors recommend www.dawnbuse.com as a source of comprehensive guidance.
