The Traffic Light of Headache

Simplifying Acute Migraine Management for Physicians and Patients Using the Canadian Headache Society Guidelines

A recent study completed by Ana Marissa Lagman-Bartolome, MD, and Christine Lay, MD from the Centre for Headache, Women’s College Hospital, University of Toronto, offers a simple solution to change the way physicians help their patients identify and manage acute migraine attacks.

The article, called “The Traffic Light of Headache: Simplifying Acute Migraine Management for Physicians and Patients Using the Canadian Headache Society Guidelines,” was recently featured in the Headache Journal.

The purpose of the study was to find an easy to use tool to help physicians teach patients how to treat migraine attacks early and effectively. “There are patients who report a 10-out-of-10 headache who are able to sit in their doctors’ brightly lit office without apparent discomfort, while other patients might be bedbound with a 6-out-of-10 pain,” says Dr. Lagman-Bartolome.

Patients have different criteria for defining pain, particularly when using a 1-10 rating scale.

“It’s difficult to strategize care and plan medications when someone endorses an excruciating headache but they are able to function, while someone else reports a mild headache attack that confines them to bed rest,” says Dr. Lay.

The Traffic Light System

To level the playing field, the two physicians came up with a system that they deemed easier than the 1-10 pain scale, and called it the Traffic Light of Headache. With three tiers of pain levels, patients are asked to define the category of their migraine attack on the following basis.

•      Green light: I have a headache but I’m able to GO (i.e. “I have a headache but I’m going to work” or “I’m going to look after my kids”)
•      Yellow light: I have to SLOW down (i.e. “I better take it easy or I might not make that meeting later. I have to be cautious.”)
•      Red light: I have to STOP (i.e. “I have to stop what I’m doing, go home from work, go lie down, I can’t look after my children”, etc.)

To help patients to align their symptoms and level of function, they are given a graphic card to choose their pain scale. Physicians then provide a course of treatment for each level of pain, to help prevent headache attacks from becoming debilitating.

“We teach them that a migraine is like a fire,” says Dr. Lay. “If they come home and there’s a pot sparking on the stove, not treating their migraine is essentially like saying, oh, well, the pot’s only sparking. I’ll go pay some bills. When they come back, the whole kitchen is on fire.”

What’s next?

The physicians have seen positive results in their patients.

“Our patients find it helpful and are now more confident and feel more in control about treating their headaches,” says Dr. Lagman-Bartolome. “They know what to do and they know which medication to take. This reduces their headache disability and duration.”

Drs. Lagman-Bartolome and Lay have plans to conduct an additional study that will look at how this plan impacts headache and migraine days, but also the link between anxiety and depression. The goal will be to see if this treatment mechanism reduces the anxiety around – and in between – migraine attacks.

“I think initially some people lacked faith in the Traffic Light system because it’s so simple,” says Dr. Lay. “But both patients and physicians now realize that sometimes the simplest approach is the best approach.”