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Welcome to the Headache Network Canada Website

Bienvenue au site Web du Canada de résauu de mal de tête

Terms of Use Agreement

Headache Network Canada and the Canadian Headache Society have developed this website to provide information to the Canadian public and to health care professionals in Canada with regard to the diagnosis and treatment of headache. In making information about headache available to individuals with headache, our objective is to enable such individuals to work more effectively with their health care providers to manage their headache problem.

It is important that you read all the following terms and conditions carefully. This Terms of Use Agreement ("Agreement") is a legal agreement between you and Headache Network Canada and the Canadian Headache Society, the owners and operators ("Owner") of this Web site (the "Web site"). It states the terms and conditions under which you may access and use the Web site and all written and other materials displayed or made available through the Web site (the "Content"). By accessing and using the Web site, you are indicating your acceptance to be bound by the terms and conditions of this Agreement. If you do not accept these terms and conditions, you must not access or use the Web site. As the Owner may revise this Agreement at any time, you should visit this page periodically to review this Agreement.

The information provided on the Web site is for informational purposes only and is not professional medical advice. Always seek the advice of a physician or other qualified health provider properly licensed to practise medicine or general health care in your jurisdiction concerning any questions you may have regarding any information obtained from this Web site and any medical condition you believe may be relevant to you or to someone else. Never disregard professional medical advice or delay in seeking it because of something you have read on this Web site. Always consult with your physician or other qualified health care provider before embarking on a new treatment, diet or fitness program.

The presentation of information on the Web site does not establish a physician-patient relationship between you and the Owner (or any of its physicians) and is not intended as a solicitation of individuals to become patients or clients of the Owner (or any of its physicians). Unless specifically stated, the Owner does not recommend or endorse any specific brand of products, services, procedures or other information that appears or that may be advertised on the Web site.

This website does not accept email communication from users to the owners.

The Web site and the Content are provided "AS IS". While the Owner endeavours to provide information that is correct, accurate, current and timely, the Owner makes no representations, warranties or covenants, express or implied, regarding the Web site and the Content including, without limitation, no representation, warranty or covenant that (i) the Content contained in or made available through the Web site or any item(s) made available on or through the Web site will be of merchantable quality and/or fit for a particular purpose, (ii) the Web site or Content will be accurate, complete, current, reliable, timely or suitable for any particular purpose, (iii) that the operation of the Web site will be uninterrupted or error-free, (iv) that defects or errors in the Web site or the Content, be it human or computer errors, will be corrected, (v) that the Web site will be free from viruses or harmful components, and (vi) that communications to or from the Website will be secure and/or not intercepted. You acknowledge and agree that your access and use of the Web site and the Content is entirely at your own risk and liability.

In no event shall the Owner, its physicians, officers, directors, employees, agents, licensors, and their respective successors and assigns be liable for damages of any kind, including, without limitation, any direct, special, indirect, punitive, incidental or consequential damages including, without limitation, any loss or damages in the nature of, or relating to, lost business, medical injury, personal injury, wrongful death, improper diagnosis, inaccurate information, improper treatment or any other loss incurred in connection with your use, misuse or reliance upon the Web site or the Content, or your inability to use the Web site, regardless of the cause and whether arising in contract (including fundamental breach), tort (including negligence), or otherwise. The foregoing limitation shall apply even if the Owner knew of or ought to have known of the possibility of such damages. The Owner also expressly disclaims any and all liability for the acts, omissions and conduct of any third-party user of the Web site, or any advertiser or sponsor of the Web site ("third-party"). Under no circumstances shall the Owner, its physicians, officers, directors, employees, agents, licensors and their respective successors and assigns, be liable for any injury, loss, damage (including direct, special, indirect, punitive, incidental or consequential damages), or expense arising in any manner whatsoever from (i) the acts, omissions or conduct of any third-party, and (ii) any access, use, reliance upon or inability to use any materials, content, goods or services located at, or made available at, any Web site linked to or from the Web site, regardless of the cause and whether arising in contract (including fundamental breach), tort (including negligence), or otherwise. The foregoing limitation shall apply even if the owner knew of or ought to have known of the possibility of such damages.

You agree to indemnify, defend and hold harmless the Owner and its physicians, officers, directors, employees, agents, licensors, and their respective successors and assigns, from and against any and all claims, demands, liabilities, costs, or expenses whatsoever, including, without limitation, legal fees and disbursements, resulting directly or indirectly from (i) your breach of any of the terms and conditions of this Agreement, (ii) your access to, use, misuse, reliance upon or inability to access or use the Web site, the Content or any Web site to which the Web site is or may be linked to from time to time or, (iii) your use of, reliance on, publication, communication, distribution, uploading or downloading of anything (including the Content) on or from the Web site.

The display of third-party trademarks on the Web site should not be taken to imply any relationship or license between the Owner and the owner of the trademark or to imply that the Owner endorses the wares, services or business of the owner of the said trademark.

The Web site contains links to third-party Web sites. These links are provided solely as a convenience to you and not as an endorsement by the owner of any third-party Web site or the content thereof. The owner is not responsible for the content of any third-party Web site, nor does it make any representation, warranty or covenant of any kind regarding any third-party Web site.

While the Owner encourages links to the Web site, it does not wish to be linked to or from any third-party Web site which contains, posts or transmits any unlawful or indecent information of any kind. The Owner reserves the right to prohibit or refuse to accept any link to the Website. You agree to remove any link you may have to the Web site upon the request of the owner.

The Web site may provide features which allow you to post messages and content to designated areas on the Web site, to participate in chat groups, to interact with the Owner and other users and to upload files, documents, or other materials ("Submission(s)"). The Owner does not control the content of any Submissions and has no obligation to monitor the Submissions. However, the Owner reserves the right at all times to disclose any information necessary to satisfy any law, regulation or governmental or law enforcement request, or to edit, refuse to post or to remove any Submission, in whole or in part, that, in the Owner's sole discretion, are objectionable or in violation of this Agreement. You acknowledge that you alone are responsible for the content of your Submissions and the consequences thereof.

When using any of the features of the Web site which allow you to post, upload or make Submissions, it is a condition of your use of the Web site that you do not: 1.Restrict or inhibit any other user from using and enjoying the Web site, interfere or attempt to interfere with the proper workings of the Web site or do anything, which in the sole discretion of the Owner, imposes an unreasonable or disproportionately large load on the Web site infrastructure; 2.Post or transmit any unlawful, abusive, defamatory or obscene information of any kind. 3.Post or transmit any Submission, including, without limitation, articles, images, stories, software, or other material, which violates or infringes upon the rights of others, including material which is an invasion of privacy or publicity rights, or which is protected by any intellectual property rights, including, without limitation, copyright, patent, trade secret, trademark, or other proprietary rights herein, or derivative works with respect thereto, without first obtaining permission from the owner or rights holder; 4.Post or transmit any Submission which contains a virus or other harmful component; 5.Post or transmit "junk mail", "chain letters", unsolicited mass mailing or "spam"; and 6.Use or "mine" the Web site for commercial purposes, including, without limitation, posting, uploading or transmitting any Submission which contains advertising, which engages in commercial activities, solicitations or sales, or which involves contests, sweepstakes, advertising and pyramid schemes.

By posting or uploading Submissions to the Web site, you grant the owner a royalty-free, perpetual, non-exclusive, irrevocable, unrestricted, worldwide licence to (i) use, reproduce, store,adapt, translate, modify, make derivative works from, transmit, distribute, publicly perform or display such Submissions for any purpose, and (ii) consent to your name, address and e-mail appearing as the contributor of your submission, where applicable, and to the disclosure and display of such information and any other information which appears in or is associated with your Submission, (iii) acknowledge and agree that the owner is not responsible for any loss, damage or corruption that may occur to your Submission, and (iv) acknowledge and agree that your Submission will be non-confidential.

To use certain features of the Web site, you may be asked to create an account with the Web site. When you register with the Web site, you agree (i) to provide true, accurate, current and complete information about yourself as prompted by any registration form, and (ii) to maintain and promptly update the information to ensure it remains true, accurate, current and complete. If the Owner has reasonable grounds to suspect that such information is untrue, inaccurate, not current or incomplete, the Owner has the right to suspend or terminate your access to all or part of the Web site. The Owner's use of any personally identifying information you provide as part of the registration process is governed by the terms of our Privacy Policy.

You are responsible for maintaining the confidentiality of the password you use in association with your account and are responsible for all activities that occur under your user name and password. You agree to notify the Owner immediately of any unauthorized use of your password or account or any other breach of security, and to ensure that you exit from your account at the end of each session. The Owner will not be liable for any loss or damage arising from the Owner's failure or your failure to protect your password or account information.

Any tools provided on the Web site are provided for general and illustrative purposes only. Such tools and/or calculators are not medical advice nor are they intended to be a substitute therefor. You should not act or abstain from acting based on any information provided by any such tool available on this Web site.

Any information sent or received over the Internet is generally not secure. The Owner cannot guarantee the security or confidentiality of any communication to or from the Web site.

The Owner reserves the right any time, and from time to time, to modify or discontinue, temporarily or permanently, the Web site (or any part thereof) with or without notice to you. The Owner shall have no liability to you or any third party for any modifications, suspension or discontinuance of the Web site or any part thereof.

Use of this Web site is unauthorized in any jurisdiction where the Web site or any of the Content may violate any laws or regulations. You agree not to access or use the Web site in such jurisdictions. You agree that you are responsible for compliance with all applicable laws or regulations. Any contravention of this provision (or any provision of this Agreement) is entirely at your own risk.

Governing law and jurisdiction. The Web site is operated by the Owners from its offices within the Provinces of Alberta and Ontario, Canada. You agree that all matters relating to your access, or use of the Web site and its Content shall be governed by the laws of the Provinces of Alberta and Ontario and the laws of Canada applicable therein, without regard to conflict of laws and principles. You agree and hereby submit to the exclusive and preferential jurisdiction of the courts of the Provinces of Alberta and Ontario with respect to all matters relating to your access and use of the Web site and the Content as well as any dispute that may arise therefrom and that the applicable law shall be the law of the Province of Alberta and Ontario and of Canada.

Waiver. Any consent by the Owner to, or waiver of, a breach of this Agreement which you have committed, whether express or implied, shall not constitute a consent to, or waiver of any other, different or subsequent breach.

The invalidity or unenforceability of any provision of this Agreement or any covenant contained herein shall not affect the validity or enforceability of any other provision or covenant contained herein and any such invalid provision or covenant shall be deemed severable from the rest of this Agreement.

The Owner may, in its sole discretion, cancel or terminate your right to use the Web site, or any part of the Web site, at any time without notice. In the event of termination,you are no longer authorized to access the Web site, or the part of the Web site affected by such cancellation or termination. The restrictions imposed on you with respect to material downloaded from the Web site and the disclaimers and limitations of liabilities set forth in this Agreement, shall survive termination of this Agreement. The Owner shall not be liable to any party for such termination.

This is the entire Agreement between you and the Owner relating to your access and use of the Web site.

Conditions d'utilisation

Le Réseau canadien des céphalées et la Canadian Headache Society ont créé le présent site web afin d'informer le public et les professionnels de la santé du Canada sur le diagnostic et le traitement de la céphalée. En rendant cette information accessible aux personnes souffrant de céphalées, notre objectif est de permettre à ces personnes de mieux collaborer avec leur professionnel de la santé dans la prise en charge de leur problème.

Il est important que vous lisiez attentivement les modalités suivantes. Le présent accord sur les modalités d'utilisation (« l'Accord ») est une entente légale qui vous lie au Réseau canadien des céphalées et à la Canadian Headache Society, propriétaires et exploitants (« le Propriétaire ») du présent site web (« le Site web »). Il établit les modalités régissant votre accès au Site web ainsi que votre utilisation du Site web et de toute la documentation, écrite ou autre, qui y est affichée ou rendue accessible par son entremise (« le Contenu »). En accédant au Site web et en l'utilisant, vous signifiez que vous acceptez d'être lié par les modalités de l'Accord. Si vous n'acceptez pas ces modalités, vous ne devez pas accéder au Site web ni l'utiliser. Comme le Propriétaire peut à tout moment modifier l'Accord, vous devez revenir périodiquement à la présente page afin de revoir l'Accord.

Les renseignements fournis sur le Site web ont une visée essentiellement informative et ne constituent pas un avis médical professionnel. Pour toute question relative à l'information trouvée sur ce Site web et à tout problème de santé qui pourrait vous concerner, vous ou une autre personne, demandez toujours l'avis d'un médecin ou d'un autre professionnel de la santé dûment autorisé à pratiquer la médecine ou à fournir des soins de santé généraux dans votre collectivité publique. Ne négligez jamais un avis médical professionnel et ne tardez jamais à en demander un, sur la foi d'une information que vous auriez lue sur le Site web. Consultez toujours votre médecin ou un autre professionnel de la santé qualifié avant d'entreprendre un nouveau traitement, un nouveau régime ou un nouveau programme de conditionnement physique.

La présentation d'information sur le Site web n'établit pas une relation patient-médecin entre vous et le Propriétaire (ni aucun des médecins membres) et ne se veut en aucun cas une forme de sollicitation de patients ou de clients pour le Propriétaire (ni aucun des médecins membres). À moins d'indication contraire, le Propriétaire ne recommande et ne fait la promotion d'aucune marque particulière de produits, d'aucun service, d'aucune procédure ni d'aucun autre renseignement affiché sur le Site web.

Le Site web ne permet pas l'envoi de courriels au Propriétaire par les utilisateurs.

Le Site web et son Contenu sont fournis « TELS QUELS ». Le Propriétaire s'efforce de fournir une information juste, précise, actuelle et à propos, mais le Propriétaire ne fait aucune déclaration, ne donne aucune garantie ni ne prend aucun engagement, exprès ou tacite, quant au Site web et à son Contenu, il ne fait notamment aucune déclaration, garantie ni aucun engagement concernant le fait que (i) le Contenu affiché sur le Site web ou rendu accessible par son entremise ou tout élément accessible sur le Site web ou par son entremise auront une qualité marchande ou répondront à des critères particuliers; (ii) le Site web et son Contenu seront toujours précis, complets, à jour, fiables, opportuns et pertinents pour une quelconque question particulière; (iii) l'exploitation du Site Web sera continue ou exempte d'erreurs; (iv) les défauts ou les erreurs dans le Site Web ou son Contenu, qu'ils soient attribuables à une erreur humaine ou informatique, seront corrigés; (v) le Site Web sera exempt de virus ou d'éléments nuisibles; et (vi) les communications à destination ou en provenance du Site Web seront sûres ou ne seront pas interceptées. Vous reconnaissez et convenez que vous accédez au Site web et à son Contenu, et que vous les utilisez, à vos propres risques et que vous assumez l'entière responsabilité de cette utilisation.

En aucun cas, le Propriétaire, ses médecins membres, ses représentants, ses administrateurs, ses employés, ses agents ou ses bailleurs de licence, ni leurs successeurs ou ayants droit respectifs, ne peuvent être tenus responsables de quelques dommages-intérêts que ce soit, notamment, et sans limiter ce qui précède, de dommages-intérêts directs, particuliers, indirects, punitifs, accessoires ou consécutifs, y compris tout perte ou dommage relatif à un manque à gagner, à un préjudice médical, à un préjudice personnel, à un décès imputable à une faute, à un mauvais diagnostic, à une information inexacte, à un traitement inapproprié ou tout autre perte subie en rapport avec l'utilisation, malveillante ou non, du Site web ou de son Contenu, avec la confiance que vous leur accordez ou votre incapacité de les utiliser, peu importe la cause de ce dommage et peu importe s'il découle d'une responsabilité contractuelle (y compris une rupture fondamentale), d'une responsabilité civile délictuelle (y compris la négligence) ou autrement. La limitation qui précède s'applique même si le Propriétaire était informé ou aurait dû être informé de la possibilité de tels dommages. Le Propriétaire décline expressément toute responsabilité pour les agissements, les omissions et les comportements de toute tierce partie utilisant le Site web ou de tout publicitaire ou commanditaire du Site web (« tierce partie »). En aucun cas, le Propriétaire, ses médecins membres, ses représentants, ses administrateurs, ses employés, ses agents ou ses bailleurs de licence, ni leurs successeurs ou ayants droit respectifs, ne peuvent être tenus responsables d'aucun préjudice, perte ou dommage (notamment de tout dommage direct, particulier, indirect, punitif, accessoire ou consécutif), ni d'aucuns frais encourus résultant de quelque manière (i) des agissements, des omissions ou des comportements de toute tierce partie et (ii) de tout accès au Site web, de son utilisation, de la confiance qui lui est accordée ou de l'impossibilité d'utiliser tout matériel, documentation, marchandise ou service accessibles sur le Site web ou sur tout autre site auquel le Site web donne accès, quelle que soit la cause et que ce soit dans le cadre d'un contrat (y compris une rupture fondamentale), de la responsabilité civile (y compris la négligence) ou autrement. La limitation qui précède s'applique même si le Propriétaire était informé ou aurait dû être informé de la possibilité de tels dommages.

Vous acceptez d'indemniser, de défendre et de dégager de toute responsabilité le Propriétaire et ses médecins membres, ses représentants, ses administrateurs, ses employés, ses agents, ses bailleurs de licence, ainsi que leurs successeurs ou ayants droit respectifs, pour et contre toutes prétentions, réclamations, responsabilités, dépenses et tous frais, y compris les frais juridiques, résultant directement ou indirectement de (i) toute violation de votre part des modalités du présent Accord; (ii) votre accès au Site web, à son Contenu ou à tout autre site web auquel le Site web pourrait être lié à l'occasion et de l'utilisation que vous en faites, malveillante ou non, de la confiance que vous leur accordez ou de votre incapacité d'y accéder ou de les utiliser; ou (iii) votre utilisation, de la publication, de la communication, de la diffusion, du téléversement ou du téléchargement de tout élément (y compris le Contenu) du Site web ou accessible par l'entremise du Site web ou de la confiance que vous lui accordez.

L'affichage sur le Site web des marques de commerce de tierces parties ne doit pas être interprété comme la confirmation d'aucune relation ou licence entre le Propriétaire et le propriétaire de la marque de commerce, ni d'aucune promotion des produits, des services ou de l'entreprise du propriétaire de ladite marque de commerce.

Le Site web contient des liens vers les sites web de tierces parties. Ces liens sont offerts essentiellement pour votre commodité et ne constituent aucune recommandation ou promotion de quelque site Web de tiers ou de son contenu. Le Propriétaire n'est pas responsable du contenu d'aucun site web de tiers et ne fait aucune déclaration, ne donne aucune garantie ni ne prend aucun engagement de quelque nature que ce soit concernant aucun site web de tiers.

Même si le Propriétaire encourage les liens au Site web, il ne souhaite pas être lié à quelque site Web de tiers qui contient, affiche ou transmet toute information illégale ou indécente de quelque nature que ce soit. Le Propriétaire se réserve le droit d'interdire ou de refuser l'établissement d'un lien avec son Site web. Vous convenez de retirer, sur demande du Propriétaire, tout lien que vous pouvez avoir vers le Site web.

Le Site web peut fournir des dispositifs vous permettant d'afficher des messages et de l'information dans des zones désignées du Site web, de participer à des forums de bavardage, d'interagir avec le Propriétaire et d'autres usagers et de téléverser des fichiers, des documents et d'autre matériel (« Soumissions »). Le propriétaire ne vérifie pas le contenu de toutes les Soumissions et n'a aucune obligation de contrôler les Soumissions. Cependant, le Propriétaire se réserve le droit, en tout temps, de divulguer l'information requise pour se conformer à toute loi, à tout règlement ou à toute demande de la part du gouvernement ou des autorités policières, ou d'éditer, de refuser d'afficher ou de retirer, en tout ou en partie, toute Soumission qui, de l'avis du Propriétaire, est inadmissible ou contrevient au présent Accord. Vous reconnaissez que vous êtes le seul responsable du contenu de vos Soumissions et de leurs conséquences.

Lors de l'utilisation de tout dispositif du Site web qui vous permet d'afficher, de téléverser ou de faire des Soumissions, les conditions suivantes d'utilisation du Site web s'appliquent : 1. Vous ne devez pas restreindre ni empêcher l'utilisation du Site web par aucun autre usager, ni perturber ou tenter de perturber le bon fonctionnement du Site web, ni faire quoi que ce soit qui, de l'avis du Propriétaire, impose une charge démesurée ou disproportionnée à l'infrastructure du Site web. 2. Vous ne devez pas afficher ni transmettre aucune information illégale, injurieuse, diffamatoire ou obscène de quelque nature que ce soit. 3. Vous ne devez pas afficher ni transmettre aucune Soumission, notamment des articles, des images, des histoires, des logiciels ou tout autre matériel, qui enfreint ou qui lèse les droits d'autres personnes, y compris tout matériel qui constitue une atteinte à la vie privée ou au droit à la protection de la personnalité, ou qui est protégé par des droits de propriété intellectuelle, notamment des droits d'auteur, un brevet d'invention, un secret industriel, une marque de commerce ou tout autre droit propriétal ci-inclus, ou toute œuvre dérivée, sans avoir obtenu l'autorisation préalable du propriétaire ou du détenteur de ces droits. 4.Vous ne devez pas afficher ni transmettre aucune Soumission contenant un virus ou tout autre élément nuisible. 5. Vous ne devez pas afficher ni transmettre aucun « pourriel » ni « chaîne de courriels », ni aucun courriel ou publipostage non sollicités. 6. Vous ne devez pas utiliser ni « miner » le Site web à des fins commerciales, notamment afficher, téléverser ou transmettre aucune Soumission contenant de la publicité qui inciterait à des activités commerciales, de sollicitation ou de vente ou qui proposerait des concours, des loteries promotionnelles, de la publicité ou des opérations pyramidales.

En affichant ou en téléversant des Soumissions sur le Site web, (i) vous accordez au Propriétaire une licence libre de redevances, perpétuelle, non exclusive, irrévocable, sans restriction et de portée mondiale pour qu'il puisse utiliser, reproduire, archiver, adapter, traduire, modifier, transmettre, distribuer, diffuser ou afficher lesdites Soumissions et en faire des œuvres dérivées, quel que soit le but recherché; (ii) vous consentez à ce que votre soumission soit identifiée avec votre nom, votre adresse et votre courriel, s'il y a lieu, et à ce que de tels renseignements soient dévoilés et affichés, ainsi que tout autre renseignement apparaissant dans votre soumission ou associé à elle; (iii) vous reconnaissez et convenez que le Propriétaire n'est responsable d'aucune perte, d'aucun dommage ni d'aucune altération que pourrait subir votre Soumission; et (iv) vous reconnaissez et convenez que votre Soumission sera non confidentielle.

Pour utiliser certains dispositifs du Site web, on pourrait vous demander de créer un compte. Lorsque vous vous inscrivez sur le Site web, vous acceptez (i) de fournir des renseignements véridiques, exacts, complets et à jour à votre sujet, tels que tout formulaire d'inscription peut le demander; et (ii) et de maintenir sans retard ces renseignements à jour afin d'assurer qu'ils demeurent véridiques, exacts, complets et à jour. Si le propriétaire a de bonnes raisons de croire que de tels renseignements sont faux, inexacts, incomplets ou périmés, il a le droit de suspendre ou de résilier votre accès à l'ensemble ou à une partie du Site web. L'utilisation par le Propriétaire de tout renseignement personnel que vous fournissez dans le processus d'inscription est régie par les modalités de notre Politique de confidentialité.

Vous êtes responsable de la confidentialité du mot de passe associé à votre compte et êtes responsable de toute activité réalisée sous votre nom d'usager et avec votre mot de passe. Vous convenez d'aviser immédiatement le Propriétaire de toute utilisation non autorisée de votre mot de passe ou de votre compte ou de toute autre infraction à la sécurité, et de quitter votre compte à la fin de chacune de vos sessions. Le propriétaire ne sera responsable d'aucune perte ni d'aucun dommage découlant d'une mauvaise protection, par le Propriétaire ou par vous-même, de votre mot de passe et des renseignements associés à votre compte.

Tous les outils accessibles sur le Site web sont fournis essentiellement à des fins d'information et d'illustration de nature générale. De tels outils ou calculateurs ne constituent pas un avis médical, ni ne doivent être considérés comme un substitut d'un tel avis. Vous ne devez pas agir ou vous abstenir d'agir sur la foi des renseignements fournis par les outils accessibles sur le Site web.

Toute information envoyée ou reçue par l'intermédiaire d'Internet n'est généralement pas sécurisée. Le Propriétaire ne peut garantir la sécurité ou la confidentialité de quelque communication que ce soit à destination ou en provenance du Site Web.

Le Propriétaire se réserve le droit, à l'occasion, de modifier le Site Web (ou toute partie de celui-ci), ou de discontinuer l'accès au Site Web (ou à toute partie de celui-ci), temporairement ou en permanence, avec ou sans préavis. Le Propriétaire ne doit pas être tenu responsable envers vous ou quiconque de la modification, de l'interruption ou de l'annulation du Site Web ou de toute partie de celui-ci.

L'utilisation du Site web est interdite dans les territoires juridiques où le Site web ou son Contenu peuvent violer les lois ou les règlements en vigueur. Vous acceptez de ne pas accéder au Site web et de ne pas l'utiliser lorsque vous vous trouvez dans de tels territoires juridiques. Vous acceptez d'être responsable de votre conformité à toutes les lois et règlemens applicables. Tout manquement à la présente disposition (ou à toute autre disposition du présent Accord) est entièrement à vos propres risques.

Lois applicables et compétence juridique. Le Site web est exploité par le Propriétaire à partir de ses bureaux situés dans les provinces d'Alberta et d'Ontario, au Canada. Vous acceptez que toutes les questions relatives à votre accès au Site web et à son Contenu ou à votre utilisation de ceux-ci sont régies par les lois des provinces d'Alberta et d'Ontario et par les lois du Canada s'y appliquant, sans égard aux règles en matière de conlit de droit. Vous acceptez de vous soumettre à la compétence exclusive et prioritaire des tribunaux des provinces d'Alberta et d'Ontario pour toute question relative à votre accès au Site web et à son Contenu et à leur utilisation, ainsi que pour tout litige qui pourrait en découler, et que les lois applicables sont les lois des provinces d'Alberta et d'Ontario et celles du Canada.

Renonciation. Tout consentement du Propriétaire à une dérogation au présent Accord de votre part, qu'elle soit exprès ou tacite, ou toute renonciation par le Propriétaire à une telle dérogation ne constitue pas un consentement ou une renonciation à toute autre dérogation différente ou subséquente.

L'invalidité ou l'inexigibilité de toute disposition du présent Accord ou de tout engagement contenu dans les présentes n'affecte en rien la validité ou le caractère exécutoire de toute autre disposition ou de tout autre engagement contenu dans les présentes, et toute disposition ou tout engagement invalides est réputé divisible du reste du présent Accord.

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The Headache Network | Medications to reduce migraine frequency | What are my choices for preventive medication?

What are my choices for preventive medication?

If a preventive medication is the best thing for you to try, then the choice of which medication to try is a decision to be made with your doctor.  The information below is provided so that you will have some idea of what is available.  By understanding the principles of prophylactic medication use, and by having some knowledge of the available medications, you can be a better partner for your doctor in developing a good treatment plan to control you migraines.

The main medications or medication groups used in migraine prevention will be discussed briefly below.  This brief discussion is meant as a guide only, as for example, not all potential side effects or dosage ranges can be listed here.

Tricyclic antidepressants: These medications (the “tricyclics”) are some of the most commonly used migraine prophylactics.  Although they were originally developed for depression, they are widely used and effective as migraine prophylactics whether or not patients are depressed.  So if your doctor recommends these for you, it does not mean that the doctor thinks you are depressed.  In fact, the dosages of these medications that are used for migraine prevention are generally much lower that those used for depression.  However, if you do have both migraine and some degree of depression, these medications can help both.  In that case, you may need to go a little higher in dosage than is usually done just for migraine prevention.  These medications are taken just once a day, about an hour before bedtime or at bedtime.  One of their big advantages is that they help to improve sleep, and insomnia is a very common problem in people with migraine.  They are not “sleeping pills” in the usual sense, and unlike many medications used as sleeping pills, it is fine to take the tricyclics long term if that is necessary.

The tricyclics most commonly used for migraine prevention are amitriptyline and nortiptyline, although desipramine can be used as well.  Like many migraine prophylactic drugs, these medications can cause weight gain in some people who take them.  It is wise, therefore to monitor your weight every week after you start them, and to note whether you are eating more than usual.  The way they make you gain weight seems to be mainly through appetite stimulation.  If you find you are one of those who tend to gain weight on these medications, you can try to control this through dieting and exercise. If the weight gain continues, then the medication can always be stopped and something else tried.

Amitriptyline has been the most widely used tricyclic for migraine prophylaxis.  It has the most effect on restoring disturbed sleep.  However, it also has the most side effects in terms of causing some mouth dryness, sedation, and weight gain.  Although these are not usually a problem with the low doses used in migraine prevention, they can be.  Should some of these side effects be a problem, one can switch to nortiptyline which usually has fewer side effects. Alternatively, especially if insomnia is not a big problem, one can try nortiptyline from the start.

For migraine, these medications are usually started at a low dose, 10 mg a day, and built up slowly.  A common schedule is to increase the daily dose by 10 mg every week until a dose of 20 or 30 mg a day is reached.  One can go much higher than this, even up to 100 mg a day or in some instances ever higher, but of course this should only be done under a doctor’s guidance.  For the treatment to be successful, however, it is important that you do your share.  If, as you increase the dose, you develop side effects which you can’t tolerate, it is usually best to reduce the dose and see if a lower dose will not produce the side effects, but still work for your migraines.  In the same way, if you are not having any side effects, but the medication is not helping for your migraines either, then it may well be advisable to gradually increase the dose.  In other words, the idea is, under your doctor’s guidance, to titrate the dose gradually to determine what dose is best for you.  The objective is to reduce your migraine frequency without unacceptable side effects.  In practice, the usual reason for patients not to go higher with their dose is the presence of some degree of sedation in the morning after the evening dose.  If this does not go away after a few days at a given dose, it may be that you have reached your dosage limit for the medication, and you may need to reduce back to a slightly lower daily dose.

Another potential side effect to watch for is some slowing down of the bladder, with incomplete bladder emptying.  It is unusual for this to happen with the doses used in migraine prophylaxis, but it is a possibility.  Reduce the dose and see your doctor if you think this is happening to you.

The beta-blockers: This is a large group of medications that are frequently used for migraine prophylaxis.  For many migraine sufferers, this is often the first one tried.  If insomnia is a big problem, however, the tricyclics may be better as the beta-blockers do not benefit sleep in the same way that the tricyclics do.  Individual medications that are commonly used for migraine prophylaxis include propranolol, nadolol, and metoprolol, although others are used as well.  As with the tricyclics, the beta-blockers are usually started at a low dose and built up over several weeks.  The dosage depends upon which beta-blocker is used.  It is important to understand from your doctor how high you should go with the daily dosage, as a common reason for these medications to fail in reducing migraine frequency is not going to a high enough dosage.

The beta-blockers generally cause few side effects.  They do slow the pulse somewhat, and this will reduce your ability to do strenuous exercise.  If you are a marathon runner or a major athlete, you should likely not go on beta-blockers as it will spoil your competitiveness.  Let your doctor know if you are an athlete, as it will influence which medications he or she might prescribe for you for migraine prophylaxis.  Beta-blockers can also predispose towards weight gain, so monitor your weight.  If you develop unusually vivid dreams while on them and this becomes a problem, mention this to your doctor, as these can be a side effect of the beta-blockers.  The beta-blockers can also sometimes cause tiredness and fatigue.  If you are an asthmatic, you should not be on them as they can make asthma worse.  They are also a problem for diabetics, as they can mask the warning symptoms of low blood sugar.  As you can see, it is important that your doctor is aware of your general medical condition when a prophylactic medication for migraine is chosen for you.

The anticonvulsant (anti-seizure) medications: These medications were first developed and used for the treatment of epilepsy, but were eventually found to work for migraine prophylaxis as well.  They all decrease to some extent the excitability of the central nervous system, and this may explain why they make migraine attacks less frequent.  These medications are all fairly different, and will be discussed separately.

Topiramate: Topiramate has been tested widely for use in migraine prophylaxis through several large clinical trials.  It clearly has a positive effect and does reduce migraine frequency for many migraine sufferers.  Among the migraine prophylactic drugs, it is almost unique in that it tends to cause weight loss rather than weight gain.  It does have a number of other side effects as well, some of which are less desirable.  One of the most common is a sensation of numbness in the hands and feet.  This side effect is harmless, and is not a cause for concern.  It can usually be reduced by taking more dietary potassium, either in the form of potassium rich foods like bananas, or in the form of potassium supplements prescribed by your doctor.  Other side effects include tiredness, sedation, and speech problems like word finding difficulty.  Some people for example find it more difficult to find the right word while speaking.  An interesting example of this is that some find it more difficult to do crossword puzzles while on topiramate.  These side effects are common enough that about a quarter to one third of people who try topiramate stop it because of them.  Topiramate can also make carbonated soft drinks taste differently and somewhat flat, but most patients do not find this side effect to be a problem, and it is certainly nothing to worry about.

Despite its side effects, however many people tolerate topiramate well.  There are two other much less common side effects which should be mentioned.  One is that topiramate does predispose towards kidney stone formation very slightly.  Therefore, doctors don’t usually give it to people with a prior history of kidney stones.  All people who take it should drink lots of fluids and keep themselves well hydrated.  Topiramate can also on very rare occasions cause acute glaucoma, with increased pressure in one or both eyes.  If this is going to happen, it usually happens within a few weeks of starting treatment.  Symptoms include marked blurring of vision because people quite quickly become very near sighted, and often pain in the eye and redness of the eye. The blurring of vision in this case is very obvious and persistent, and not the minor blurring which people may experience from time to time, for example if their eyes are watering.  If you experience symptoms which suggest you might be developing an eye problem from topiramate, it is time to stop the drug immediately and see your doctor.  Stopping the drug is usually enough to let the pressure return to normal, especially if the medication is stopped very soon after the symptoms start, and everything gets better. It is best to see your doctor to make sure everything necessary gets done.

Topiramate is started at a low dose and built up slowly.  Common ways of doing this are to start off with 25 mg a day, and building up the daily dose by another 25 mg every 2 weeks until you reach the target dose of 100 mg per day.  One can go to higher doses as well.  In the migraine clinical trials, doses as high as 200 mg per day were tested, but these did not seem to work any better in large patient groups than the 100 mg dose.  It is still possible, however, that for some individuals who tolerate the medication well, 200 mg might work better than 100 mg.  Another way to start off topiramate is to take 15 mg per day, and increase the daily dose every week by 15 mg until the desired dose is reached.  The medication is usually taken twice a day when the higher doses are reached because such divided daily dosing was used in the clinical research on this medication.  It does have a long “half life” which means that the body breaks down the medication quite slowly.  It is therefore possible to take the medication just once a day and still maintain fairly even medication levels throughout the 24 hours between doses.  Some people will just take their topiramate at bedtime so that their blood levels of the medication are somewhat lower during the day.  This can help to avoid side effects.

So topiramate is worth discussing with your doctor if your migraines are frequent and troublesome, especially if you have already tried and not had much luck with the beta-blockers and the tricyclics, or if you have a significant problem with being over weight.

Valproate or Sodium valproate: This is another anticonvulsant which has been found in clinical trials to benefit a significant proportion of migraine sufferers.  It also has a significant number of side effects.  Most of the migraine prophylactic drugs should not be taken during pregnancy, and this is especially true of valproate.  It can cause severe malformations of the fetus, so make sure you discuss prevention of pregnancy if you are being prescribed this medication and are in the child bearing years.  It also can cause some degree of tremor (shaking of the hands), hair loss, weight gain, and gastro intestinal upset.  However, many patients do tolerate it well, as not everyone gets these side effects, and the medication can always be stopped if they start to happen and are severe enough to be a problem.  If there is an increase in hair loss, it grows back when the valproate is stopped.  Valproate has also been reported to very rarely cause serious and dangerous liver problems.  These are very rare indeed in otherwise healthy adults, probably less than one in several million patients, but your doctor may want to do some blood tests to check your liver function before and after starting the medication.

Valproate is usually prescribed for migraine prevention in Canada as the divalproex sodium tablet trade named Epival, which is enteric coated.  The medication is usually started at 250 mg once or twice a day, and built up to 500 mg twice a day over several weeks.

Gabapentin: There is less research supporting the use of gabapentin in migraine.  It does seem to help some individuals and make their migraines less frequent, so your doctor may want to try it.  The dosages used are quite variable, and the medication is sometimes built up to quite high doses of several thousand mg per day.  Side effects, in particular sedation, limit how much many patients can tolerate.

Calcium Channel Blockers: Medications in this class that are used in migraine prevention are flunarizine and verapamil.

Flunarizine: Flunarizine is one of the few prophylactic medications that was developed for that purpose.  Clinical trials showed that it helped a significant proportion of patients.  It is usually taken at bedtime in a dose of 10 mg.  It does predispose towards depression, and for this reason is not usually prescribed for people with a history of previous significant depression, or a strong family history of depression.  It is important that individuals on the medication are aware of this possible side effect, so that if they do become somewhat depressed while taking the medication, they can discuss stopping it with their doctor.  Like many other migraine prophylactic drugs, flunarizine can cause appetite stimulation and this can result in weight gain.

Verapamil: Verapamil is an older drug which has been used for a long time for treating high blood pressure and some heart problems.  It is beneficial as a migraine prophylactic for some people with migraine, although not a lot of research has been done on this use of the medication.  It tends to have few side effects, but does predispose towards constipation.

Serotonin Blockers: There are two older medications in this drug class that are used for migraine prophylaxis.  One is pizotifen, which tends to have few side effects other than weight gain in some individuals.  The other is methysergide.  Although quite effective for some people, methysergide has to be used with care, as it can cause a rare by serious complication called retroperitoneal fibrosis.  This is a condition where fibrous tissue forms in the back of the abdominal cavity and this can damage the kidneys if it goes on for too long.  A similar problem can involve the lungs and heart valves.  Although this does sound serious, these complications are rare, and seem to be almost non existent if methysergide is used for only 6 months or less.  In patients where nothing else seems to work, therefore, this medication can be tried, and sometimes seems to be the only thing that works for some patients.  If it is quite successful, repeated courses of 6 months can be given, with a drug holiday of a month or two in between.  Alternatively, if the benefit of the medication is significant enough, it can be used for longer time periods, and periodic testing can be done to ensure that the fibrotic complications are not developing.  This medication is probably complicated enough that it might be time to see a specialist if you need to try it, depending upon how much experience your family doctor has in treating migraine.

Botulinum toxin: Botulinum toxin type A or Botox for migraine treatment has received a lot of press.  This medication is widely used for cosmetic purposes like reducing wrinkles.  For this purpose, it is injected into the muscles under the skin of the face, especially the forehead.  Some people with migraine reported that their headaches were diminished after they received botulinum toxin for cosmetic purposes.  This resulted in clinical research to prove whether or not botulinum toxin benefited people with migraine.  It is fair to say at this point that the jury is still out.  When these large and carefully done trials were analyzed, it was found that many people with migraine who received botulinum toxin did indeed have a significant improvement in their headache problem, but so did the people who received placebo (an inactive salt solution, saline, that was also injected into the muscles of the head and neck).  For patients with intermittent migraine headache attacks on 15 days a month or less, the improvement on placebo was virtually equal to the improvement seen with the botulinum toxin.  In patients who had headache on more than 15 days a month when they entered the clinical research trials, botulinum toxin outperformed placebo on some measures, but not on others.  It is unclear why so much improvement occurred in those receiving placebo in these clinical trials.  Some improvement with placebo is to be expected in migraine trials as it is in trials of many painful and non painful conditions.  The brain’s pain control pathways, it seems, can be activated if patients take something for pain and expect relief, and significant relief occurs as a result in some patients even if they are given something inactive like saline.  In the case of the botulinum toxin trials, there are a number of possible reasons why the amount of improvement seen in patients on placebo was greater than in most other migraine research trials.  First of all, the treatment was much more dramatic that simply taking a pill.  Botulinum toxin is given through over a dozen tiny injections into the muscles of the head and neck.  This could increase the response to placebo.  Secondly, needling these muscles may in itself have some pain reducing properties, as we see with acupuncture, and with a physiotherapy treatment called “dry needling”.  Thirdly, patients may have expected a great deal from their botulinum toxin injections, given the publicity that has occurred surrounding this interesting treatment.  In theory, this could increase the placebo response.  Fourthly, these were long clinical trials that took close to a year, and during this time patients were seen monthly in the clinic.  During this time they may have learned a lot about avoiding migraine from the research nurses and doctors.  Many patients also stopped their overuse of pain killers and other symptomatic migraine medications during this time.  It is unclear if this happened because the botulinum toxin improved their migraine and made it possible for them to do this, or if they were motivated to do so because of their discussions in the clinic.  In either case, stopping medication overuse itself could have led to improvement in many patients.

In summary, more research needs to be done with botulinum toxin and migraine, and this is being planned.  In the meantime, your doctor may want to try botulinum toxin if other prophylactic medications have not worked or there is reason not to use them.  If you have difficult migraine, based on current knowledge and clinical experience, that would seem a reasonable option, but it is indeed important that more research be done.  It is also important that migraine sufferers who try this treatment work hard to reduce their medication overuse if they are overusers, and do all they can to improve their lifestyle and discover and avoid their headache triggers.  At the present time, botulinum toxin would appear to be an option mainly for migraine sufferers with more than 15 headache days a month.

It is also an interesting question as to whether many migraine patients would benefit simply with the injection of saline (salt solution) into the muscles of the head and neck as was done in the placebo groups in the botulinum toxin clinical trials.  It is unclear at this point how much of the improvement in the placebo groups in the clinical trials depended upon the actual injections or on the expectation that the patients had that there was a good chance they might be getting botulinum toxin (even though when they received the placebo injections no botulinum toxin was given).  It may be that the expectation of receiving a possibly powerful treatment was the main factor in making the brain turn on its pain control systems.  In that case, the saline injections would not be expected to work if they were given as a clinical treatment in the clinic if the patients knew what they were receiving.

Botulinum toxin is in some ways not the simplest headache prophylactic treatment.  It needs to be injected every 3 months or so, as the effect wears off.  It is given by needle into muscles of the forehead, temporal regions, and in the back of the head and neck, and usually this means well over a dozen small injections.  Although it is a very powerful toxin (poison), in the well controlled tiny amounts given in treatment, it has very few side effects.  If enough spreads down into the eyelids, it may cause drooping of the eyelids which will last a number of weeks, but this is unusual.  It may also cause a temporary feeling of heaviness in the neck.  Botulinum toxin makes muscles weak because it temporarily takes away some of their nerve supply.  After treatment for headache, as after treatment for wrinkles, people will find it difficult or impossible to raise their eyebrows or wrinkle their forehead normally for several months.  These are all side effects which may bother some people.  Just how botulinum toxin might reduce headache is not known, although this effect likely involves the pain nerves of the head and neck and is probably not dependant on the production of muscle weakness or muscle relaxation.

Other medications used for blood pressure control:  Occasionally patients with migraine who receive other types of medication for blood pressure control  (besides beta-blockers and verapamil)  will report an improvement in their migraines.  One example is patients receiving candesarten.  A clinical trial has shown that candesarten can improve migraine in some patients.  Therefore, although not widely used for migraine prevention, it is an option which can be tried.

Other miscellaneous migraine preventives: Some plant products have been used for migraine prophylaxis.  One of the best known is feverfew, which is sold in many pharmacies.  Feverfew has been tested to some extent through clinical research, and it does indeed have a measurable effect in making migraine less frequent, although this is probably less than many of the drugs used in prophylaxis.  It is important to recognize that feverfew, although it generally has few side effects, is actually a drug itself, and the active chemical in feverfew which produces the anti migraine effect has been identified.

Magnesium may also have the ability to reduce the frequency of migraine in some people, although the research has been conflicting as to whether it is effective or not.  Any migraine preventive effect that it might have does not seem to be very strong.  However, it has few side effects in recommended doses, and may be worth a try.  There are many different forms of magnesium available.  One that is absorbed better from the gastrointestinal tract than many others is magnesium citrate.  A common dose is about  300 mg  twice a day.

The B vitamin, riboflavin, has also been tried for migraine prophylaxis.  There is some research that supports its use, although its benefit in practice appears to be limited.  It has few side effects. The dose that reduced migraine frequency that was used in the research trials was 400 mg taken once daily.  This is a high dose, and is about ten times the amount that most people need each day to prevent riboflavin deficiency.  You should discuss this with your doctor before starting it.

Sometimes some of the non-steroidal anti-inflammatory drugs, like aspirin or naproxen are used daily for migraine prophylaxis.  This may benefit some people, but is not widely done.  First of all, taken on a daily basis these medications can have significant side effects like gastrointestinal irritation, ulceration, and bleeding.  Secondly, unless the dose is very low, there is also concern that in some migraine sufferers these medications can cause medication overuse headache with worsening of the migraine.  In most cases, other prophylactic medications should be tried first.