Headache Medicine 2020, 11(1):7-9 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.3

Headache Medicine

Original

The Migraine Tree: a shared tool for migraine information

A Árvore da Migrânea: uma ferramenta compartilhada para informação sobre migrânea

Elizabeth Leroux

Brunswick Medical Center, Montreal, Canada.

Abstract

Migraine awareness is a critical step in minimizing the disease burden. The Migraine Tree is

a web structure designed by a Canadian team to inform people living with migraine and give

them the knowledge they need to understand their disease and make daily decisions. This

article summarizes the reasons for the creation of the Migraine Tree, its design and underlying

principles and proposes future collaborations for translation in other languages.

Resumo

A conscientização sobre a migrânea é uma etapa crítica para minimizar a carga da doença.

A Árvore da Migrânea é uma estrutura online projetada por uma equipe canadense para

informar as pessoas que vivem com migrânea e fornecer o conhecimento necessário para

entender sua doença e tomar decisões diárias. Este artigo resume os motivos da criação

da árvore da migrânea, seu design e princípios subjacentes e propõe futuras colaborações

para tradução em outros idiomas.

Elizabeth Leroux

Medical Center, Montreal, Canada

leroux.mail@gmail.com

Received: March 26, 2020.

Accepted: March 28, 2020.

Edited by

Mario Fernando Prieto Peres

Keywords:

Migraine

Awareness

Education

Palavras-chave:

Migrânea

Conscientização

Educação

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Leroux E

The Migraine Tree: a shared tool for migraine information

Introduction

he Migraine Tree is a web structure designed by a Canadian

team to inform people living with migraine and give them the

knowledge they need to understand their disease and make daily

decisions. This article summarizes the reasons for the creation of the

Migraine Tree, its design and underlying principles and proposes

future collaborations for translation in other languages.

A need for therapeutic education tools

Therapeutic education has been recommended to manage chronic

diseases

. A World Health Organization report in 1998 summari-

zed its principles and benets. People living with migraine make

numerous decisions every day related to their condition and need

the knowledge to make choices that will allow them to function and

avoid negative consequences. A systematic review of therapeutic

education for migraine found positive outcomes on quality of life,

headache related disability, depression and headache frequency

The amount of information on migraine that has to be explained to

patients is overwhelming. It cannot be synthetized in a busy clinic visit.

Physicians may not have the time or communication skills to effectively

counsel patients

. Education sessions have been found to be effective

to improve outcomes and limit visit to the emergency department,

but organizing and funding such sessions is not always possible

. The

amount of misleading information available online is signicant.

People looking for reliable information can be bewildered by the

numerous promises of cures and quick xes. On the other side,

scientic websites and blogs sometimes have too much unclassied

information, making it difcult to nd the topic needed. Every person

with migraine has different needs. Attacks, symptoms, triggers and

response to therapy vary. Having access to relevant, easy to unders-

tand information is crucial for migraine management. Some resources

are also written in a language for health care providers and do not

necessarily address people’s needs and concerns.

The Migraine Tree structure and design

The Migraine Tree is an original idea of Dr Elizabeth Leroux, a

headache neurologist from Canada. After years of involvement in

headache care and counselling, and previous web experiences with

Migraine Quebec, she realized that a structure could help patients

and health care providers to nd what they need, contribute to a

better understanding of the global approach and also have an

educational value for health care providers not familiar with mi-

graine management.

It was very important to choose a positive symbol for the structure.

The Tree was chosen as a symbol of growth. Every culture, every

country is familiar with trees. Trees assemble in forests, communities.

They are resilient, they can lose their leaves and then grow new

ones. They can bear owers and fruits. Every person with migraine

is part of a forest and can grow as new skills are learned.

The Migraine Tree uses a structure linking the network of the roots

to the trunk and then to another network of branches. The structure

was presented to patients during a focus group for feedback and the

structure was found to be easy to use and understand. One interes-

ting points the patients provided was that the the word «alternative

therapies» was not used. This was a mindful decision, as opposing

alternative and traditional medicine was not thought to be benecial

to patients. For example, some supplements have been shown to be

effective for migraine prevention and acupuncture is also supported

by evidence.

For some options at the Leaf level, two pages exist on a single topic:

the WHY focuses on the rationale and proof of effectiveness. The

HOW presents practical tips to use the treatment.

The Migraine Tree visual design was accomplished through a gra-

phic design contest led by 3aLogic, a company based in Quebec.

The nal design was chosen for its simplicity and colored in green

and blue, in order to offer a soothing image. Images accompanying

the texts were acquired in majority from the 123RF database and

paid for by Migraine Canada. The team valued positivity, diversity

and even humor to give an encouraging vibe to the readers. In the

team’s experience, people with migraine do not like to see images

of pain and suffering repeatedly, as is unfortunately the case in

the media.

Figure 1. The Migraine Tree.

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Leroux E

The Migraine Tree: a shared tool for migraine information

is the excess of distracting ads that may bother people with migraine

who are photosensitive. It can be used in the clinic for teaching, the

health care provider familiar with the pages being able to point out

which topics are of interest from a particular patients.

The writing of the content

Topics were chosen and structured by Dr Leroux. Due to the large

numbers of pages needed (close to 140), a team of Canadian

writers was assembled. All writers were volunteers and agreed to

decline authorship on the texts they provided. The guidelines of

the Sick Kids Hospital from Toronto were used to determine format

(PDF). The format chosen for most pages is a Question and Answer,

that makes browsing for specic information easier. Questions were

inspired from the clinical work of the health care providers who

contributed. A checklist format has also been used, especially for the

HOW pages. The pages have been limited to 600 to 900 words to

avoid reading fatigue. The tone, format and style of pilot pages

were reviewed by volunteer patient editors to provide guidance

to the writers. Writers were instructed to write in an accessible

and friendly way. They were encouraged to describe the typical

challenges met by patients and choose words to empower them as

much as possible. Some articles are more complex and may not

be accessible to all readers but could benet readers with higher

literacy or scientic background.

In order to optimize search engine optimization (SEO), internal

and external links were included in the pages. Key words and tags

were selected. Scientic references were imported from Pubmed,

prioritizing recent review articles.

A branch of the tree (Social Life) is still to be written by patients. This

branch focuses on social impact of migraine and how to deal with

relationships, school, and the workplace. Input from patients will be

solicited through Migraine Canada in 2020. Engaging the patient

community is extremely important.

Building a Migraine Tree community, sharing with

other countries

The Migraine Tree was created in a spirit of sharing. The need for

patient information of migraine is universal. Migraine is a common

disease in all countries. Numerous resources are available in the

English language, with the United Kingdom and the United States

leading the way with well-organized and nancially sustainable

associations. For other languages though, resources are scarce.

Headache associations don’t always have the resources necessary

to build elaborate educational tools. Reinventing the website wheel

for each country, each association, would be time consuming for

busy health care providers and volunteers alike. One of the goals of

the team was to save time to other patient associations. In order to

facilitate sharing, all the pages of the Migraine Tree are archived in

a DropBox. Folders and pages all have an ID number. This archive

is easy to share for translation.

Another important aspect of the Migraine Tree is its sustainability.

As it is based on a hierarchical ensemble of numerated articles, it

can be maintained relatively easily as knowledge progresses. Each

article could be improved by requesting feedback from patients. As

long as there is no duplication, new leaves can be added or even

replace a similar leaf with a better version that can then be trans-

lated in other languages, a bit like the articles of the Wikipedia

encyclopedia. Pages containing country-specic data would need

to be adapted (lists of medications, coverage comments).

In order to improve the Migraine Tree, feedback from users should be

gathered in the future, both from health care providers and patients.

Concl usion

The Migraine Tree is a new online structure offering people with

migraine a wealth of reliable information in a format that is easy to

browse. Future collaborations could be developed with other coun-

tries to make this information accessible to more people.

References

1. Ofman JJ, Badamgarav E, Henning JM, Knight K, Gano AD,

Jr., Levan RK, et al. Does disease management improve clinical

and economic outcomes in patients with chronic diseases? A

systematic review. Am J Med. 2004;117(3):182-92.

2. Kindelan-Calvo P, Gil-Martinez A, Paris-Alemany A, PardoMon-

tero J, Munoz-Garcia D, Angulo-Diaz-Parreno S, et al. Effective-

ness of therapeutic patient education for adults with migraine. A

systematic review and meta-analysis of randomized controlled

trials. Pain medicine (Malden, Mass). 2014;15(9):1619-36.

3. Fortin AHt. Communication skills to improve patient satisfaction

and quality of care. Ethn Dis. 2002;12(4):S3-58-61.

4. Lagman-Bartolome AM, Lawler V, Lay C. Headache Education

Active-Waiting Directive: A Program to Enhance Well-Being Du-

ring Long Referral Wait Times. Headache. 2018;58(1):109-17.

Table 1. The different levels of the Migraine Tree.

Level Denition Examples

Roots The medical background and diversity of people with migraine. Medical and psychological comorbidities

Hormonal factors

Other headaches

Trunk information that is relevant for most people with migraine at the beginning of

their journey to improvement

Causes of migraine

Use of a diary

Research and placebo response

Branches Treatment approaches are presented on an equal level. Behavioral approaches, acute and preventive

medications, neuromodulation

Leaves Details on approaches, skills and treatments. Individual medications, devices, skills