Headache Medicine 2020, 11(1):7-9 ISSN 2178-7468, e-ISSN 2763-6178
DOI: 10.48208/HeadacheMed.2020.3
Headache Medicine
© Copyright 2020
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.
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.
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
Received: March 26, 2020.
Accepted: March 28, 2020.
Edited by
Mario Fernando Prieto Peres
Leroux E
The Migraine Tree: a shared tool for migraine information
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
. 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.
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 specic 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.
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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
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