Migraine is a common and often debilitating condition, with around 4.9 million Australians affected, nearly three quarters of them women. Despite being so common, migraine remains under-diagnosed and under-treated. Only 40% of people with migraine seek medical help, only 10% are correctly diagnosed and only 4.5% get treatment!

And yet there have been some significant breakthroughs in the last few years, particularly with medications offering effective prevention of attacks for chronic migraine sufferers. 

 

What’s the latest?

Let’s cut to the chase, because if you are a frequent migraine sufferer, this is what you want to know!

Frequent migraines are one of the most debilitating illnesses around. The key to treating this type of migraine lies in preventing attacks from occurring in the first place or at least reducing the number and severity of them. Most preventer medications to date were not specifically designed to treat migraine, but a reduction in migraine was noted as a “side-effect”. Medications for blood pressure, depression and even epilepsy have been used and work really well for many migraine sufferers. Some people can’t tolerate them though, as they may have other unwanted side-effects.

Now we have a new kid on the preventer block, CGRP monoclonal antibodies (mabs). CGRP is a neurotransmitter thought to be key in the onset of migraine. CGRP mabs block either the CGRP receptors on the brain cells or some of its chemical signallers.

The types available in Australia come in injection form and need to be initiated by a specialist neurologist. They don’t come cheap but if certain strict criteria are met, including having failed on other types of preventers, they are subsidised by the PBS.

Bottom line: if you are experiencing more than 3-4 migraine attacks per month, you should be considered for prevention medications. Start with a visit to your GP.

OK, now for a quick crash course in migraine…

 

How is migraine different from a “normal” headache?

Here’s what we need to diagnose migraine:

The headache has at least 2 of these..

  • one-sided 
  • throbbing 
  • moderate to severe in intensity 
  • aggravated by movement 

PLUS at least one of these..

  • nausea 
  • vomiting
  • sensitivity to light
  • sensitivity to sound

AND it lasts for between 4-72 hours.

There are several different subtypes including migraine with aura, aura without headache, menstrual migraine, vestibular migraine and abdominal migraine.

 

What causes migraine?

Whilst we don’t fully understand the cause we think it’s a complex combination of genetics (90% have a family history), hormones (migraine is twice as likely in women), external triggers and sensory processing problems that lead to a cascade of neurotransmitter chemicals that trigger pain and blood vessel changes in the brain.

 

When to see your doctor

If you are experiencing headaches of any type, you should always see your GP. We can rule out other causes and ask questions about any of the migraine-type patterns described above. We will often ask you to keep a headache diary for a period too.

If you have already been diagnosed with migraine and are still getting frequent attacks or have noticed a change in the pattern, you should also get this checked. Treatments may have changed since you last saw your GP! Often it’s a matter of trial and error and finding what works for you.

 

Treatment options

Lifestyle factors for migraine prevention
Identify (then try and avoid!) your triggers. A headache diary can help. Common ones include:

  • Stress
  • Lack of sleep
  • Certain foods eg chocolate, caffeine, processed food, MSG
  • Alcohol, especially red wine
  • Sensory triggers like bright or flickering lights, strong smells like perfume
  • Hormone changes around the menstrual cycle or peri-menopause

Other lifestyle tips:

  • Good quality sleep – check out these tips
  • Hydration – keep up your fluids, 1.5 – 2L of water per day
  • Diet – eat a healthy diet, don’t skip meals and avoid or minimise processed food.
  • Exercise – aim for 30-50 minutes 3-5 days per week
  • Physical therapies like physiotherapy, massage, acupuncture
  • Relaxation techniques such as breathing exercises, meditation or yoga
  • Counselling and cognitive behavioural therapy to help manage stress, anxiety or depression

Medications for migraine prevention

  • Supplements: magnesium, vitamin B2 (riboflavin) and coenzyme Q10
  • Prescription medicines: beta-blockers, serotonin blockers, some anti-epilepsy medicines, some older style anti-depressants, botox injections.
  • CGRP monoclonal antibodies (see above!)

Acute management of an attack
The aim here is to be headache free within 1-2 hours.

  • Recognise the warning signs
  • Treat early! Paracetamol, aspirin or ibuprofen, anti-nausea medication, caffeine, triptans or CGRPs. 
  • Keep up the hydration
  • Try and stop what you’re doing and find somewhere quiet and dark to rest

If you are needing acute migraine treatment more than 3-4 times a month, it’s worth a visit to your GP to explore whether some other treatment options might be better for you.

Photo by Pavel Danilyuk

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