A neurologist answers some common migraine questions

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It’s often said that migraines are ‘more than just a headache’ – yet if you’re not among the one in seven people who suffers from them, or their families, it’s very likely you’ll just tag migraine as a headache, albeit possibly a very bad one.

But migraines can be immensely debilitating and cause a range of symptoms, beyond headache pain.

The Migraine Trust (migrainetrust.org) says migraine is more common than diabetes, epilepsy and asthma combined, and this Migraine Awareness Week (612 September), the charity is highlighting migraine triggers, which can include stress, poor sleep, alcohol, hunger, hormonal changes and the environment. It’s also a good opportunity to raise awareness of migraine symptoms, which include a painful headache, vision problems, sensitivity to light, sound and smells, plus nausea and vomiting.

Here, Dr Ben Turner, a consultant neurologist, explains more about the condition.

What causes migraines?
“In neuroscience terms, migraine is a ‘disorder of central sensory processing’, or in non-medical terms, ‘incorrect signals within the brain’. In essence, the cause of migraine is the complexity of the brain – 86 billion neurons are bound to misfire at times,” says Dr Turner. “The brain is a highly sophisticated computer and, like computers, it may inexplicably freeze and need reboots. On an individual level, the main risk factors for migraine are genetic – i.e. a family history – and lifestyle, lack of meals or sleep.”

Are some people more likely to suffer migraines?
“Migraines are more common in females, particularly between the onset of menstruation and menopause. People with relatives, such as parents or siblings with migraine, will be more prone to suffer, too.”

What are the treatments and how successful are they?
“There are three pillars of treatment: lifestyle, treatment of individual attacks (acute management), and preventative treatments (prophylaxis),” explains Dr Turner, who stresses that all of these can play an important role in managing migraine.

“Lifestyle is about routine, regular diet – breakfast, lunch and evening meals – and avoiding low blood sugar, which is a biological stress and trigger. Whether individual foods act as a trigger is less clear, but chocolate, caffeine and dairy are considered potential triggers, in addition to alcoholic drinks – although triggers tend to be unreliable and individual. It’s established that shift workers are more prone to migraine, so regular sleep patterns reduce the risk. Regular exercise is also protective.

“Acute management is about taking medication early, such as soluble aspirin in a carbonated drink with caffeine. Alternatives to aspirin are the triptan family of drugs, which are now available over the counter. Both these approaches should ease two-thirds of migraines – they don’t stop all attacks, but doses can be repeated if necessary. If nausea is a factor, then using medication to treat this is important.

“Prophylactic treatment used to require taking a medication such as a beta blocker, antidepressant or anti-epileptic medication regularly for weeks or months. More recently, a new group of drugs targeting the calcitonin gene-related peptide pathway has shown good outcomes. On average, these preventative treatments reduce migraine attacks by 50 per cent.”

How psychologically damaging are migraines?
“Regular migraine sufferers are more prone to low mood and anxiety, not just because of the regular threat of incapacitating attacks, but it appears the changes in the brain before and after migraine also make individuals low in mood,” says Dr Turner.

Keep a migraine diary to spot triggers
“A migraine attack is often triggered by something, and understanding what triggers your attacks can help you manage it,” explains Migraine Trust spokesperson Una Farrell. “Triggers vary for different people – alcohol might be a trigger for one person, while hormonal changes might trigger monthly attacks for one woman but not another.”

Ms Farrell says identifying a trigger isn’t always easy, and they can sometimes be wrongly identified. “For example, at the beginning of an attack, before the pain’s begun, you may experience a craving for sweet things,” she says. “If you eat some chocolate to satisfy this craving, and then get a headache, you may identify chocolate as one of your triggers. In fact, you were starting to get a migraine before you ate the chocolate.”

A good way to identify triggers, she says, is to keep a detailed diary of your activity, food and drink, changes to your mood and body, and external factors such as the weather and room temperature, to help you spot patterns and thus identify your real migraine triggers.

Migraine and Headache Australia are offering the chance to learn from Australian headache experts and ask questions live from 1418 September 2020. See here for more details.

Do you suffer from migraines? What do you do when you feel one coming on? Do you feel others are sympathetic or do they not understand how debilitating they can be?

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