Migraines and headaches: New ways to beat the pain
For the one in seven Aussies who suffer from migraines, the pain can be crippling. Our experts discuss common causes — and the latest treatments to ease symptoms.
For anyone who can shift a headache with a couple of paracetamols, it may be hard to understand that a migraine can put you out of action for hours, if not days.
Ever wondered how bad a migraine can be? “During a severe attack, some people feel they would rather be dead, in contrast to people who have had a heart attack and worry they may die,” says neurologist Dr Jon Simcock.
Watch someone grappling with a migraine, and it’s easy to understand why World Health Organization experts have called migraine the third most disabling human medical condition.
What is a migraine?
Migraines affect about one in seven people and may be experienced regularly — on average, around 13 times a year. For around 30 per cent of people who get them, migraines are preceded by an aura — that is, loss of vision and flashing lights. Migraines are often accompanied by nausea and vomiting, and they can also be associated with hypersensitivity, particularly to light and noise, and sometimes even to strong smells.
A migraine can last for hours or days. The severity and frequency of migraines can be highly variable between people, and over one person’s lifetime. It happens as a result of abnormal brain activity affecting nerve signals. Pain nerves switch on when nothing is wrong, forcing the body to experience and cope with a series of other changes.
Learning to recognise your triggers for a migraine can give you some ability to help deal with an attack, and to avoid or limit the impact migraines have on your life.
We don’t yet know the underlying causes, but some common factors may bring on a migraine.
The six usual suspects are:
Specific foods and drink
Common triggers include chocolate, caffeinated or alcoholic drinks, artificial sweeteners, and cheese.
This common trigger is easiest to avoid by ensuring you drink eight glasses of water, spacing them out throughout the day.
Change to routine
Skipping meals, sleeping in at the weekend or doing an all-nighter at work are all potential triggers.
Both too much and too little sleep are linked to a migraine attack.
Anxiety or stress
Some sufferers say that any kind of tension or shock leads to an attack. Others report that a migraine strikes once stress is reduced — at weekends or on holiday. Learning how to pace yourself may help prevent migraines.
For women, migraines may improve during the later teens and 20s, only to worsen after having children, then improve again after menopause. For some women, migraines are predictable at certain times in their monthly cycle.
Managing your migraines
There’s currently no cure for migraines, but that doesn’t mean nothing can be done to reduce the frequency of your attacks or the severity of pain.
Prevention measures include managing your usual triggers. This might mean eating regular meals, staying hydrated, getting the right amount of sleep and learning to manage stress better.
Headache specialists say that simply eating a ‘trigger’ food, such as chocolate or cheese is unlikely to bring on a migraine attack on its own. More often it’s a combination of events that are collectively to blame fora migraine attack, such as a late night, drinking red wine and coffee, becoming dehydrated and getting up late.
A range of prescription medications is available to relieve the pain and nausea of migraines. In addition to medication, most people find lying in a quiet, darkened room, using hot and/or cold packs, and applying pressure around the temples, helps them to relieve, or at least tolerate, the pain.
The evidence for different therapies to treat migraines and other headaches is not strong, as the body of research is limited. However, for people who suffer frequent or severe migraines, trying different treatments, as long as they do no harm, could reap huge rewards.
What are rebound headaches?
Here’s a good reason not to pop those pills if you don’t really need to. If you overuse headache medication, you can get more headaches!
Medication overuse headaches (MOH) are the third most common headache type (after tension and migraine). The only way to stop the cycle is to go cold turkey on the medication, with medical supervision. Speak to your GP if you think you might need medical help.
Botulinum toxin A (better known as Botox) treatment works by temporarily blocking the release of chemicals in the brain that are associated with causing chronic migraines. It is administered by injection. In 2014, Botox became available on the Australian Pharmaceutical Benefits Scheme (PBS) for those who meet certain criteria.
The Botox treatment involves multiple tiny injections to the face every 12 weeks. Two large randomised clinical trials have found the treatment to be effective, with no serious, irreversible side effects reported.
2 New drugs for anti-migraine
A breakthrough new migraine treatment is now under medical review by the PBS. Aimovig, also known as erenumab, is the first preventative drug designed specifically to stop a migraine before it starts. Trials show that this treatment is safe and effective, with many patients experiencing a significant reduction in the frequency of their migraines.
Stimulating acupoints may ease your pain by encouraging production of endorphins (natural painkillers). This alternative treatment may help treat frequent tension-type headaches, and could also help those who suffer from migraines, according to two studies that were reported in 2016.
A medication-free approach to migraines is to treat muscle tension in the neck and improve posture, which can release pressure that may lead to headaches and migraines. One technique developed by an Australian physiotherapist, the Watson Headache Approach, has shown an 80 per cent improvement in symptoms. For more information, visit watsonheadache.com
Products on the markets that combine 400mg of vitamin B2 with 400mg of magnesium and 150mg of co-enzyme Q10, have had some effect in preventing migraines. Magnesium is a brain electrolyte thought to be beneficial for clearing some headaches.
6 Devices to stimulate nerves
Similar to the TENS machines used for pain-relief during labour and for some health conditions, neuromodulation devices help prevent migraines by stimulating nerves on the head and neck with electrical pulses. The idea is that, over time, the electrical stimulation calms down the brain waves. Several different devices are available, including the Cefaly, an external nerve stimulator worn for 20 minutes a day. It can be used to prevent a migraine attack, or to treat the pain that occurs once an attack is underway.