Migraines are a debilitating physical problem that upend a sufferer’s social and work lives. But how do you treat something medicine knows so little about?
Migraines are the most common form of headache, affecting an estimated two million Australians – about 1 in 6 women and 1 in 16 men – and can blight the everyday lives of sufferers.
"They hit me on the weekends, so I have to cancel all plans," says migraine sufferer Clare, 29. "At work, there are days where I just can't look at the computer screen. I have to make up the time after hours if I want to keep up."
"Migraines are not likely to take life, but can destroy the quality of life," says Dr Daniel Lane from Perth Brain Centre in Attadale, a chiropractor with a special interest in brain-based disorders. He adds that while anyone – including children – can get migraines, the most likely sufferers are women in their 20s and 30s.
But widespread as migraines are, there isn't much in the way of medically proven hard facts about them, whether that be what causes them, how to treat them or how to prevent them. "They are considered to be a disorder of the brain, and it is clear that genetics often has a role to play," says Dr Lane. "Sophisticated brain imaging has also shown abnormalities in the function of parts of the brain known as the brain-stem and cerebral cortex."
While people may say they have a migraine, sometimes what they're enduring is a tension, hypnic or cluster headache. A true migraine is usually (but not always) on one side of the head and can last two to seventy-two hours, with a side serving of throbbing pain, nausea and/or vomiting and sensitivity to light and/or sound.
"Migraine is a very complex condition that requires complex care," says Dr Rob Cowan, director of the Stanford Headache Clinic at Stanford University. "We don't have a cure, so the goal is to manage it as a chronic condition."
Scientists do know what happens physically when an attack occurs. Stanford Headache Clinic explains it as a noxious stimulus reaching the trigeminal nerve (one of the cranial nerves that mediates sensation in the head), triggering the release of chemicals called vasoactive peptides that create changes in the diameter of blood vessels in the membrane lining of the brain. That also changes the ability of nerves in particular parts of the brain to fire correctly, and causes the brain to become overly sensitive to sensory input (explaining sensitivity to light and sound).
"Many people that suffer migraines recognise that they experience five different stages that reflect the different underlying neurological changes that occur," says Dr Lane. "These are: early warning symptoms; aura; the headache itself; resolution; and recovery."
Early warnings may include general aches and pains (especially neck tension and stiffness), changes in mood, lethargy, incessant yawning, difficulty thinking, changes in appetite and gut problems such as constipation or diarrhoea.
There are several categories of migraine, and knowing what type you suffer from determines how best to manage it, with treatments varying accordingly. The classic migraine is preceded by a warning symptom, the aura (which may include visual changes such as flashing lights, difficulty focussing, blind spots and zig-zag lines). Headaches that begin with pain and no warning are known as common migraine, although there are several less well-known forms. Migraine can also include more than one type of headache (such as migraine plus tension headache).
"Headache management has really improved over the last decade," says Dr Meredith Barad, a Stanford Headache Clinic neurologist with additional training in pain management. "We are no longer throwing opiates at the pain; studies show they don't work."
The Stanford Headache Clinic's treatment integrates medical, complementary and behavioural medicine. Dr Cowan says, "We offer physical therapists who understand people with migraines are sensitive to touch, psychologists who understand a migraine is a genetic condition at the interface of mind and body, nutritionists who understand it's not just what you eat but when, and neurosurgeons, pain specialists, sleep experts, endocrinologists, gynaecologists and primary care doctors who recognise the needs of patients who experience severe headaches."
The Stanford Headache Clinic recommends regular sleep, regular mealtimes and exercise, recognition of triggers and monitoring of issues such as sleep apnoea and jaw clenching.
'Non-traditional' therapies the clinic uses include biofeedback, yoga, and acupuncture.
Physical therapy via a chiropractor or physiotherapist may also help. "Chiropractors concentrate on the relationship between the spine and the nervous system, so we use spinal adjustments to correct impairments, which may cause a variety of symptoms including headaches," says Dr Joshua Tymms of Duncraig Chiropractic. "In a study at Macquarie University, specific chiropractic adjustments to the spine significantly reduced migraines in 71 per cent of the people surveyed. The frequency, duration, severity and amount of medication required improved markedly."
Kylie Tomich, physiotherapist and owner of BodyMove Physiotherapy in Claremont says two ways to prevent migraines are by managing the tension in your muscles, and decreasing the stiffness of the joints, specifically around the neck and shoulders. "One way a physio works is through mobilisation of the joint, releasing a tightness in the muscle, and treating neural tension," she says. "People trying to manage tension should have regular physiotherapy, and partake in a regular exercise program."
Early recognition and then having a treatment plan in place, ensuring you have medication on hand, are important. Over-the-counter analgesics such as ibuprofen and aspirin may assist with mild to moderate and relatively infrequent attacks, but frequent or neurological migraines are best treated with preventative medicine, according to the Johns Hopkins Medical Center in the USA. This might include vitamins and daily prescription medications often used for other medical purposes, like blood-pressure drugs, antidepressants, or epilepsy medications. Individual headaches, the Center says, are best treated early with meds including triptans (that constrict blood vessels in the brain), NSAIDs (non steroidal anti-inflammatories), anti-emetics (anti-nausea), and sometimes narcotics or steroids. Botulinum toxin A has also proven effective.
Interestingly, some sufferers (or migraineurs, as they are dubbed) find their attacks diminish with age – and for women especially post-menopause. This is possibly linked to the rebalance of hormones in the human body, and hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle.
Recognising your personal triggers and warning signs seems to be the key to early prevention and management. "Normally the pain starts as a small headache around my forehead," says Clare. "If I take small breaks and really try and relax more, don't take work home on week nights, see a physio to relieve muscle tension, and clear my mind with meditation I can reduce the incidence of migraines."
Headache specialists may tell you that implementing lifestyle changes are as important as medication. Often it's the little things that set up an attack, so generate a routine that has worked smoothly for you in the past and stick to it like glue – regular meal times, regular sleep and regular exercise. While there is a huge range of options, it's often this modest 'tweaking' of lifestyle that can result in huge decreases in the frequency and severity of attacks.
Trigger points
What causes your migraine? John Hopkins Medical Center in the USA says triggers may include:
-
Alcohol
-
Weather changes
-
Lack of sleep
-
Schedule changes
-
Dehydration
-
Hunger
-
Certain foods
-
Strong smells
-
Teeth grinding at night
-
Menstruation
BodyMove Physiotherapy, Claremont (08) 9286 1661, bodymove.com.au; Duncraig Chiropractic (08) 9246 9558, duncraigchiropractic.com.au;
Perth Brain Centre, Attadale 0430 099 647, perthbraincentre.com.au.