Millions of Canadians suffer from migraines—but there is relief. Here's what you need to know about this painful condition and how to keep it under control

By Lesley Young

How to control migraines

Migraine is a painful recurrent headache disorder sometimes accompanied by other symptoms such as nausea and sensitivity to light and sound. Migraine sufferers, who number roughly three million women and one million men in Canada, can get headaches with or without “aura.” The 10 to 15 percent who experience aura see transient visual disturbances such as light flashes or zigzag patterns.

One of three primary headache disorders, “migraine should be treated as a chronic illness, but it’s often not given its fair due,” says Dr. Werner Becker, a neurologist and professor in the departments of clinical neuro-sciences and medicine in the University of Calgary’s faculty of medicine. He heads up the Calgary Headache Assessment and Management Program at the Foothills Medical Centre, a leading headache treatment facility. “Historically, migraine has been under-treated,” adds Dr. Rob Cowan, medical director of the Keeler Center for the Study of Headache, a non-profit clinic in Ojai, Calif. “It’s partly our culture; people feel it’s a weakness of the constitution and that sufferers should tough it out. In general, there’s failure to recognize that migraine is a real condition that is incredibly disabling.” Just half of Canadians with migraine are likely to have been diagnosed and, of these, many may give up on treatment, or suffer in silence.

Migraine sufferers experience attacks anywhere from once or twice a year to every day. Whatever the occurrence, it is important to have migraine diagnosed, says Cowan. Clear diagnostic criteria are available, and once other causes are ruled out, doctors should work with patients to develop a multidisciplinary treatment plan. If it’s left untreated, or treated improperly, migraine can become “chronic.”

And that’s not all. Increasingly, migraine is being linked to risk of heart disease and stroke. A recent Icelandic study, published in the British Medical Journal in August 2010, showed that people who experienced migraine with aura were 27 percent more likely to die from cardiovascular disease than those with no headaches.

The good news? Researchers are developing promising new treatments, and there is growing recognition that migraine research—both into causes and patient care, as well as into treatment development—needs to be addressed with the same energy, dedication and focus as any other serious illness.

What causes migraines?

For some time, migraine was thought to be a result of blood vessels dilating and then constricting too rapidly and causing pain. In the 1970s, researchers recognized there had to be a problem with the nerves in the brain, and the emphasis switched to neurological causes, explains Cowan. “Now, the view is that migraine is a combination of both.”
In the brain stem, incoming stimuli—sounds and sights, for example—are categorized as dangerous or safe, and the brain responds with pain or nothing, respectively. “In people with migraine, this nerve processing is disrupted and a normal stimulus is perceived as painful. As a result, chemicals are released that change the diameter of the blood vessels, causing pain,” says Cowan. Just what makes the brain stem misread certain signals and cue pain is unknown.
Neither is it understood why migraine sufferers do or don’t have aura, says Becker. Researchers theorize that an interaction of several factors, including abnormalities in the central nervous system that increase pain sensitivity and perception, and changes in neurotransmitters, are at play.

Migraine may also be hereditary—although you can have the gene without getting the symptoms. A landmark study published in Nature Genetics in August 2010 found that 24 percent of people with migraine have a particular variant on a gene involved with the neurotransmitter glutamate. This discovery opens the door for new studies to look in depth at how this gene variation may exert its effect.

How to control migraine triggers

While you may inherit the migraine gene, the tendency and frequency of migraine episodes depend greatly on your lifestyle, and the triggers you experience. “Migraine is a condition that is very sensitive to whatever is happening in your life,” says Becker. “Patients often don’t want to take responsibility and learn self-management skills for migraine, such as how to manage their stress. It’s a big barrier for treatment.”

Migraine patients report many triggers including stress, sleep deprivation and irregular food intake
(skipping meals). Many female migraine sufferers will have menstrual-related migraines, which may last longer at higher intensity and can be more difficult to treat.

According to Dr. Michel Aubé, senior neurologist at the Montreal Neurological Institute and Hospital, and associate professor in the faculty of medicine at McGill University, many patients report certain foods, such as aged cheese and alcohol (red wine especially), bring on an attack. They are advised to avoid any personal triggers. Becker’s research team in Alberta has found that changes in outdoor temperature can also be a trigger—e.g., Calgary’s sudden mild weather pattern (a chinook).

In many instances, being prepared for an attack can successfully treat migraine. That means knowing your triggers and using appropriate medications as advised by your doctor at the first symptoms. However, a study published in the journal Headache in March 2010 showed that only 21 percent of migraine sufferers could predict their next attack within three days, and 92 percent reported being forced to change daily plans. So experts recommend people keep a diary to help identify and avoid triggers, and discuss troublesome ones (such as lack of sleep) with a doctor.

People with migraine also tend to treat themselves progressively by taking less than the prescribed amount of medication at the first sign, and then waiting a few hours before taking more, explains Aubé. That approach isn’t as effective as taking the prescribed dose at the outset to manage the pain at its worst. Four out of five migraines can progress to severe intensity if not treated right away with the advised medications.

This article was originally titled "Migraines Can Be Managed” in the January/February 2011 issue of Best Health. Subscribe today to get the full Best Health experience—and never miss an issue!—and make sure to check out what's new in the latest issue of Best Health

Best Health Magazine, January/February 2011

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