Tracy Murray is no stranger to the pain of migraine headaches. Her migraines usually come on like a knife behind one eye and have plagued her since childhood, says the Toronto kindergarten teacher. They run in the family, she adds: “My mom had them all her life. One Christmas dinner, she couldn’t even come downstairs.”
Murray’s headaches have ranged from one a month to three or four a month at different times in her life, and they can be can be triggered by stress, a change in air pressure, her menstrual cycle, what she eats or when she sleeps.
Four million Canadians like Murray deal with migraine headaches. The condition, which affects three times more women than men, can be so disruptive to productivity and quality of life that the World Health Organization ranks it among the top 20 causes of disability.
What is a migraine?
Most of us will get a headache from time to time. So what makes it a migraine? If you think it’s nothing more than extreme pain, think again, says neurologist Dr. Rose Giammarco, director of the Hamilton Headache Clinic in Hamilton, Ontario. In fact, the intensity of migraines can vary between moderate to severe. “They may not always be disabling”, she says.
Other characteristics of migraine can include nausea, light and noise sensitivity or worsening pain with exertion. Only about 10 percent of sufferers get an aura—flashing lights or vision changes—before a migraine. And how about the common belief that migraine headaches are one-sided? Usually they are, but not always: they can occur on both temples or even in the back of the head. Misconceptions about migraine headaches may explain why the condition is underdiagnosed.
Can migraines be prevented?
In a national survey, almost 40 percent of Canadian women with migraines 'fessed up: They’ve never seen a doctor for their headaches. “There’s still that social stigma: Oh, it’s just a headache,” says Dr. Giammarco. Yet these women may be missing out on help in managing their migraines. Just keeping a headache diary and tracking triggers can go a long way to preventing pain.
Murray has learned to not to skip meals or sleep in because these can lead to a migraine. “Basically, I just try and keep on a schedule and try not to get stressed out. And I avoid the foods I’m not supposed to be eating.” Murray’s food triggers include red wine and pistachio nuts. Cheese and chocolate are common for others, says Dr. Giammarco. “But the list is endless. Patients are very individual.” Regular exercise may reduce migraines. And there may be some evidence that natural remedies such as magnesium, feverfew and butterbur root could have beneficial effects as well.
Migraine treatments
There’s a place for a pain reliever, whether it’s aspirin, ibuprofen or prescription medication. But proceed with caution: medication overuse or “rebound” headaches can result from popping pills more than three days a week on a regular basis. Some people swear by alternative, drug-free treatments like massage, biofeedback or acupuncture.
Murray uses medication only sparingly. And although she says she’s too chicken to face acupuncture needles, she has treated her migraines with cold packs and air massage baths. “I never discourage any of these with my patients,” says Dr. Giammarco. “If we can avoid overuse of medication, and if it does give them additional benefit, then I’m all for it.”
The future of migraine therapy
Although it's not yet approved for use in Canada, there may be a role in the future for Botox in migraine prevention, along with its many other uses. And then there’s always menopause. The majority of women—about 70 percent—may improve after menopause. But because of the hormone fluctuations in perimenopause, headaches may get worse before they get better.
And finally, a potential silver lining for migraine sufferers has emerged: a new study at the Fred Hutchinson Cancer Research Center in Seattle has found that women with migraines have a reduced risk of breast cancer. It's just one study, but at least there’s room for optimism next time your head feels like it’s being pounded with a club hammer.
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Web exclusive: September 2009
