How to control migraines
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
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
Do have any other blogs on chronic headaches?
I take preventitive meds for my migraines. I was getting about 8 a month that were severe, with nausea, light and sounds sensitivites, etc...Now I take propanalol and amitriptaline dailey (it's taken about 2 years to get proper dosage figured out) but now I usually only get one a month related to hormones. I still get some of the sensitivites but nothing I can't manage.
My migraines have 5 triggers which I have identified, and these occur in a specific sequence: overtiredness, dehydration, becoming overheated, hunger, then eating something sweet/sugary when really hungry. Nausea, vomiting, sensitivity to light and sound and severe pain all over my head and down my neck occur within minutes of the final trigger. So, I have learned to note the appearance of all the triggers. I can stave off a migraine with a litre of cold water and removing extra layers of clothes if I notice the first pain soon enough after the 2nd trigger. If I get to the 4th trigger, it's often too late. Then I slam it with 2 liquid gel ibuprofen and get myself to a dark quiet room for sleep ASAP. The worst of it will be over in 2 hours, during most of which I will be asleep. I had migraines monthly for decades until I analyzed the pattern of the triggers. Now I get them just once or twice a year, usually in the spring or fall, when changeable weather makes it easy to get overheated.
I'm prone to chronic migraines - related to air pressure changes - thanks to genetics. (This has been in my family several generations.) As the article states, they can vary from slight to debilitatingly painful. I can definitely sympathize with the other sufferers here. As for the treatments, I recently found a natural solution that really seems to help. Taking Magnesium supplements at least once a day reduces the symptoms drastically. They're a natural anti-inflammatory from what I've been told by a nutritionist. There are a couple studies that have shown it's helped some migraine sufferers. And, at least for me, it's worked really well. Just thought I'd throw a recommendation out there in case anyone else reading this has the same issue that I do. (Plus it's probably cheaper than buying prescribed meds if it does work.)
I went from 50+ severe to 1-2 moderate migraines per year when I stopped taking the birth control pill. Hormone therapy would bring them right back so I'm going through menopause without "treatment," just like women before HRT became the norm. I have also not taken any herbal remedies as some of them also work on hormones. I've been menopausal for about 9 years and it has been only a little uncomfortable (primarily night sweats that I can usually manage).
I had suffered from migraines for 25 years. I would lose my vision, feel nauseous, have tingling in my hand or lip. I had tried many different medications and became very aware of what my triggers were (perfume/fragrance, red wine, too much coffee/chocolate, cheese, skipping meals, too little or too much sleep). The medication (immitrex, painkillers, etc) never agreed with me and I was always looking for healthier alternative options. About three years ago I started taking a multivitamin, fish oil, calcium/magnesium and vitamin B2 daily. The calcium/magnesium was 2:1 ratio. I started taking 400 mg of Vitamin B2. I would take 4 x 100mg tablets of B2 spread out through the day (one in the morning, at lunch, dinner and then before bed). After being on this regime for one year I reduced the B2 to 100 mg per day and continued to take the other vitamins. It has now been three years and a half years that I have been taking this combinations of vitamins and I have only had three headaches. There is a lot of information on the web regarding calcium/magnesium and B2 and their relation to migraines. It is worthwhile to check it out. All I can say is that it has worked for me and I am thrilled to to not have to take medication anymore. I used to have headaches monthly and would feel like I was hit by a mac truck so I would not be able to doing anything for a few days so I understand how disabling these can be. Now if I feel like a migraine could be coming on I take 400mg of liquid advil at the first sign and that is it - it's gone. Check out the research on the vitamin option and good luck.
My family suffer with migraines. My 17-year-old son's seem to be treatable with acupuncture. He usually presents with vision problems (seeing only half a person's face), followed by snowy vision (he refers to them as "seeing cells"), typically prior to onset, so if we can get him in for acupuncture right away it seems to really help. He used to get them two or three times a week, after a few treatments, we can just go prior to one coming on. He actually hasn't had one in months!!
I too have suffered from migraine from an early age (10)and am now 45. I have been very fortunate to have the family doctor I do as he has been incredibly pro-active with my treatment. We have finally got the headaches under control with a combination of meds. I take 1 Nadolol daily and when I do have a migraine, I take a triptan drug (either Maxalt-MLT or Axert). This therapy has been a godsend as I had chronic daily headaches with between 10-12 migraine a month. Since I started this therapy, I now have 5-6 headaches a month of which 2 are migraine. I hope this helps.
I suffer from migraine since I was about 12 (now almost 40) when I get a very strong one it impedes me from even walking or coordinating, sometimes they start from 0 to 100 in a matter of only a couple minutes, but most of the times there are warning signs.
The best cure I've found so far is a strong dose of caffeine (either in pills or a very, very, very strong dark coffee) or some medication such as Cafergo (ergotamine + caffeine), and it is best to take any analgesic right when you get the first signs that one migraine is comming.
I hope this helps someone else who suffer these debilitating pains too.