Migraines are a specific type of headache that occur in up to one in five people around the world. However, many normal ‘tension’ headaches are incorrectly referred to as being migraines, which have a particular definition.
The word migraine is derived from the Greek word ‘hemicrania’ – meaning half of the head and unilateral pain is one of the defining features of this condition. Other characteristic symptoms include a pulsatile nature of pain, a disabling intensity, and associated nausea and vomiting. Migraines are usually between 4-72 hours in duration.
However, there are other serious causes of headaches such as stroke, meningitis and cerebrovascular aneurysm that may share some of these symptoms, so it is important to consult a doctor to safely exclude other possibilities. It should be noted that migraines do not cause fever or any nerve problems affecting the body.
One subtype of migraines are ‘classic’ migraines in which a person will first have an aura in either a visual, sensory or speech form. These migraines can increase the risk for stroke in the long-term, unlike the more regular ‘common’ migraines without an aura. However, they are both treated the same.
A well known feature of migraine headaches is that they often have triggers that precipitate attacks. The most common triggers are also the hardest to avoid in modern life; missing meals, poor sleep, fatigue and stress. Hormone fluctuations can also cause migraines with women especially vulnerable around their period time. Other reported triggers are: flashing lights, fumes, scents, drugs and loud noises. Many foods like diary products are also implicated in triggering migraines.
Unfortunately, there is no simple laboratory or hospital tests to confirm a migraine diagnosis. Imaging techniques are under investigation but they are only at very early stages of research.
There are two or three ways to manage migraine attacks. The first is avoidance altogether by eliminating any of the precipitating triggers discussed above.
The second is treatment at early onset with appropriate medication. For mild to moderate attacks, Paracetamol (in soluble or dispersible form) or Aspirin/Ibuprofen at standard doses are the first choice. They can also be taken in combination forms with an anti sickness drug such as Migramax and Paramax. Codeine containing medications are not recommended as they can cause headaches, particularly when used frequently.
For moderate to severe attacks (or those not treated by those above) the choice of drugs are Triptans. They work in the brain directly to reduce the transmission of chemicals that cause the pain. They are effective, with 45-75% of people reporting relief within 2 hours of taking them. However, they must NOT be used if there is any history of heart disease, strokes or high blood pressure as they can cause narrowing of blood vessels manifesting as dizziness and tightness in the chest/throat.
If the first triptan proves ineffective, next steps include either increasing dose, trying another of the 7 triptans available, or adding in an antisickness drug.
The third tactic is prevention for those who suffer from more than two attacks a month, worsening attacks or who are unable to take the acute treatment medication above. It involves taking a beta-blocker tablet every day to prevent recurring attacks. If beta blockers are unsuitable other medications can be prescribed but as an unlicensed indication.
Some small studies have also shown that Vitamin B2 (riboflavin) 400mg and CQ10 supplements may also work for prevention. However, as yet there is no strong evidence that CBT, meditation or other psychological techniques are effective preventers.
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Last updated on October 12, 2016.