Migraines

Migraine is a neurological condition with a pattern of episodes (“attacks”) and specific symptoms, of which headache and nausea are the most characteristic.¹

A migraine headache is usually moderate to severe in intensity, with throbbing pain often on one side of the head.²

Migraine differs from a normal or tension-type headache, which is typically mild or moderate and described as tightness around the head.⁴

Migraines are common: globally, they’re the second-leading cause of disability and the third most prevalent illness.^3,5

About 1 in 5 people will experience migraines at some point in their lives. In South Africa (population 63 million), that equates to over 12.6 million people.^6.7

Migraine likely has a genetic basis, as about 90% of migraine sufferers have a family history of the condition. Migraines are most commonly experienced between ages 18 and 44, with three times as many women as men suffering from migraine in adulthood.³

Migraine affects many aspects of life, including work, study and leisure activities, social and family relationships. Generally, patients report poorer well-being and health-related quality of life during pain-free periods as well.⁸

According to the Migraine Research Foundation, 71% of sufferers feel that their mental health has been affected by migraine. One US-based study found that a third of migraine patients reported a negative effect on their careers, almost half felt they would be better partners without migraine and almost 40% said it had compromised their ability as parents.⁶

Migraine sufferers usually experience at least five attacks in a lifetime. These last from around four hours to three days, and the headache has at least two of the following features:^2,9

• Felt one side of the head or behind the eye
• Pulsating (throbbing) pain
• Moderate or severe intensity
• Worsened by, or makes you avoid, physical activity.

Also, during the headache you have at least one of:²

• Nausea and/or vomiting
• Light sensitivity (photophobia) and sound sensitivity (phonophobia).

In children, attacks tend to be shorter and abdominal symptoms are more likely.⁹

Source: American Migraine Foundation.¹⁰

A migraine attack has four phases (stages):^10,11,12

1. Prodrome: the “pre-headache” phase that signals the start of an attack, hours, even days, before the headache. Prodrome symptoms may include mood changes, fatigue, sensitivity to light and sound, insomnia, nausea, constipation or diarrhoea, and muscle stiffness, especially in the neck and shoulders. Symptoms unique to the prodrome phase include yawning, food cravings and frequent urination.
2. Aura: a temporary sensory disturbance that lasts 5-60 minutes and is usually visual, such as seeing geometric patterns, lights or blind spots. Other examples of auras are phantom smells, or confusion. Aura affects 20% of migraine sufferers.
3. Headache: Lasts from several hours to three days. Besides pain, headache phase symptoms can include nausea, insomnia, anxiety, and sensitivity to sound, light and smell.
4. Postdrome: the “migraine hangover”, with after-effects such as fatigue, body aches, trouble concentrating, dizziness and photophobia. Even though the headache is over, you are still experiencing an attack and should avoid aggravating triggers.

Not everyone experiences all four phases with each attack, and symptoms can overlap significantly between phases.¹²

Understanding migraine phases helps you manage your condition. Symptoms associated with the prodrome and aura phases can serve as warning signs, so you can take action to lessen the severity of the oncoming headache. Identifying and treating an attack early on can even help sometimes to prevent symptoms.¹¹

Medical scientists think that a mechanism deep in the brain becomes activated, releasing pain-producing inflammatory substances around the nerves and blood vessels of the head.¹

It’s not yet understood why this happens periodically, and what brings the process – and the migraine attack – to an end.¹

A migraine trigger is any factor that sets off a migraine episode. People typically have several different triggers.¹³

Some of the more common triggers include:¹³

• Stress
• Irregular sleep schedule
• Hormonal changes
• Alcohol
• Weather changes
• Diet, especially processed foods and additives
• Dehydration
• Light
• Strong smells
• Certain medication overuse

Less than half of people with migraine consult a doctor, and the disease remains undiagnosed and undertreated in at least 50% of patients.¹⁴

If you suspect you have migraines, it’s essential to get medical advice. A confirmed diagnosis leads to appropriate treatment and the best route for managing symptoms and improving your quality of life. Your doctor will consider other medical conditions you may have alongside migraine: this is important for your treatment plan, since certain medications can’t be taken together.¹⁵

To diagnose a migraine, your doctor must identify the characteristic pattern of recurring headaches with associated symptoms. It’s helpful to keep a diary of your migraine attacks for a few weeks, including when they occurred, triggers, symptoms and any medications taken.¹⁶

There’s no specific test for migraine, but your doctor might do a physical examination and check your vision, co-ordination, reflexes and sensations to help rule out other possible causes of your symptoms.¹⁶

Treatment aims to avoid attacks when possible, manage attacks rapidly and consistently when they do occur, and restore normal functioning and quality of life. Work with your doctor to draw up an individualised treatment plan based on your specific migraine experience.⁸

Various effective therapies are available, including medications and lifestyle or behavioural therapies.⁸

Non-prescription pain medications such as paracetamol, aspirin or ibuprofen may help ease symptoms, especially when taken at the first signs of an attack.¹⁷

Triptans are migraine-specific pain medications that can help reverse changes in the brain that may cause migraines.¹⁷

Anti-nausea medicines, or antiemetics, can be taken alongside pain medications.¹⁷

Combination medicines, some combination medicines, containing both pain medications and anti-emetics, are available over-the-counter. Combining a triptan with another pain medication such as ibuprofen can also be effective.¹⁷

You may need to try different medication types or combinations before you find which works best for you, please consult your health care professional.¹⁷

It’s a good idea to keep a record of your medications, as taking too many pain medications can cause a medication overuse headache.¹⁷

Healthy lifestyle habits include a regular sleep-wake schedule, regular meals, a nutritious diet low in processed foods, regular exercise, avoiding excessive caffeine or alcohol, and stopping smoking. Practising stress-relieving techniques or relaxation therapy is also valuable.^{8, 11}

One of the best ways of preventing migraine is recognising your triggers, avoiding them as far as possible, and finding behaviours that help ease symptoms. For example, many people find it helpful to sleep or lie in a darkened room during an attack.¹⁷

Treatment is available.

STOP MIGRAINES AS THEY START 

For more information speak to your health care professional