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Migraines

Introduction

Migraines are the worst. They make you just want to curl up in a dark room and wait for the bed to swallow you. They can ruin your day and a bad one can ruin your week (lasting from 4-72 hours) leaving you irritable and tired. The headaches can cause intense and debilitating pain, that’s difficult for non-sufferers to comprehend.

 If you are a woman you are three times more likely to suffer from migraines and 90% of migraine sufferers have a family history of migraines. In general they begin in early adulthood or adolescence. Unfortunately there isn’t a cure and no one really understands the cause yet – not even the really really smart brain people. However, migraines don’t have to be a curse, the symptoms can be managed and relieved, and there are a number of preventative actions you can take.

Symptoms

There a four distinct stages of migraine and they can start up to 1-2 days before the actual attack phase.

    Prodrome

    Not everyone experiences a prodrome but if you do, and you can learn to identify your usual prodrome symptoms, you may be able to abort an attack before it hits you hard. It most likely starts a few hours before the main migraine attack, but can start up to one or even two days before. Keeping a headache diary can help you to identify if you have a prodrome or not and how to recognize it in future. Common prodrome symptoms:

  • Constipation or diarrhoea
  • Food cravings - often but not always for sugary or fatty foods
  • Mood change depression or irritability
  • Neck stiffness
  • Hyperactivity - you just can’t sit still or focus

    Aura

    The Aura is the phase directly before the migraine headache, it usually last less than an hour. Approximately 20% of the migraine sufferers experience the aura stage. There are a range of possible aura symptoms, some of which can be worrying if you are experiencing them for the first time.

  • Visual phenomena
  • Bright spots
  • Flashes of light
  • Loss of vision
  • Blurred vision
  • Trouble speaking
  • Confusion
  • Pins and needle or numbness/weakness in limbs
  • Hypersensitivity to touch
  • Odd smells
  • Hearing loss/hallucinations - fairly scary stuff
  • Headache/Attack

    This is the most common and worst bit of a migraine and it can last between 1-72 hours (if it lasts longer than 72 hours – 3 days! – you should seek medical help. The main symptoms include:

  • Pain that is on one side of your head
  • Pain of a pulsating, throbbing quality
  • Sensitivity to light/sounds or even smells
  • Nausea and vomiting
  • Blurred vision
  • Depression or anxiety
  • Dizziness/confusion
  • Runny nose or nasal stuffiness (migraines are often confused for sinus headaches)
  • Diarrhoea or constipation
  • Postdrome

    After the migraine you may feel drained, or zombie like. This can also be the side effect of some prescribedmigraine medications. Others may feel euphoric after a migraine attack but, in general, fatigue is more normal.

Causes

Migraines are one of the least understood among the headache family. There is definitely a genetic component with 90% of sufferers showing a family history of migraines. There are certain environmental factors as well such as food, weather changes and sun glare that can prompt a migraine.

The current preferred theory among the smart people is that a migraine is the outcome of a chemical imbalance, in particular a drop in serotonin.  A drop in serotonin leads to the release of neuropeptides (brain chemicals) which may lead to inflammation in blood vessels in the brain and can impact the brain stem’s interaction with a major nerve pathway, the trigemenal nerve, leading to pain.

Triggers

Although the cause is somewhat foggy, most people have identifiable triggers. Needless to say if you learn your trigger/s, you can avoid them and hopefully minimize the number of migraines you suffer from.

    Hormonal changes in women (unfortunately unavoidable)

  • Fluctuations in oestrogen (hormones) often trigger headaches
  • During and before your period your oestrogen level will drop and could lead to a migraine
  • Oral contraception (the pill), birth control implants and patches, may trigger a migraine or may actually help to improve migraine. If you think this is your problem talk to your doctor and try out a number of birth control options to see what suits you best
  • Pregnancy will lead to changes in oestrogen and many women get their first migraine during pregnancy. They usually get better as the pregnancy develops
  • Food
    Certain foods can trigger migraines. Skipping meals can also lead to migraines so if you are a sufferer carry a small snack like an apple or cereal bar in your bag for emergencies.

  • Alcoho(in particular red wine and beer)
  • Chocolate
  • Aged cheese
  • Aspartame (often found in diet fizzy drinks and low/zero sugar foods)
  • Caffeine
  • Monosodium glutamate (often found in Asian food)
  • Stress
    Sensory stimuli

  • Bright lights, sun glare
  • Unusual smells either pleasant (like perfume) or unpleasant.
  • Sleep changes/jet lag
  • Intense physical activity, including sex in some instances
  • Environmental factors, weather, barometric pressure
  • Some medications

Treatment

  • Dark room and sleep/rest
  • Cool pack or damp towel on neck or scalp
  • Over the counter pain relieving medication
    • For mild to moderate migraine pain ibuprofen/paracetemol/aspirin can all be effective pain relievers. You can also try some of the combination pain killers, such as paracetemol and caffeine or codeine and caffeine. (Codeine can make nausea worse)
    • Tip! Don’t wait for your headache to get bad to take pain relief. If you have a prodrome or aura start taking pain medication then. It will take some time for the pain killers to be absorbed into your blood stream so rather than being a martyr take the pain killers as soon as you feel the headache start and don’t suffer longer than you have to. Your friends and family and co-workers will thank you too!
    • Soluble pain killers will also be absorbed more quickly into your blood stream compared to non-soluble ones
    • Be careful not to take too much pain relief and use it as directed on the package. Not only is overusing pain medication like ibuprofen potentially harmful (it can damage you stomach and cause internal bleeding), it may also cause rebound headaches which is kind of against the point
  • Triptans
    • A doctor may prescribe you triptans to help with your migraines.
    • Triptans will not prevent migraines but they can abort/stop symptoms
    • The actual mechanism of triptans is not fully understood but they are thought to help stimulate production of serotonin, prevent neuropeptide release and therefore decrease blood vessel inflammation

    There are a number of different types of triptans and you may have to work with your doctor and try a couple to find one that works for you. They can both relieve nausea and light sensitivity as well as cause nausea, dizziness and muscle aches

    Anti-nausea medication

    Over the counter options but can also be prescribed

  • Taken in combination with pain killers
  • Oestrogen patches
    • 3 days before period
    • 7 days during

Prevention

As always the best and most obvious move is to avoid your triggers

Reduce stress

  • Bath
  • Massage
  • Meditation

Sleep the appropriate amount, between 6-8 hours and avoid oversleeping. Regular exercise

  • Can reduce tension
  • There may also be an obesity link to migraines

Your doc may prescribe preventative medicine for severe of frequent attacks that normal pain killers don’t work

  • Beta blockers
  • Anti-depressants

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