Just as a heavy cold is not the flu, a bad headache is not necessarily a migraine.
More women (18%) than men (6%) are likely to have this type of chronic, episodic headache. The pain may be pulsating and one sided, with other symptoms such as vomiting, sensitivity to light and noise or visual disturbance (“aura”). In some cases it may mimic a transient ischaemic attack (TIA) with numbness on one side of the body, trouble speaking or reverting to a first language. In some cases a migraine may last up to 3 days (4-72 hours). Migraines often run in families.
Prodrome – some migraine sufferers notice certain symptoms occurring hours or days before an attack. These may include fatigue, mood swings, food cravings (often sugar or chocolate) or changes to bowel motions.
The aura – refers to some of the warning symptoms that a migraine is developing before the headache occurs. These symptoms include visual disturbance (often zig-zag shimmering lines), numbness or tingling in the body, difficulty speaking etc. Some people experience aura without a headache.
After the cessation of symptoms – most people feel wiped out for a day.
Causes: in the last few years more research into migraines is uncovering other possible physiological causes of these types of headaches. Previously, vascular (blood vessels) narrowing or dilation was thought to be the major problem but focus has widened to a variety of other neurological (nervous system) and even hormonal factors. Under current consideration are issues involving the trigeminal nerves and also serotonin levels. One theory is that serotonin levels drop, causing the trigeminal nerves to release a neuropeptide that causes dilatation and inflammation to the meninges that causes pain and a change of function.
Musculo-skeletal problems especially affecting the neck, shoulders or temporomandibular joint (TMJ). Jaw clenching and teeth grinding are another symptom of imbalance in this part of your body.
Dehydration – yes 8 glasses of water a day seems like a lot but is what the average migraine sufferer need.
Caffeine – can affect hydration levels but also cause changes in the blood vessels. However a cup of coffee at the onset of an attack may be useful, don’t drink it at any other time.
Alcohol – especially red wine. However when this is due to a reaction to histamines, white wines matured in wooden barrels (eg an oaked chardonnay) may also trigger a reaction.
Hormonal – puberty, peri-menstrual, OCP (pill) related, menopause and pregnancy are common migraine triggers. Note, oestrogen containing medication (HRT, the pill and other hormonal contraceptives) have not only been shown to cause migraines in some women but new research has suggested a link between women with migraines who use the pill and having an increased risk of having a stroke.
Withdrawal from pain or migraine specific medication (“rebound headache”).
Changes in weather, specifically barometric pressure swings can trigger some migraines.
Foods – being a co-factor are often an intolerance meaning you can sometimes get away with eating food and other times you can’t, which can make it difficult to track down initially. Topping the list of suspect foods are: chocolate, dairy (especially strong cheeses), oranges, tomatoes, food additives (especially tartrazine a yellow colouring). The only evidence based medicine proving a food trigger for migraine is monosodium glutamate (MSG) common to flavour boosters, as well as Chinese, Thai, Vietnamese and Japanese restaurant meals.
Stress – can be a player in its own right but also may increase muscular tension worsening neck and shoulder problems, cause you to change your eating and drinking patterns, or rob you of sleep.
Complementary medicine for migraines
Feverfew (Tanacetum) – is a commonly used herb for the prevention and treatment of migraine. Traditionally a leaf each day was eaten as a preventative (only consider this if your feverfew plant has been conclusively identified and not sprayed with any pesticides). Evidence based medicine (EBB) supporting its use is mixed. Meta-analysis shows “The majority (of trials) favor feverfew over placebo… Yet the clinical effectiveness of feverfew in the prevention of migraine has not been established beyond reasonable doubt.” (Interestingly, when EBB medicine is applied to most conventional treatments for a variety of conditions a similar caveat exists).
Chaste tree berry (Vitex agnus castus) is invaluable for hormonal triggers of migraines when a woman is not concurrently taking pharmaceutical oestrogens etc. Taken over 3-6 cycles chaste tree berry is very effective in treating all peri-menstrual related chronic conditions through its action as a ‘hormonal normaliser’.
St John’s Wort (Hypericum) migraines have low serotonin levels in common with insomnia and depression. Theoretically, St John’s Wort would be well indicated as long as you are not taking any of these drugs.
Other herbs used in migraine treatment would depend on the individual. Usually herbs for the nervous system (such as skullcap, passionflower or chamomile) are used in conjunction with liver or other digestive herbs depending on the person’s general heath.
NB: You might read about Butterbur (Petasites) as a herbal treatment for the migraines, however this herb is scheduled as a poison in Australia and is not recommended.
Aromatherapy: Cooling oils such as peppermint and lavender, applied to the back of the neck on a cold face washer can stop some migraines developing. Once company make a handy little roll on aromatherapy ‘stick’ suitable for migraines. (More on aromatherapy.)
Vitamin B2: very high doses, around 400 mg, of B2 have been investigated as a treatment for migraines. This is around 8-10 the amount found in some of the stronger OTC B-multivitamins on the market. As use of one B vitamin in high doses unbalanced by all the other B’s can cause deficiencies I would be hesitant to endorse this treatment at the current time. A daily multivitamin with at least 50 mg of B2 may be worth trying as part of a preventative program.
Magnesium: is a key nutrient for muscular tension. New research indicates a daily dose of up to 600mg of magnesium can reduce frequency and severity of attacks. NB: this is a very high dose and long term could disturb your calcium levels if calcium supplementation is not also used.
Coenzyme Q10 (CoQ10) a nutrient that has a strong affinity with the muscles and is often used for heart health is looking promising for a new role in migraine prevention. While sample sizes in the studies I have cited are very small, a daily dose of 150 mg of CoQ10 could reduce attacks by around 25%. Interestingly, cholesterol lowering drugs are known to reduce CoQ10 levels in the body, I’d strongly suggest any one with migraines who takes statin drugs to consider this as a supplement.
Acupuncture is endorsed by groups such as the British Medical Association as an effective treatment for migraines. In Victoria the practice of Traditional Chinese Medicine is regulated, so see a registered practitioner.
Remedial therapies: In my experience every migraine sufferer should look into assessment and treatment for back, neck or jaw problems. My preference is to see an osteopath but many other kinds of remedial therapists can be useful. See the recent show on muscles to learn more.
Lifestyle: There is a strong relationship between inadequate sleep and migraine attacks. Make 8 hours in bed a priority in how you organise your timetable. If you have trouble sleeping, read the notes from this show on insomnia. Sleep disturbance is often connected with stress. For stress management check out these links.
Regular, appropriate exercise which can be as simple as a daily walk for half an hour can relieve the build up of pressure in the muscles, help you sleep better and relieve tension. If you are “too busy” to find 30 minutes out of your day, that alone could be a key indication as to why you are prone to experience migraines.
Many of the women I see with migraines are busy at work and home, always putting other people first. Despite other symptoms suggesting they are tired or stressed they tend to ‘soldier on’ til a migraine hits, becoming so debilitated that they finally have to stop. Like many health issues, the first step to improving your health is to listen to your body.