Migraines: more than a bad headache

15% of Australians regularly experience migraines. But what are they and how are they treated?

Helen Foster
May 2018

Migraines are severe headaches that tend to throb or pulsate (rather than feel like a tight band round the head, which is usually associated with a tension headache). They typically last from 4-72 hours. Migraines also often get worse when you move.

“They can come with some level of sensitivity to noise, light or smells and/or nausea or vomiting,” explains Perth-based migraine specialist Dr Julian Rodrigues. “This might be during the headache itself, or in the hours or days before it starts.”

Unfortunately migraine can be a very debilitating condition, affecting your ability to function in everyday life. Nearly all people who suffer from migraines report a reduction in social activities and work capacity.

At its worst, the pain and associated symptoms of a migraine can be disabling, with people affected unable to do anything except lie down in a dark room. In the case of chronic migraines, sufferers can experience 15 or more episodes a month.

Although migraines are common, many patients remain undiagnosed or untreated.

What triggers migraines?

No one knows exactly what causes them. One theory is that the severe pain is caused when blood vessels in the brain suddenly expand, or when something causes a large number of neurons (the cells which send nerve impulses) in the brain to suddenly fire at once.

“Neither has been conclusively proven – and both might happen,” says Dr Cheryl Carcel, neurologist and research fellow from The George Institute in Sydney. “The firing of the neurons might trigger the blood vessels to expand.”

Whatever the cause, migraine triggers could involve things like food or drink (cheese, chocolate and caffeine are commonly associated with attacks); hormonal changes, stress, lack of sleep or skipping meals.

Trying to avoid a trigger can reduce the amount of attacks but spotting which trigger affects you can be tricky.

“I’m therefore a big fan of keeping headache diaries that allow you to spot patterns,” says Dr Rodrigues.

“Remember, though, that the early stages of a migraine can start hours or even days before, so look for any changes in how you feel when trying to spot triggers – not just things you’ve done close to when the it starts.”

How to treat a migraine

Treatment for migraines falls into 2 camps. First, your GP may offer treatments to take when an attack starts. These treat the pain and other symptoms, and might include painkillers like ibuprofen, drugs that tackle nausea or specialist migraine drugs called triptans.

If you’re experiencing more than 2 migraine attacks a month, however, your doctor might also suggest you try a preventive treatment to stop attacks happening in the first place.

Despite the disabling effect of chronic migraine, only about 20% of chronic sufferers use a preventive treatment.

“One reason is side effects. The preventive drugs we use aren’t specific migraine treatments, they’re drugs like beta blockers or anti-epilepsy medication that have been discovered to also prevent headaches,” says Dr Carcel.

A series of Botox injections across 7 specific muscle areas in the head and neck can also help.

“As with so much of migraine, we don’t know exactly why but it probably acts on the nervous system in some way,” says Dr Rodrigues.

Only patients with severe migraines are eligible for this kind of treatment. Ask your doctor for details.

If you regularly get migraines or headaches, ask your doctor for treatment advice.

Developing new migraine treatment

An alternative to current treatments is being researched by Dr Carcel in Sydney. It’s a combination of 3 blood pressure drugs – a calcium channel blocker, a diuretic and an ARB (angiotensin receptor blocker).

“These are all at a very low dose and in our pilot trial don’t seem to be associated with side effects,” says Dr Carcel.

Why they work, no one yet knows – but in the pilot trial they did seem to be effective in reducing the number and severity of attacks. The George Institute is now planning a larger trial later this year.