Migraine is a common and painful illness that affects men and women all over the world. Symptoms of Migraine (including pain and nausea, as well as excessive sensitivity to light and sound) are often very distressing for the person with migraine and for their families. Migraine Headache may completely disrupt normal activities during attacks and reduce the quality of life between attacks.
Despite its terrible effects on people’s lives, many people with migraine are inadequately treated. This is sometimes because people with migraine think that there is no treatment for their condition and have never gone to see their doctor about it. Others have given up on seeing their doctors, believing that nothing could be done to help them.
However, with the advent of newer and more effective medications, there is no hope for many people with migraine.
This Article was written to help you to understand more about your migraine, its meaning, What causes Migraine, how it affects your life and what you can do to find relief.
We include two simple forms that you can use to check how severely it affects you. Finally, we suggest how you can obtain the best treatment of Migraine when you go to see your doctor.
Who Suffers from Migraine?
Migraine is a very common disorder. About one in ten people suffer from it. Most people have their first attack during childhood or as teenagers, although it sometimes begins in adult life.
Migraine may affect people at any age but is most common from 25 to 55 years of age. About three times as many women as men suffer from migraine.
However, it is not just a ‘women’s disorder’. Over one in every 20 men also suffer from migraine. Migraine affects all types of people, although it is more common in white people than in other racial groups.
We do not know the full reasons why people suffer from migraine. It is clear that migraine runs in families – most people with migraine have a close relative who also suffers from it.
A number of specific brain mechanisms involved in the development of migraine have been identified, and the newer treatments for migraine were designed to interact with these brain mechanisms.
What Happens During a Migraine Attack?
What causes a migraine attack is not known. Some migraine attacks start for no obvious reason, but many people with migraine believe that there can be some of the following causes which trigger Migraine.
These may include
- Little sleep,
- Strong Light,
- Weather changes
- Red wine
In many women, hormonal changes or the onset of menstruation triggers a migraine, although attacks often occur at other times. The migraine attack can be divided into four phases, but most people with migraine do not go through all of them.
The Phases of Migraine
1. WARNING PHASE
The first stage of migraine usually lasts for several hours but may last for up to several days. It includes warning signs like
- Mood changes
- Cravings for some foods
and increased awareness of light, noise, and smells. About six in every ten people with migraine go through the warning phase.
Auras are symptoms originating from within the brain that usually occur 20 minutes to 1 hour before the headache attack. Only about three in every ten people with migraine experience aura symptoms.
These usually include problems with vision, such as flashing lights, zig-zag lines or a greying of vision. There may also be hearing or speech problems, disorientation or confusion, and ‘pins and needles’ feelings in parts of the body or face.
The aura may disappear before the headache begins or it may last into the headache phase.
3. HEADACHE PHASE
For most people, the headache is the worst part of the migraine attack. It is usually throbbing, painful, and often
limited to one side of the head. Pain may alternate sides from attack to attack or may occur on both sides of the head. The pain usually becomes worse with physical activities like walking or climbing stairs.
However, migraine is not ‘just a headache’. Most people also feel nauseous and some actually vomit. Other common symptoms that accompany the migraine headache include sensitivity to light, sound or smells. Many people with migraine seek a dark, quiet room during their attacks. If no treatment is taken, the migraine typically lasts from 4 hours to 3 days, but it usually lasts about 1 day.
4. RESOLUTION PHASE
After the headache eases or resolves, people with migraine often have other symptoms that persist for a long time
before feeling normal again. Migraine attacks happen usually about once or twice a month but can be more frequent. Attacks vary in severity and are unpredictable in occurrence.
All four stages are usually not seen in any given attack. Severity varies from moderate headache with little interference with activities to severe headache with lengthy disability. Often, no two attacks are the same for a person with migraine.
Although migraine can be very distressing, it is important to understand that eventually the migraine attack will subside and nothing more serious will happen. Some people with migraine worry that there may be something more serious causing their symptoms, but this is very rare. Other causes of headache are excluded in a good medical evaluation.
How do you know if You have Migraines Headaches?
If your headaches are not relieved by treatments like aspirin, paracetamol or ibuprofen then you should probably go to see your doctor about them. With headaches, as with other illnesses, obtaining the proper treatment depends on the right diagnosis.
Therefore, it is important to determine whether you have a migraine or another type of headache. You may have already seen a doctor about your headaches and received a medical diagnosis of migraine. In this case, this section will help you to better understand your condition.
If you are finding that the treatment your doctor recommended is not working, you may want to go and see your doctor again and discuss the points raised in this section. If you have not yet seen a doctor about your headaches, please note that this section cannot substitute for a professional medical diagnosis.
You may prepare for this visit by thinking about the points raised in this section, which outline what your doctor needs to know to understand how severely your headaches are affecting your life, what sort of headaches you are having and how best to treat them.
If you suffer from headaches more than 15 days per month, you may have a condition called chronic daily headache. The following symptoms and signs suggest the possibility of serious illness and warrant immediate medical attention:
Very sudden onset of a headache without warning
Getting a new type of headache after the age of 55
Headache with a fever or stiff neck
Headache associated with the new onset of changes in vision, weakness, sensory loss, weakness (especially on one side of your body), or any difficulty walking
Headaches that progress in frequency, duration, or severity
Headache following an accident or head injury
Constant headaches that never go away. If you have any of these features, go to see your doctor.
If you do not have these characteristics, but you have all three described below, you most likely have migraine:
1. You have had at least five headache attacks in your life with similar features lasting from 4 to 72 hours each.
2. You have two of the following three pain features:
- Moderate to severe pain
- Pain on just one side of the head
- Headaches that are throbbing or pulsing.
3. You have one of the following three features:
- Having Aura.
- Feeling sick (nauseous) during your headaches.
- Check if you are usually sensitive to light and sound during your headaches. Of course, if you want to know your headache diagnosis, see your doctor.
Measuring the Effects of Migraine Questionnaire
How Badly Does Migraine Effect your Life, Brain and Body?
1. Missing Education
- Migraine may interfere with school work because of absenteeism, difficulty concentrating or studying, and interfering with tests and exams.
- Disrupted education may set people up for a lifetime of underachievement.
2. Missing Paid Work
Workers take sick leave, or if they try to work their productivity is affected.
Most people with migraine are able to work during most of their attacks. However, some workers with migraine
do not do as well in their jobs as their colleagues. For example, they may not be able to do their best when they try to work during attacks.
- A few say they lose out to their colleagues for promotion or even lose their jobs altogether because of their migraine.
- Unemployment tends to be higher in people with severe migraine than in people who do not have a migraine.
- Fear of migraine can make workers reluctant to take on new jobs or to stretch themselves at work.
3. Inability to do Household Work
People with migraine are not able to carry out household chores such as housework, home repairs, shopping and caring for children and relatives.
4. Missing Family, Social, and Leisure Activities
- People are not able to take part in a normal family and social activities (for example, holidays and social events
may be canceled) and this may affect relationships between the person with migraine and their partner, children, and friends.
- Migraine affects people not just during an attack but between them as well, due to the worry of not knowing when the next attack might happen.
- Frequent, severe attacks are associated with reduced quality of life.
5. Financial Cost
- People with migraine have to spend money on pain relievers or prescription medications.
- Some people with migraine may be less well off than they could be if they did not have the illness, due to underachievement, absenteeism or reduced productivity.
- Over a lifetime, some people with migraine may find that they are paid less than people they know who do not have a migraine. You may feel that you are in this situation. You may find that your migraine affects you in some, or all of these ways.
In the next section of this Article, we show you how you can assess how badly your migraine affects your body, life, and how you can work with your doctor to help you obtain better treatment.
Finding Out Best Treatment for your Migraine?
There are many different ways of treating migraine, from medications to changes in lifestyle or behavior. However, most treatments of migraine headache involve taking medications, which can be used in one of two ways.
1. In acute therapy, the medication is taken only after a migraine attack has started, to relieve the headache pain and other symptoms.
2. In preventative therapy, the medication is taken every day to try to prevent the attacks from happening. No single treatment is right for every person with migraine. In the same way that having migraine affects different people to different extents, some treatments suit some people more than others.
In this section, we advise you on the various treatments available to help you choose the one that best suits your needs.
Help Yourself Before You See Doctor Avoiding Migraine Triggers
Certain foods or drinks sometimes act to ‘trigger’ your migraine attacks. These include cheese, chocolate, red wine, tea, and coffee, as shown in the following table.
You should review the potential food triggers of Migraine and use the diary to note associations between your headaches and the triggers. If you see connections, try eliminating the trigger.
By doing this you may reduce the number of attacks you have, although it is unlikely that they will disappear altogether. Remember also that some people develop cravings for foods during the warning phase of their attacks. In this case, eating the food does not cause the migraine, but is a part of the attack.
Avoiding the food will not prevent a migraine attack, but will not do any harm either. Triggers often have variable effects. A piece of chocolate may not trigger a migraine whereas a whole bar might.
Vulnerability to triggers also varies with other factors such as stress, stage of the menstrual cycle, sleep, etc.
Changing in LifeStyle can help in Treating Migraine
You may notice that you sometimes have a migraine attack after a bad day at work, or if you miss meals, become over-tired or if you over-sleep. It is true that stress may lead to migraines, as can changes in daily routine.
Migraine often happens at weekends and holidays, when people change their lifestyles.
People often sleep longer, eat different things at different times and are less stressed than in the working week. If you see these patterns in your migraines, a change in your lifestyle could reduce the number of migraines you have.
Try to avoid stress if you can. If you are unable to do so, use stress reduction techniques, such as relaxation or yoga after work.
Acupuncture helps some people with migraine. To help unwind, try to do something you really enjoy for at least 30 minutes each day. It is worth trying to keep to the same general routine every day, including weekends and holidays.
Try to go to bed and get up at about the same time, and eat and drink similar foods at regular times. To find out more about the many different ways that you may help yourself if you have a migraine, you could join a support group for migraine patients.
Triggers that sometimes cause
• Hormonal changes
• Not eating regularly
• Too much sleep
• Foods, particularly chocolate, dairy
products, alcohol, fried fatty foods,
tea, coffee, wheat and seafood
• Some chemicals and medications
• Head injury
• Strong light
• Too much exercise
• Weather changes
Many countries have national associations for migraine patients, usually run by people who suffer from migraine themselves. These organizations provide useful advice on how to cope with migraine, and they may be able to put you in touch with other people with migraine living near you.
Treating Migraine with Medicines
Pain relievers medicines to treat Migraine headaches include non-prescription medications such as aspirin, paracetamol (acetaminophen) and ibuprofen, and a combination of these products.
Some tablets contain two or more pain relievers for stronger pain relief. In the USA, the only non-prescription treatment approved for migraine is a combination of aspirin, paracetamol (acetaminophen) and caffeine.
In some countries, ibuprofen and other non-prescription products are also recommended for migraine. When over-the-counter remedies bring good pain relief, they are an appropriate choice.
If you experience significant pain and disability despite using appropriate over-the-counter treatments, you should see your doctor. There are some associated problems with using pain relievers. Over-use may lead to a condition called chronic daily headache.
As the pain reliever wears off, it may trigger the next headache. If you are taking pain relievers every, or nearly every, day for headaches, you should tell your doctor.
Treatment of Migraine from Doctor
Your doctor can recommend medications that are available only with a prescription.
Sometimes you may be given simple pain relievers similar to those you can buy from the pharmacist, but they are often stronger. You may also be given tablets containing mixtures of drugs, which can be better at easing migraine headaches.
Some also help to reduce the feelings of sickness caused by migraine. These drugs are called combination therapies. If your migraine attacks are severe, you may find that simple pain reliever and combination therapies do not adequately ease your migraine.
In this case, your doctor may prescribe one of two types of medication. Ergots (ergotamine or dihydroergotamine) have been used for many years. These are powerful medications that can ease severe migraine attacks. Ergotamine has many side-effects.
If used too much, they may lead to a chronic daily headache. The latest type of medication, the triptans, are very effective treatments for severe migraines.
There are currently four triptans available:
If you have severe migraine attacks, your doctor may prescribe one of these drugs. All of these medications are acute therapies to relieve the attack only after the headache starts. Your doctor might also prescribe a preventative therapy to try to prevent the attacks from occurring.
These are given to people who have migraine attacks frequently. They help to reduce the number of migraine attacks but do not prevent them altogether.
If you have 3 or more days of headache-related disability per month, your doctor may suggest preventative therapy. If your doctor prescribes you preventative therapy, please remember that you will also need an acute therapy to treat the migraine attacks that still occur.
We believe that migraine is an important medical illness that causes real suffering to the people who have it. It is not only painful and often distressing, but it may also lead to problems with daily activities.
Despite this, many people with the migraine still do not visit their doctors or obtain the best treatment. We hope that this booklet has given you the information you need to better manage your migraines.
You should now understand a little more about who suffers from migraine and what happens during an attack. You should also know about the many treatments available for migraine. The list of features given above should help you determine if you have a migraine.
The Questionaire mentioned above will then help you to talk to your doctor to obtain the best possible treatment for your migraine. With recent medical advances in migraine, all people with migraine can now benefit from available treatments.
By using the information in this Article we hope that if you suffer from migraine, you will now be in a better position to talk to your doctor about your migraines, the effect they have on your life, and receive appropriate treatment to ease your suffering.