Do you have migraines? I’ve only had one in my life and it was awful. I think I was in my late teens – it felt like one side of my head was going to explode and all I could do was lie in a dark room for a whole day until it got better. I’ve never forgotten it.
I was listening to a podcast about management of headaches the other day (yes, that is how exciting my life is) and they were talking about how both lifestyle changes and complementary therapies can improve frequency and severity of migraines. It was fascinating so I thought I’d look at it in a bit more depth and share it with you.
What is a migraine?
A migraine is a severe throbbing headache which usually affects one side of the head. The headache is often accompanied by nausea or vomitting and sensitivity to light and sound. Migraines last for between a few hours to several days. People often don’t feel quite right for a day or two beforehand with a variety of symptoms like irritability, depression, constipation and food cravings.
About a quarter of people with migraine have what is called an “aura”. This can occur before or alongside the headache. There are many different kinds of aura although visual auras are most common. People may see bright lights or shapes like zig zags in their vision. Other auras that occur may be things like strange sensations, loss of vision, or weakness in an arm or a leg.
It’s thought that migraines are precipitated by a wave of electrical stimulation across the nerves within the brain that result in inflammation and pain.
Why do people get it?
Like so many other medical conditions it often runs in families. It’s really common and affects at least 12% of the population, more often occurring in women than in men. It’s commonest in people in their 30’s.
There is a huge list of factors that can trigger migraine. The most common ones reported are stress, the menstrual cycle or hormonal medications, skipping meals, changes in the weather and sleep disturbance. Various elements in the diet can trigger migraines in certain people. Common examples are alcohol, cheese, chocolate, Aspartame in diet drinks and caffeine. Keeping a diary can be useful to try and work out triggers.
What can you do about it?
There’s good evidence that aerobic exercise makes a difference. A study showed that 40 mins of aerobic exercise three times a week was as effective as a commonly used medication and a relaxation program. A regular sleep pattern, eating regularly and avoiding sugary foods have also been shown to help. Getting to know your triggers is helpful. At present advice is to usually to avoid triggers although people are looking into the benefits of learning to cope with triggers to reduce sensitivity to them.
Other non-medical treatments include specific neck exercises to strengthen the neck muscles in those with migraines accompanied by neck pain or relaxation techniques like body scans. Some complementary therapies such as Acupuncture or Biofeedback have shown to be beneficial. There are various psychological therapies that have been used successfully including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) – availability may be variable and limited.
Medicines and lifestyle changes work in tandem with each other. Medicines for migraine are either given as soon as symptoms start to relief the pain of acute attacks. Or, if acute attacks are frequent they may be given for prevention. Mild attacks can often be treated effectively anti-inflammatory medication like aspirin or ibuprofen, along with anti-sickness medication. Paracetamol may also be useful for some people.
For more severe attacks the group of medications called Triptans are often used eg. Sumatriptan. They work by blocking the pain messages in the brain. They can be taken in tablet form or by nasal spray or injection if the you are vomiting and unable to take tablets. If one of the Triptans doesn’t work for you, it’s worth trying another one in the group as different people respond to different ones. The various Triptans, anti-inflammatories and anti-sickness medication may be used in combination if necessary and there are other more specialist options available as well.
If migraines are frequent or last for a long time regular preventative treatment may be beneficial. They won’t cut out migraines completely, but will reduce frequency. A huge variety of medications can be used such as beta-blockers, pizotifen and some anti-depressant medicines.
- Keep a diary to see if you can work out triggers so you can see if avoiding them helps
- Manage stress as best you can
- Sleep well
- Be active
- Eat regularly and avoid sugary food
- See your doctor to discuss medication and/or consider complimentary therapies.