HEADACHE OR MIGRAINE?: know the signs
There is nothing quite like a pounding headache to ruin your day. However, there is a big difference between regular headaches and a genuine attack of migraine, says Professor Kerryn Phelps.
You might be able to struggle through the tasks you have to do for a while, but once a headache gets a hold it can be impossible to concentrate or to function normally. There is a big difference between regular, milder headache and a genuine attack of migraine.
A migraine is a severe throbbing headache, often accompanied by nausea, vomiting and sensitivity to light and sound. It is thought to be a result of abnormal nerve function and imbalances in chemicals in the brain. It affects women more often than men, likely because of hormonal factors.
There may be an advance warning, called an “aura”, up to half an hour before the headache appears. This can take the form of a vision disturbance such as shimmering lights around objects, zigzag lines, hallucinations or temporary loss of vision. Limb weakness, trouble speaking, dizziness, and tingling or numbness of your face, tongue or limbs can also signal an approaching migraine.
Another puzzling condition we see from time to time is the migraine without headache. You get the aura or a neurological symptom, but the headache doesn’t arrive.
Uncontrolled migraines are more than an interruption to your schedule. Having migraines more than doubles the risk for an ischaemic stroke, and the risk is about eightfold greater in users of oral contraceptives than in those not using them. The risk is increased if you smoke. Because of this, we recommend women with migraine find other forms of contraception and avoid the oral contraceptive Pill.
Looking at managing migraine, step one is to get the diagnosis right, particularly distinguishing migraine from other causes of headache.
Treatment of attacks needs to be tailored to your individual case. That starts with understanding migraine triggers and avoiding them. Triggers might include emotional stress, sensitivity to particular chemicals and preservatives in foods and alcohol, food additives such as nitrates (in preserved meats) and monosodium glutamate (MSG), excessive caffeine or withdrawal from caffeine, changing weather conditions, hormonal fluctuation, getting overtired and skipping meals.
If you suffer from frequent attacks of migraine, there are medical treatments available which will prevent attacks.
Whenever possible, preventing migraines should be done without the use of medication. That means avoiding triggers, managing stress and getting enough sleep. Once a headache starts, you will almost always need medication. You may be able to abort an escalation of the pain.
If migraines are frequent, your
GP or neurologist will advise you on which preventive medication is right for you. Some non-pharmaceutical approaches have been found to be useful in reducing the frequency or severity of attacks:
• A supervised elimination diet may identify dietary triggers which you can then avoid.
• Supplements, including Coenzyme Q10 (an antioxidant), magnesium, vitamin B2 and the herbs feverfew and butterbur may be recommended.
• Massage therapy or physiotherapy to release muscle tension in the neck and shoulders, as well as acupuncture, may help.
• Yoga and Tai Chi have been shown to have some benefit.
Migraine can be professionally and socially devastating. Many people with migraine find their lifestyle is severely impaired, particularly if they have frequent attacks that lay them low for days at a time. Most people with migraines learn to manage them with expert advice combining medicines, physical therapies, lifestyle changes, diet and supplements. However, if headaches become different in quality or intensity, or the neurological symptoms of aura do not rapidly subside, see your doctor as a precaution.
If you persist, you will find a combination of medical and complementary treatments which will help to get your headaches under control.
“Treatment of attacks needs to be tailored to your case.”