Migraine

What is Migraine?

Migraine is a common disabling neurological disorder that affects around 1 in 6 women and 1 in 16 men. Although migraine can affect people of all ages, it most commonly occurs in your 20s and 30s. Migraine can sometimes be so severe that it significantly impacts upon quality of life. Alarmingly studies show that around half of people that suffer from migraine have not actually been diagnosed, which means that they are probably not getting the best treatment.

Currently the available medication to treat and prevent migraines only work 50% of the time and unfortunately, the most effective medications often have side effects that are intolerable. Considering this, it is not surprising that neuromodulation (brain changing) methods have come to the forefront of research, providing a safe and effective treatment option.

5 Distinct Phases

Firstly, it is important to understand the symptoms that characterise a migraine. There are 5 phases that distinguish migraines from other types of headaches. These phases reflect the underlying neurological changes that occur.

Prodromol (early warning symptoms)

A large number of people experience ‘warning symptoms’ for up to 24 hours before a migraine attack. Symptoms can include:

  • Gut related: nausea, appetite changes, constipation, diarrhoea
  • Neurological: drowsiness, vision changes, dysphagia (difficulty finding the right words), sensitivity to light and sound, incessant yawning, thirst
  • Behavioural: changes in mood, hyperactivity, clumsiness, lethargy
  • Muscular: general aches and pains

Aura

Aura occurs in 20-30% of people experiencing migraines. Visual disturbances are the most common aura symptoms, these can include bright zig-zag lines, flashing lights, focusing problems and blind spots. Aura symptoms can also include disturbance in sensation or speech.

Headache

The headache can last up to 3 days, is usually one-sided and throbbing in nature and aggravated by movement. The most common symptoms that accompany the headache are nausea, vomiting and sensitivity to light, smell and noise.

Resolution

Eventually the migraine attack will come to an end. Sometimes people don’t start to feel better until after they have been sick and for others not until they have ‘slept it off’.

Recovery

Many people feel quite fragile and drained after an attack and it can take a day or so to recover.

What Causes Migraine?

Migraine is thought to be caused by a complex interaction between genetics and environment which create dysfunctional networks in the central nervous system. It is well documented that changes in motor cortex excitability play a pivotal role in the functional changes in the brain that occur in migraine. The cortex also appears to be more sensitive to repetitive sensory stimulation known as ‘reduced habituation’ and can show reduced activity of connections between different parts of the brain known as a ‘decreased pre-activation’ level.

Triggers

Research has identified various factors that increase the likelihood of a migraine attack. It is important to investigate triggers that are individual to each migraineur. These factors are varied and include:

  • Foods containing amines such as chocolate, cheese and dairy, citrus, caffeine, alcohol, pork, seafood, onions, wheat
  • Fluctuations in blood sugar (skipping meals)
  • Dehydration
  • Bright lights, loud noises, or strong smells
  • Too much or not enough sleep
  • Hormonal changes
  • Stress and anxiety
  • Changes in weather/environment
  • Foods containing additives such as MSG, nitrates/nitrites

What Can I do to help myself?

A daily migraine diary including food, drink, activities and emotions can be a very useful tool for identifying patterns and triggers. Some additional tips to help are:

  • Drink water (and lots of it!)
  • Eat well. A healthy diet is important
  • Be active! Aim for at least 30 minutes of exercise every day
  • Find ways to manage /prevent stress such as mediation and biofeedback
  • Ensure sufficient quality sleep (8hrs a night on average)

At The Perth Brain Centre, we focus on identifying the underlying problems through a detailed examination and perform a Quantitive Electroencephalogram (QEEG), a scan that measures brain wave activity and compares it to databases with known ‘normal’ and ‘abnormal’ patterns. This information is then used to develop an individualised treatment program which often involves a course of neurofeedback therapy and/or transcranial direct current stimulation (tDCS), combined with dietary and lifestyle changes in order to optimise brain function.

Additional Preventative Treatments

The latest evidenced based guidelines from the American Academy of Neurology and the American Headache Society have highlighted some additional preventative treatments. These include:

  • Petasites (extract of the butterbur plant) which has been proven to be effective in preventing migraine attacks
  • Vitamin B2 (riboflavin), Magnesium, Ibuprofen, Naproxen, Feverfew and Histamines are all considered likely to be effective and should be considered for preventing migraine attacks.

A qualified health professional trained in nutrition will be able to guide you in the most appropriate preventative supplements.

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