What is a migraine?

A migraine is a type of headache that typically involves throbbing pain, sensitivity to light and sounds, nausea and vomiting. Migraines can worsen with normal daily activities and can last anywhere from four hours to three days.

Migraines occur more commonly in women, with about one in five women being affected at some point. In contrast, about one in 20 men are affected. [1] The most common age bracket in which migraines occur is 20-50 years of age.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Signs and symptoms

Some of the signs and symptoms that are associated with migraines can include:

  • Auras - these are the symptoms that occur before a migraine and include visual disturbances such as flashing lights and blind spots, sensitivity to smell, tingling in the face and hands, weakness in limbs and speech disturbance;
  • Sound and light sensitivity;
  • Pulsating headache;
  • Nausea and vomiting;
  • Long-lasting headache (up to 72 hours), and;
  • Pain on one or both sides of the head.

Migraine.Migraine symptoms can include pain on one or both sides of the head. 

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Causes

The cause of migraines is complex. Migraines are thought to be caused by an alteration in the blood vessels to the brain. Migraines may also start like other headaches, with a wave of electrical activity spreading across the brain. This electrical activity is thought to give rise to auras. The electrical activity also stimulates the nerve that supplies sensation to the head and neck, known as the trigeminal nerve, causing localised pain. In addition, such activity heightens the sensitivity of nerve cells elsewhere in the brain, causing symptoms such as nausea and vomiting, light and sound sensitivity and pulsing sensation.

There are many different emotional, diet-related and environmental triggers that can start a migraine. Some causes include:

  • Tension and stress;
  • Tiredness, physical exhaustion, lack of sleep or oversleeping;
  • Certain foods (e.g., cheese, chocolate, citrus fruits, tomatoes), food additives (e.g., monosodium glutamate (MSG) and sodium nitrite), certain drinks (e.g., caffeine and wine);
  • Hormonal changes (e.g., before or during menstruation, during pregnancy or menopause);
  • Head trauma (e.g., sporting injury);
  • Bright or flickering lights, excessive noise, strong perfume;
  • Dehydration, and;
  • Medication (e.g., oral contraceptive pill, vasodilators).

Dehydration

The state of insufficient hydration; excessive loss of water; requiring more water in order to function normally.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Vasodilators

Medications that widen blood vessels.

Sodium nitrite

A type of salt used in meat curing and preserving.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Risk factors

Risk factors associated with migraines include:

  • Family history - there is an increased risk if other people in your family experience migraines;
  • Gender - migraines are four times as common in women than in men, [1]  and;
  • Age - migraines are more likely to occur in people 20-50 years of age.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Types

There are two main types of migraine. These relate to the presence or absence of an 'aura' prior to the migraine. An aura occurs 10-30 minutes prior to a migraine and can include seeing flashing lights or blind spots, numbness or tingling in the hands or face, or an altered sense of smell. A migraine with an aura is termed a classic migraine, while migraine without an aura are termed common migraine.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Methods for diagnosis

There is no specific test to diagnose a migraine. Your doctor will ask you questions about your medical history and symptoms that were experienced at the time. They may also ask you when and how often the symptoms occur, to help identify the cause of the migraines. It may also be useful to create a diary of the migraine occurrence. A diary could include the following information:

  • The date of the migraine;
  • Location of the pain;
  • Length of migraine;
  • Symptoms experienced;
  • When the symptoms occured, and;
  • Suspected triggers.

If your doctor believes that there is something other than a migraine causing your headache, they might recommend blood tests and/or computerised tomography (CT) or magnetic resonance imaging (MRI) scans. It is important to note that the early signs of a stroke can sometimes be similar to those of a migraine, so imaging with CT or MRI can help exclude a stroke.

Computerised tomography

A scan that uses X-rays to create a 3D image of the body. This can detect abnormalities more effectively than a simple X-ray can.

Magnetic resonance imaging

A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Types of treatment

There is no cure for migraines, but they can often be well managed. It is possible to adopt a lifestyle that helps to prevent them by identifying and possibly avoiding the various triggers. This could involve avoiding specific foods, reducing tension or stress, or avoiding bright lights or loud music where possible.

Treatment during a migraine

During a migraine, it is best to begin treatment as soon as possible. Treatment steps can include:

  • Taking pain-relief medications such as aspirin or paracetamol;
  • Resting in a quiet, dark, cool room;
  • Placing cold packs on the forehead or neck, and;
  • Staying hydrated by drinking water.

Medications

Acute treatment

If pain-relief medications, including paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, do not relieve symptoms, other medications may be prescribed by your doctor. These can include triptan medications that cause dilated blood vessels in the brain to constrict, helping to relieve the symptoms of a migraine. Examples of triptans include sumitriptan, zolmitriptan and naratriptan.

Anti-nausea medications can also be used to relieve the nausea associated with migraines. Some examples of anti-nausea medications include domperidone, metoclopramide and prochloperazine.

Preventative treatment

For some people who experience regular migraines (two or more each month), certain medications can be prescribed as a preventative measure. Preventative medication can also be used for people who cannot take or do not respond to medication used for acute treatment. These medications can help prevent the frequency or severity of migraines. Each medication works slightly differently to help prevent migraines, so your doctor will prescribe one that is right for you. Some medications can include:

  • Beta-blockers including propranolol and metoprolol;
  • Serotonin antagonists including pizotifen;
  • Antiepileptic medications including topiramate, and;
  • Ergot derivatives including methysergide.

Beta-blockers

Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particuarly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.

NSAIDs

Non-steroidal anti-inflammatory drugs are commonly used to manage arthritis-related pain and inflammation and other musculoskeletal disorders. NSAIDs include aspirin and ibuprofen.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Potential complications

Some complications associated with migraines can include:

  • Abdominal problems from prolonged use of NSAIDs. This can lead to the formation of stomach ulcers and abdominal bleeding;
  • Medication overuse - headaches can occur when too much headache medication, such as codeine, is used. These can occur when medication stops relieving pain and actually causes a headache (rebound headache);
  • A condition called serotonin syndrome, which can also occur in people taking triptans. It occurs when your body has too much serotonin and is a rare but life-threatening condition. Certain medications should be avoided while taking triptans. Always check with your doctor or pharmacist when taking new tablets;
  • Status migrainosus, a complication in which a migraine remains for three or more days;
  • Chronic migraine, a complication in which migraine has been present for more than 15 days each month for more than three months, and;
  • Persistent auras that last from one hour up to one week. This can also be a symptom of bleeding in the brain (stroke) and is important to be evaluated by your doctor.

NSAIDs

Non-steroidal anti-inflammatory drugs are commonly used to manage arthritis-related pain and inflammation and other musculoskeletal disorders. NSAIDs include aspirin and ibuprofen.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Abdominal

Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.

Codeine

A type of pain-relief medication, similar to morphine.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Prognosis

Migraines are a common condition that affect one in five women and one in 20 men. There is no cure to stop them from ever happening again, but you can limit their occurrence by recognising specific triggers and avoiding them.

If a migraine does start to occur, it is best to act quickly to reduce the severity of symptoms. This can include taking pain-relief medication and resting in a cool, dark room. For people that experience migraines often, preventative medication is possible to reduce the likelihood and severity of developing migraines.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.

Prevention

To help prevent migraines, some lifestyle changes can be made. This can include eating a healthy diet and exercising regularly. It is important to identify and avoid any trigger factors that cause your migraines such as tension and stress, fatigue, physical exhaustion and certain foods or drinks including cheese, chocolate and red wine. Some people benefit from relaxation or meditation techniques to help prevent migraines. There is sufficient evidence to suggest that acupuncture is effective for both acute treatment and preventative treatment of migraines, often with fewer side effects. If migraines occur frequently, specific medication can be prescribed by your doctor to help prevent their occurrence.

Acupuncture

A form of complementary therapy that involves fine sterilised needles being inserted into the skin at specific points to treat medical conditions.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

1. Murtagh John. MD. (2011) John Murtagh's General Practice (5th revised edition). North Ryde N.S.W.: McGraw-Hill Publishing.