Understanding Migraine

Migraine symptoms are individual and vary considerably from person to person. There is a wide spectrum of disability, some patients have very infrequent, mild attacks whereas other patients experience continuous, debilitating attacks. 

How migraine presents may change and evolve over time and may include a variety of symptoms. A migraine attack generally involves head pain/pressure that is of moderate to severe intensity and has a throbbing or pulsating nature. 

Other common symptoms of migraine include nausea, vomiting, and sensitivity to light, sound, smells, or motion. A typical attack can last anywhere from four hours to several days. Migraine attacks can interfere with your daily life and impact your ability to work, study or take part in family/social activities.

Migraine thrives in chaotic, inconsistent environments. Introducing a regular predictable daily routine and implementing simple lifestyle measures can be helpful in reducing your attack frequency and severity. 

The main lifestyle areas to focus on are, sleep hygiene (going to bed and rising at the same time/ 7 days a week), eating regularly, maintaining adequate hydration, and introducing gentle exercise and destressing techniques. 

Keeping a diary can be a helpful exercise to determine if lifestyle measures have been effective and to identify trigger factors.

A trigger factor is any physical activity, event, or external stimulus which seems to result in a migraine. It may proceed your migraine attack by up to 8 hours. Identifying a triggering factor can be a difficult and arduous process. It is often a combination of trigger factors which come together in a ‘perfect storm’ which triggers the episode.

Almost any factor can trigger an attack in a person predisposed to migraine. Potential triggers can include bright lights, loud noise, strong smells, dehydration, skipping meals, certain foods such as mature cheese, hormones, heat or sun exposure, travel, stress and anxiety and a number of other factors.

Keeping a migraine diary can be a helpful way of uncovering individual trigger factors and by limiting your exposure to known triggers you can hopefully reduce the frequency of attacks over time.

Medication for migraine varies depending on the frequency of your attacks. Episodic and chronic migraine, are treated in very different ways. The terms episodic and chronic reflect the frequency the patient experiences migraine. Episodic migraine occurs in attacks up to 14 days per month. Chronic migraine is defined as a minimum of 15 days per month of migraine, for at least a three-month period.

The recommendation for treating episodic migraine attacks is to treat early in the attack and to use a combination approach.  Your GP or headache specialist may also prescribe a migraine-specific treatment to take at the onset of symptoms to stop the migraine in its tracks. Medication used for migraine attacks is recommended to be used no more than 8 days per month to prevent rebound headaches.

If migraine becomes chronic (>14 days per month) your GP or headache specialist may prescribe a migraine preventative medication. Preventative medications are taken daily for at least a three-month period to try and break the migraine cycle and ultimately reduce the frequency and severity of attacks.

Patients are asked to limit the use of all painkillers to 8 days per month to prevent rebound or medication overuse headache (MOH). Any painkiller has the potential to lead to the development of medication overuse headache but the most common culprit is codeine based preparations. Taking regular painkillers (more than 8 days per month) for any reason can lead to the development of a chronic daily headache in the patient predisposed to migraine. If MOH is suspected your doctor may recommend complete withdrawal of the painkiller for a period of at least 6 months to ‘reset the brain chemistry’.

Date of Preparation: March 2023