Migraine disease

Key points about migraine disease

1. About one in 10 people have migraine disease, with more women affected than men. It usually first occurs between 10 and 30 years of age, and may get better in middle age.
2. If you are over 50 and a severe headache occurs for the first time, see your doctor.
3. Some people have a ‘migraine aura’ before the headache begins. This could be problems with your eyes (eg, seeing zig-zag lines), dizziness or pins and needles.
4. Treatment includes lifestyle changes and using medicines for relief or, in some cases, to stop a migraine attack from happening.
5. See your doctor if treatments are not helping or if your migraine attacks are happening more often or getting more severe.

What causes migraine disease?

The exact cause of migraine disease is still being studied but it could be partly genetic. People with migraine often find that others in their wider family also have the condition.

What are the triggers for migraine? 

People living with migraine disease have triggers that cause migraine attacks. Learning what triggers your migraine attacks and finding ways to avoid or reduce these triggers is an important part of managing migraine disease.

There are many different trigger factors that may start a migraine attack or episode. Keeping a diary of when you have a migraine episode and what may have started it is a useful way to work out your triggers.

Some foods such as chocolate, brown vinegar, cheese, citrus fruits, onions and MSG (monosodium glutamate) can be a trigger for some people. Food may be considered a trigger for a migraine episode if an attack occurs within 6 hours of eating and you don't get migraine attacks when you don't eat that food. 

Women and migraine disease

Female hormone fluctuations, the oral contraceptive, menopause and pregnancy may affect migraine.

• Migraine attacks often happen around your period (menstruation) or at other regular times of your cycle (menstrual migraine).
• Many women find migraine disappears during pregnancy.
• Oral contraceptives containing oestrogen may change migraine frequency.
• Some women get migraine during menopause.

Non-migraine headache is also a common feature of pre-menstrual syndrome.

What are the symptoms of migraine?

Some people notice a migraine aura before the headache starts, and this can alert them that a migraine attack is coming. The symptoms of an aura may be different for everyone. Examples include:

• feeling tired, fatigue
• repetitive yawning
• restless or irritability
• anxiety
• food cravings, feeling hungry or thirsty
• difficulty concentrating
• sensitivity to light or sound
• problems with vision (seeing zig-zag lines)
• dizziness 
• tingling or numbing feelings in your body.

When the headache starts, it is a strong pain, usually on one side of your head. You may feel sick or vomit (be sick), get tingling around your mouth, have trouble talking or feel dizzy or weak.

How is migraine diagnosed?

The following are common with migraine attacks and don't usually happen during a tension headache:

• aura
• headache on one side
• high sensitivity to light and noise
• nausea (feeling sick) or vomiting (being sick).

These symptoms are very particular to migraine disorder. Your doctor may do other tests if they are concerned your headaches may have another cause. However, a migraine attack are not a sign of a stroke or a tumour, and your doctor will reassure you of this.

How is migraine treated?

Migraine disorder can't be cured but you can relieve symptoms during an attack and prevent further attacks. Migraine varies between people and so does the treatment. Some things are commonly known to trigger migraine attacks in some people. Avoiding these triggers can reduce how often and how severe your migraine attacks are. 

Medicines

Medicines for the treatment of migraine is aimed at stopping symptoms and preventing future attacks fall into a few categories:

• Pain-relieving medicines, which are taken during a migraine attack to help stop symptoms that have already begun.
• Medicines for nausea (feeling sick) or vomiting (being sick).
• Medicines to prevent migraine attacks, which are taken regularly to reduce how often and how severe your migraine attacks are.

The type of medicine you need depends on many things, including how often, severe and disabling your migraine attacks are. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. Read more about medicines for migraine.

Caution – medication-overuse headache

Medication-overuse (or rebound) headache can happen from using too many pain relievers to treat headaches and migraine attacks. It may feel like a tension-type headache or migraine-like attack.

Headaches often improve within 2–4 weeks of withdrawal of the overused medicine but can feel worse before improvement is seen. To avoid this:

• triptans should not be used for more than 10 days per month
• paracetamol and NSAIDs should not be taken for headache on more than 15 days per month.

What self-care can I do when I have a migraine attack?

Here are some simple measures that you can try to ease your symptoms.

• Lie in a quiet, cool, dark room.
• Avoid moving around too much.
• Put a cold flannel on your neck or forehead.
• Avoid drinking tea, coffee or orange juice.
• Try to relax by listening to music or through meditation.
• Don't read, watch TV or drive.
• Sleep through the attack.

How can I prevent migraine attacks?

Not all migraine attacks have an obvious trigger, but sudden changes in daily routine can be a trigger. This includes a missed meal, a late night or doing more strenuous exercise than you normally do.

To reduce your chance of having a migraine attack you may find it helpful to make the following lifestyle changes:

• Have regular meals.
• Drink enough water/fluid to stay hydrated.
• Do relaxation and exercises for stress (eg, meditation and yoga).
• Aim for a regular sleep pattern and make sure you have enough sleep (but avoid long sleep-ins).
• Don't do sudden strenuous exercise.
• Limit caffeine intake to no more than 2 cups of coffee a day.

Addressing other conditions that may be causing your migraine attacks is also important. These include stress, anxiety, depression, hormonal changes and head or neck trauma. If these are problems, talk to your doctor. They may be able to help you work out how to manage these things.

Cognitive behavioural therapy (CBT), coping strategies and relaxation training are helpful for many people with migraine, especially if attacks are associated with anxiety or stress. 

Preventive medicines

Preventive medicines are taken daily to prevent migraine attacks from happening. They are not used to treat a migraine attack. Medicines to prevent migraine attacks are an option if you:

• have at least 2 migraine attacks a month
• have significant disability despite suitable treatment for migraine attacks
• cannot take suitable treatment for migraine attacks.

Preventative medicines aim to reduce how long and severe your migraine attacks are and how often you get them. They can help to reduce disruption to your daily activities that happens with migraine, and reduce overuse of pain relief medicines. They must be taken every day to work well. They may take a few weeks to start working. Read more about preventive medicines for migraine.

What happens if migraine disorder is not treated?

You will keep having migraine attacks but will not come to any harm. However, migraine attacks are likely to happen again and again and these can be very disruptive and debilitating.

Support

Migraine Down Under Blog with New Zealand-specific support and resources.
Migraine Down Under Facebook support group
Migraine New Zealand A patient body advocacy group founded to support and fight for all New Zealanders living with migraine.
Migraine NZ Chat Group Facebook support group

Learn more

The following links provide further information about migraine disorder. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Migraine Neurological Foundation, NZ
Headache and migraine disease language and image guide Coalition for Migraine and Headache Patients (CHAMP), Australia, 2018/19
A patient's guide to migraine Dr Jon Simcock, Medical Adviser, Neurological Foundation, NZ
Living with migraine The Migraine Trust, UK
Range of topics American Migraine Foundation, US
Shades for Migraine A global awareness campaign that asks everyone to wear a pair of sunglasses on 21 June to show their support for the 1 billion people living with migraine disease worldwide.

References

1. Cafergot tablets to be prohibited 1 May 2020 Medsafe, NZ, 2019
2. The role of triptans in the treatment of migraine in adults BPAC, NZ, 2014
3. Medication-overuse headache BPAC, NZ, 2008
4. Headache and migraine disease language and image guide Coalition for Migraine and Headache Patients (CHAMP), Australia, 2018/19

Reviewed by

	Angela is a pharmacist in the Quality Use of Medicines Team at Waitematā District Health Board. She has experience in hospital pharmacy in New Zealand and in the UK, and was previously a medical writer for Elsevier in The Netherlands. Angela is interested in promoting the safe use of medicines, particularly high-risk medicines.