The intense pain of migraine can often render sufferers unable to function, with some even needing bed rest during an attack. Here, neurologist Dr Jennifer Dineen provides a comprehensive guide to these acute headaches, from triggers to treatments
Migraine is an episodic disorder characterized by a severe headache. In general, it is associated with nausea and/or light and sound sensitivity. A migraine can just involve a headache, or can be associated with other neurological symptoms such as flashing lights or tingling in an arm or leg, known as an aura. Very rarely, it can occur with just the aura and no headache.
Studies have shown that up to 90pc of people suffering from a migraine have moderate or severe pain, while three-quarters have a reduced ability to function during the headache attacks, and one-third require bed rest during their attacks. It has also been shown that most people treat their symptoms with abortive treatments – which are taken once a migraine has taken hold – over preventive treatments, therefore increasing their risk of medication overuse headaches.
1 What type of headache occurs in migraine?
The headache of migraine is usually – but not always – on one side of the head, often around the eye. It tends to have a pulsatile or throbbing quality, especially as the intensity increases. As the attack intensity increases, patients may experience nausea and vomiting as well as sensitivity to both noise and light. Untreated, it can last as little as four hours or as long as several days.
2 What is a migraine aura?
A migraine aura is identified by a gradual development of symptoms lasting no longer than one hour, followed by complete resolution. Migraine aura usually impacts vision (such as flashes of light or zig-zags in part of your vision) or sensation (usually a tingling and rarely a numbness) and, in rare instances, language or motor function. The aura usually develops over more than five minutes and the symptoms should have a migrating or travelling pattern; these two features help to distinguish it from a mini stroke.
3 What are migraine triggers?
Migraine triggers are factors that are known to bring on or exacerbate migraine. Common triggers include stress, hunger, hormones in women, lack of sleep, alcohol, neck pain and sleep disturbances. It’s worth identifying your own particular migraine triggers and working out how best to deal with them.
4 How should migraine management begin?
If you suffer from migraine, the first thing you should do is start a headache diary. Keeping a written record of headache frequency and severity will help you in planning preventive treatment. Write down as much detail as possible, including information on your need for acute medications and the potential triggers for your headache. A migraine diary can be downloaded from the Migraine Association of Ireland website. Non-pharmacological measures such as biofeedback, relaxation therapy or cognitive behavioural therapy can also be very helpful.
5 Which medications should be taken?
If your migraine is mild to moderate, it’s best to start with anti-inflammatory medication. However, if it’s moderate to severe, start with a triptan to ease your symptoms.
In order to avoid an overuse headache, medications should be taken within strict parameters: anti-inflammatories, such as naproxen, should be used on less than 15 days per month; triptans, such as sumatriptan, should be used on less than 10 days per month.