Migraine

7 May

Overview

Migraine is a chronic, episodic, neurological disorder that usually comes on in early to mid-life. They may or may not include aura; neurological symptoms including, but not limited to, photosensitivity and speech symptoms (BMJ Best Practice, 2018)

Who are Affected?

15% of Australians are affected by migraines and can present as early as childhood, but usually affects adolescent to middle aged adults (age 35-45). Migraines also affect women more than men during adolescence and adulthood, with women having a lifetime prevalence of migraines at 22% while men have a lifetime prevalence of 10% (Headache Australia, 2018)

In women, the frequency and intensity of migraines are affected by hormone levels. In the period around the menarche (first menstrual cycle) and during the reproductive years, prevalence increases. It usually decreases its prevalence after menopause.
Interestingly, pregnancy tends to improve the migraines, but unfortunately will revert after giving birth.

There are a number of triggers that can lead to a migraine, for example, of all migraine sufferers, approximately 20% will get a migraine after exercise (Brukner & Khan, 2012). But the most commonly reported triggers are from foods high in fat and salt, or drinks high in caffeine or red wine and beer. Other triggers involve sensory stimulation such as bright flashing lights, strong odours, or loud sounds; and even things such as atmospheric pressure changes (weather change) and fatigue and stress may trigger a migraine.

Headache Australia (2018) state that approximately 20-30% of people who suffer from migraines experience Aura; visual disturbances that affect the vision in both eyes even though they may seem like only one is affected. Common disturbances include flashing lights, difficulty focusing, and blind spots. They often last from 5-60 minutes before vision going back to normal.

What Are The Symptoms Of Migraine?

Most people think migraines are just the headache portion, but its symptoms can range quite widely. The pain may be classified (International Headache Society) by at least two of the following:

Unilateral (one sided)
Moderate to severe
Throbbing
Aggravated by movement

There is also at least one of the following associated symptoms:

Nausea
Vomiting
Photophobia (sensitivity to light)
Phonophobia (sensitivity to sound)

Lastly the headache lasts for between 4 and 72 hours. Though the classification of migraine is characterised by specific symptoms, there are not shortage of other symptoms that may be experienced. These include:

Diarrhoea
Stiffness around the neck and shoulders
Tingling pins and needles, numbness or even one-sided weakness
Difficulty concentrating or confusion
Aura (visual disturbances such as bright zigzagging lines, flashing lights, or difficulty in focusing that last between 5-60 minutes)
Osmophobia (sensitivity to smell)
Speech disturbances
Paralysis or loss of consciousness (uncommon)

How Are Migraines Classified?

Migraines can be classified into different types, which are:

Migraines without aura

A recurrent headache wth the characteristics stated above without the associated or specific symptoms

Migraines with aura

The classic type of migraine, with both the characteristics and associated symptoms stated above
Possible to experience aura without headaches

Chronic Migraine

A chronic migraine is applied when you experience a migraine for more than 15 days of the month. Out of those 15+ days, 8 of which you experience a migraine with or without aura. This may be caused by overuse of medications.

What Are The Common Medications Used To Treat Migraine?

It is recommended that when a person recognises that a migraine attack is starting, that they take some medicine, and then again during the middle of the attack. Some effective acute medicines include:

Paracetamol
Aspirin
Triptans (eg. Naratriptans, Sumatriptans)
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

If pregnant, Triptan and NSAIDs are not recommended, but paracetamol may be used.

If above medication doesn't seem to make much change, consult with your healthcare professional.

Migraine In Multiple Sclerosis

People with Multiple Sclerosis (MS) are known to have a wide range of debilitating symptoms, one of which is migraine. The MS Society Australia states in Pain and Multiple Sclerosis (2009) that migraine accounts for 41% of all headaches in MS. This high incidence is reported to be linked to the use of immunological modulating medications that may increase the frequency of headaches. Other reasons for high incidences of headaches are thought to occur due to brain stem or cervical demyelinating plaques.

How Can We Help?

From a musculoskeletal standpoint, manual therapies has proven effective in managing the headache, decreasing intensity and frequency as stated by Chaibi, and Russell (2014). Our practitioner Julius Principe has an keen interest in the treatment of headaches and migraines. Recognising the importance of a multidisciplinary approach, Julius can work collaboratively with your existing healthcare professionals to help you address your Migraine symptoms.