Migraine is a common and distressing condition which is often under diagnosed by doctors and therefore under treated.
Migraine is common, much more common than most people realise. You may be surprised to learn it affects 15% of the population and up to 25% of women. 100,000 people miss school or work every day because of migraine! The good news is that it is one of the very few things in life which gets better with age. Further good news is that there is an ever increasing range of treatment options and doctors are encouraged to be pro active and flexible in their approach. This is important, because there is an undoubted link between regular migraines and heart disease.
So how would you know if your headaches are migraines? Well this is more simple than it sounds. Recurrent headache associated with sensitivity to light, nausea or difficulty functioning is most likely to be migraine regardless of any other features. Other common features are a throbbing headache lasting 4-72 hours often preceded by yawning, mood change, light sensitivity, increased sensitivity to pain and exhaustion. Unusual symptoms can occur before migraine; these can include flashing lights, spots or partial loss of vision, pins and needles and speech disturbances . These unusual symptoms can come on over minutes and last up to an hour.
If you experience a “migraine” lasting more than 72 hours or one of these unusual symptoms lasting more than an hour then you need to have some further investigations promptly.
Migraine sufferers can be given one of two labels ; less than 15 affected days in a month gives you the label episodic migraine whereas more than 15 affected days a month earns you the label chronic migraine. Do remember in medical circles the word chronic means long lasting NOT more serious or more painful.
Migraines are often triggered and you as an individual with have probably worked out your own unique set of triggers and be trying to avoid them. Common triggers are skipped meals, irregular caffeine intake, irregular sleep and stress. In women migraines are more common before and during periods. In addition some medications can make migraines worse ; contraceptive pills, HRT, nasal decongestants, SSRI type antidepressants ( these are by far the most commonly prescribed type) and proton pump inhibitors ( widely prescribed for acid reflux and heartburn). Interestingly, in pregnancy 50-75% of migraine sufferers improve.
Much has changed in terms of its treatment over recent years. The current best advice for an acute migraine is a triptan type of tablet, which your doctor can prescribe, taken with a painkiller such as paracetamol or ibuprofen and adding in an anti nausea medication if needed. For women who experience a migraine with every period this regimen should be taken every day from 2 days before until 3 days after the period starts.
Many people are keen to prevent their migraines if possible rather than treat them when thy happen and this is very understandable. Lots of different medications have been tried over the years to prevent migraine and none are perfect. The best evidence for effectiveness is for amitriptyline (in low doses), topiramate and propranolol but a recent addition to this group is candesartan
Candesartan is prescribed for high blood pressure generally ; however an increasing number of migraine specialists are prescribing it for migraine prevention and is has made the “ recommended” list as of February 2018. Overall, the evidence and trials confirm that amitriptyline remains the most effective choice for most people.
If you would like to try to prevent frequent migraines , please talk to you doctor about the right choice of medication for you as this will vary. For example if you also have high blood pressure, candesartan might be a good choice. If you are an anxious person, propranolol might help with that and your migraines. If you have trouble sleeping as well as migraines then amitriptyline would be a good choice for you. Topiramate commonly suppresses appetite ( and is used in the USA for that purpose) so if you are battling your weight and have migraines consider this medication . Be aware thought that topiramate is not suitable for anyone trying for a pregnancy and can interfere with the pill and make it less effective as a contraceptive.