Focus on migraine

Migraine is a serious neurological condition which can have debilitating effects, such as pain, nausea and visual disturbances. Migraine attacks can also have a major impact on people’s work, family and social lives. In this blog we focus on migraine in more detail including what can trigger attacks and what you can do to help manage migraine.

It is estimated that around 10 million adults in the UK are living with migraine. This means that around one in five adults in the UK may be living with migraine or migraine like symptoms. In addition, those in their 20s, 30s and 40s are most likely to be affected. Migraine also affects two to three times as many women as men.

What is a migraine?

Migraine is a complex condition. Those with migraine experience migraine attacks which can have a range of different symptoms, often including painful headaches. Attacks can last from 4 hours to 3 days and can be a whole body experience.

Symptoms

Due to the complexity of the condition, migraine symptoms can be wide ranging and varied and can also differ from person to person and attack to attack. Symptoms can start about 24 hours before any head pain, and end about 24 hours after head pain ceases. Some people may get warning symptoms before the start of an attack, called an aura.

The main symptoms include:

• Headaches
• Nausea, vomiting and abdominal pain
• Visual changes (blind spots, zig zags, flashing lights, etc)
• Feeling sensitive to light, sound or smells
• Pins and needles
• Tingling or numbness in limbs
• Dizziness/vertigo
• Difficulty concentrating
• Fatigue
• Slurring and speech problems

Types of migraine

There are two main types of migraine: migraine without aura (previously known as common migraine) and migraine with aura (visual disturbances). They share many of the same features:

• The aura – this usually last less than an hour but can be frightening with symptoms including visual disturbances (spots, lines or lightening effects in the visual field), buzzing in the ears or partial loss of hearing, sensation loss and even partial paralysis. As the name suggests, this feature only occurs with migraine with aura. Auras usually happen before a headache, but can happen on their own without the symptoms of a migraine without aura – see below.
• A prodrome, or preheadache feelings that can include mood changes, neck stiffness, food cravings and fatigue.
• The headache itself can be severe and very debilitating, preventing you from doing your normal daily activities and worsening when you move. Symptoms are usually felt on one side of the head but can shift to the other. Common features include throbbing pain as well as sensitivity to light and sound, anxiety, nausea and vomiting.
• The postdrome or post-headache hangover is a period (hours to days) after the headache where the sufferer can feel exhausted, confused and low in mood/depressed.

What triggers migraine?

Factors that can trigger attacks in people susceptible to migraine include stress, change in sleep pattern, overtiredness or sleep disturbance, hunger and certain types of food or drink, dehydration and consumption of caffeine or alcohol, exercise, climatic conditions and use of visual display units. Hormones can also be a trigger which is why migraine is more common in women than men.

How to manage migraine

The first treatment to be recommended by The National Institute for Health and Care Excellence (NICE) for treating acute migraine will soon be available on the NHS to around 13,000 people. In addition, there are various other medical treatment options available – click here for details – but what can you do on top of medication to help manage migraine?

1. Regular moderate exercise – If you are prone to migraine, you may have found that strenuous exercise can trigger an attack. Regular moderate aerobic exercise however can help reduce the frequency and intensity of migraines. Try to exercise at least three times a week at moderate intensity and avoid exercise before bedtime. For more information and advice on exercise and how to avoid it being a migraine trigger, click here.
2. Regulate sleep – Lack of sleep or too much sleep can be triggers for migraine. Aim for a minimum of eight hours sleep a night on a regular basis. It also helps to get into a good sleep routine e.g. try to go to sleep at the same time each night and avoid screens for roughly an hour before you go to sleep. Cutting out caffeinated drinks in the afternoon can also help with your quality of sleep. For more sleep tips, see the ‘How to get a good night’s sleep’ section of our sleep blog. For more information on the relationship between sleep and migraine from the Migraine Trust, click here.
3. Take breaks from screens – If you spend a lot of time in front of a screen for work or pleasure, make sure you take plenty of regular breaks. If possible, speak to your HR department to let them know you suffer with migraines and ask if they can help put any additional support in place to help you.
4. Keep a migraine diary – Start keeping a migraine diary to help keep track of when you suffer a migraine and your symptoms. Take note of how long you slept for, how long you worked for, any activities throughout the day including exercise, what you ate and where you are in your menstrual cycle (if applicable) as this could help you or a health care professional identify your triggers. For more migraine diary tips, click here.

Acupuncture and manual therapy

NICE includes acupuncture, which can be offered by chiropractors and osteopaths as part of a treatment package, as a therapy to be considered to prevent chronic tension-type headache and migraine. For migraine, it suggests considering a course of up to 10 sessions of acupuncture over 5–8 weeks.

Manual therapy is also an effective approach to improving the health-related quality of life in those affected by migraine and tension type headaches and can be undertaken in isolation, as well as alongside medication offered through a GP. It is recommended that osteopathic and chiropractic management of migraine and headaches should be individualised, based on a package of care that addresses the individual circumstances and preferences of the patient. In addition to manual therapy, this may include a range of other interventions including exercise and lifestyle advice, acupuncture (see above) and more.