Powerful headaches lasting from four hours to three days are suffered by twelve to fifteen per cent of Australians, according to Headache Australia. These migraines, often affecting only one side of the head, may be preceded by an aura of flashing lights in front of vision and come with nausea or sensitivity to light, sound or smells. It's the kind of pain that a normal headache tablet often can't touch. “The variations in frequency and duration between sufferers add to the complexity of this condition,” says Gerald Edmunds, secretary general of the Brain Foundation and Headache Australia. What is known is more than three-quarters of people with migraines have a close relative who also suffers from them. “There is an established genetic link and research supported by Headache Australia has helped identify the cluster of genes involved,” explains Edmunds. “More research is needed to seek ways to alter the way that these genes are expressed.” While scientists continue to learn more about migraines and develop new treatments, here are the current options for managing the pain.
Tried and true
Doctors advise making a list of common triggers (hunger, dehydration, specific foods or drinks, smells, bright lights, hormonal changes, certain drugs, stress) and noting which ones you experience before each attack. The list is then reviewed to see which items were checked most often, then you try to avoid or control them. More than three-quarters of migraine sufferers are able to identify specific triggers that set off their headaches, and a British study found that avoiding the triggers can reduce migraine frequency by 50 per cent.
OVER-THE-COUNTER PAIN RELIEVERS
These medications are sometimes effective for mild to moderate attacks if you get in early. Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen sodium counteract chemicals such as prostaglandins that trigger pain signals in the nerves of the face and head. Ibuprofen, for example, has been shown to reduce headache severity from moderate/severe to mild/no pain in 60 per cent of patients. Doctors recommend using these drugs no more than three days a week; taken too often, they can become ineffective and lead to rebound headaches and damage to organs such as the liver, over time.
Data from a large study estimates up to 200,000 Australians may be using triptans every year. Triptans (available in pills, nasal sprays and injections by prescription only) stimulate serotonin, a brain chemical thought to relieve symptoms like pain and nausea, in part by constricting blood vessels. Taken at the first sign of an attack, these drugs reduce pain from severe or moderate to mild or non-existent in 59 per cent of cases, according to a review of 53 clinical trials. Ask your doctor about combining triptans with non-steroidal anti-inflammatory drugs (NSAIDs): studies have found that the two together relieve pain better than either alone, sometimes even in people who otherwise don’t respond to triptans. “Though some suffer adverse side effects,” warns Edmunds.
When German researchers asked migraine sufferers about sex, one-third of respondents said they’d engaged in intercourse during an attack, and 60 per cent of that group said it provided partial to complete relief, probably because orgasms release painkilling endorphins and distract the brain from pain.
Migraines often flare when people are stressed, and practising mindfulness can relieve both stress and migraine pain. In one study, people who took an eight-week mindfulness-based stress reduction class reported 1.4 fewer headaches a month. While that reduction wasn’t enough to be statistically significant, researchers found that the headaches were milder and shorter by almost three hours.
Lack of sleep can be a migraine trigger, as can irregular sleep habits. This presents a catch-22. “Bad headaches make it difficult to sleep, and not enough sleep aggravates headaches,” says Sheena Aurora, a clinical associate professor in neurology and neurological sciences at Stanford University School of Medicine. Try to get eight hours and go to bed at the same time each night, even on weekends.
Expected to hit the market in a few years, these drugs block a chemical called calcitonin gene-related peptide, which plays a crucial role in migraines by dilating blood vessels and amplifying pain signals. Research on the first of these drugs was halted due to concerns about liver damage, but new drugs zero in on the peptide and are thought to be safer. Clinical trials find that the drugs, which are given as monthly or quarterly injections, work especially well against chronic migraines. A recent research review concludes that CGRP blockers “will probably represent a turning point for prevention.”
The Cefaly device treats migraine pain with neurostimulation. Wearing the $440 headband for 20 minutes a day zaps the trigeminal nerve (the brain’s main pain pathway) through the skin. A trial of 67 migraine sufferers who had an average of seven migraines a month found that the headband reduced headache days to five.
Best known as a cosmetic anti-ageing treatment, Botox also seems to block pain pathways along the trigeminal nerve. Treatments, which are repeated every 12 weeks, consist of injections with tiny needles in 31 spots around the head. People who received the injections in clinical trials had about eight fewer headache days a month than untreated sufferers did.