Living with Migraine

Published : June 10, 2015

“Migraine has been my ultimate foe, merciless and efficient.
It has destroyed my career, my relationships and my reliability as a person.
It has derailed my dreams and my goals.
It has stolen from me over time – days, months, and now years.
It has all but taken my life.
Even when headache-free, I live a constant nightmare that no day seems to follow ... in dread of that next attack.”

Maree's personal account as a chronic migraine sufferer

By: Dr Anna Cuomo-Granston

Ph.D. (in Neurology and Psychophysiology); M.Appl.Psych.(Clinical Psychology)

The above extract of a personal account demonstrates the extent to which migraine can disrupt an individual’s life. It is a common, chronic, sometimes progressive, and often incapacitating, neurovascular disorder.

Ninety-six percent of the general population will experience headache in one form or another sometime during their lives but not all will develop a headache disorder. Worldwide, 46% of the adult population experience an active headache disorder, of which 42% suffer with migraine. As migraine is the most prevalent headache disorder, not surprisingly, most people either know someone who sufferers with migraine or suffer themselves.

The World Health Organisation ranks headache disorders, particularly migraine, as the tenth most disabling condition in comparison to other illnesses, for both genders, and the fifth most disabling for women.

The personal burden of this disease is widely acknowledged.

It is also accepted that many headache sufferers live in fear of the next attack, which can restrict their daily lives as well as their ability to meet social commitments.

Even between attacks many migraine sufferers do not fully recover, reporting reduced general well being and negative repercussions on their quality of life. As Jo Liddal, past director of the UK's Migraine Action Association (previously the British Migraine Association) aptly commented: “Migraine may not be life-threatening but it is certainly quality-of-life-threatening”.

The personal burden of migraine and the toll of the accompanying mental/physical stress may render some individuals increasingly vulnerable to developing various stress related illnesses. Indeed, migraine has been linked with a number of psychiatric disorders including general anxiety, depression, bipolar disorder and social phobia.

Physical health can also be threatened in cases of migraine-related stroke, with potentially lethal or permanently disabling consequences. Some studies suggest that migraine may account for 10-27% of the probable causes of stroke in those under the age of 40 for both sexes combined and from 30-60% for women younger than 45, particularly those with migraine with aura* who smoke or use oral contraceptives. The risk of stroke is clearly increased in migraine sufferers, particularly in certain subgroups.

* Flourish note: An aura is the perceptual disturbance experienced by some migraine sufferers before a migraine headache.

The importance of correct diagnosis

Headache is a common symptom that signals numerous complaints. It may be a secondary symptom to an underlying complaint such as sinusitis, hangover, fatigue, toothache, or illness (including flu, stroke, meningitis). Alternatively, headache may be the primary symptom of a headache disorder.

Accurate diagnosis of migraine from other headache disorders is crucial if it is to be managed efficiently. If not diagnosed correctly, inappropriate and unnecessary medication is likely to be administered. Not all treatments are entirely harmless, particularly pharmaceutical interventions where adverse side effects are possible. Haphazard use of medication may lead to overuse, which can exacerbate and complicate the clinical picture of headache. To ensure headache is correctly diagnosed and treated, the individual should source a health professional specialising in headache.

A migraine attack involves a cascade of complex neurological changes that frequently start before, and continue after, the symptom of headache. What differentiates migraine from the majority of other headache syndromes is prolonged (4-72 hours), often excruciatingly painful, headache. Pain is commonly restricted to one side of the head but not necessarily. Another hallmark of an attack is nausea; around 90% experience nausea and 75% vomit, so understandably migraine is sometimes referred to as ‘sick headaches’. Dizziness/vertigo, drowsiness, and body temperature changes (fever/chills) are also commonly experienced during a typical attack. In addition, increased blood flow of the head and brain is sometimes observed during attacks.

Migraine manifests differently between individuals and also sometimes within individuals from one attack to another.

Most migraine sufferers suffer from attacks without aura while a third experience attacks with aura.

Migraine aura generally appears as fully reversible symptoms including:

visual (flickering lights, spots or lines, loss of vision),
sensory (pins and needles, numbness) or
speech disturbance.

The average duration of migraine aura is between 5 to 60 minutes, usually experienced up to an hour before the onset of headache but can occur simultaneously with headache.

Any individual may experience an isolated migrainous-like headache or even a few in a lifetime but at least five lifetime attacks of migraine are required before it is regarded as a disorder and a diagnosis of migraine is given.

Treatment

Current pharmaceutical treatment of migraine is aimed at relieving the acute attack and in some cases preventative medication is also required. Depending on severity and frequency of attacks the choice of drug treatment will vary. Milder cases of migraine normally involve analgesics, anti-inflammatories and/or anti-emetics. If these drugs are not effective, migraine specific drugs (including triptans) may be required for the acute attack, particularly for those who suffer moderate to severe migraine.

For those who experience frequent attacks (four or more per month), ongoing preventive medication may be necessary. Drugs commonly used prophylactically (flourish note: to prevent the development of disease) include beta-blockers, antidepressants (tricyclics/SSRIs), non-steroid anti-inflammatories or sodium valporate (an anti-convulsant). Alternative preventative medications such as herbal (eg, feverfew), vitamin (eg, folic acid) and mineral (eg, magnesium) preparations may reduce the frequency of migraine attacks for some sufferers.

Non-pharmaceutical approaches to treatment include trigger avoidance, acupuncture, biofeedback, and stress management strategies, which may involve relaxation/meditation therapy and/or cognitive behaviour therapy. Regular and frequent aerobic exercise can also be beneficial in the management of migraine.

Migraine triggers

It may be helpful for migraine sufferers to keep a diary (perhaps for a month or so) to establish what is triggering their attacks. The headache diary is an important tool for understanding and treating migraine.

Once triggers are identified, to simply advise an individual to avoid any given trigger is not necessarily the best advice. Research indicates that, particularly in the case of supposed dietary triggers, triggers are not always consistent. It appears that a given trigger probably works in conjunction with other triggers for an attack to eventuate, for example emotional/physical stress during menstruation.

Stress is one of the major triggers for migraine but not always easily avoided. Stress is part of everyday life and can be either positive (preparing for a wedding) or negative (driving in peak hour traffic). Useful techniques to help cope with stressful situations can include cognitive behaviour therapy, relaxation techniques, biofeedback therapy, and healthy lifestyle changes such as regular nutritious meals, exercise and adequate sleep. There are many good self-help books available on all of these subjects. If the individual finds they are trapped on a merry-go-round in terms of stress and unable to cope, they should consult a clinical psychologist or allied health professional.

Depression, anxiety and migraine: is there a link?

Migraine is sometimes associated with depression or anxiety. Unfortunately the cause-effect relationship is unclear. Whether one condition causes the other, or the same underlying factors are shared, treatment should be tailored by a health professional, preferably one with an interest in both mental health and headache. Pharmaceutical and/or non-pharmaceutical treatments may be required to manage one or both conditions. Perhaps in some cases treating one condition is all that is necessary to alleviate the other.

Anxiety, depression and migraine are maladies that are partially associated with unmanageable stress. Hence, stress management techniques may to some extent relieve each. Changing the way an individual thinks about, and deals with, stress may not only lessen the impact of migraine attacks (frequency and intensity) but also symptoms of anxiety/depression.

Is it possible to live with migraine?

The understanding of migraine today is sophisticated but nonetheless the condition is still not completely understood. While there is presently no known cure for migraine, treatment, particularly pharmaceutical, is more effective now than in the past. A major goal of treatment is to relieve pain and restore the patient’s ability to function.

Therapeutic interventions may help sufferers live with migraine but there is also the need for many to be able to confidently live their life without the threat of migraine. With ongoing research that targets psychological, physical and social aspects of the disorder, perhaps one day this will become a reality.

A useful tool for migraine sufferers

The Migraine Disability Assessment Questionnaire (MIDAS,© Innovative Medical Research) is an easy to use self-administered tool that can help migraine sufferers determine the extent to which headache disrupts their lives. These results can be discussed during medical consultation and might prove useful in more efficiently managing the patient’s migraine. It might be helpful for the sufferer to complete this form at intervals throughout treatment to assess their progress.

Rather than merely being a passive recipient in the patient-doctor relationship, the self-monitoring of attacks in relation to interventions actively involve the sufferer in the direction of treatment and therapeutic decision-making. In turn, the individual is likely to feel empowered in terms of controlling their attacks rather than resigned that their lives are at the mercy of migraine.

Useful links:

Headache Australia