Migraines aren't just bad headaches. They're as real and serious as any neurological medical disorder with symptoms that vary from person to person. And no, not all migraines are the same. There are many different types including ones with and without aura and ones that are classified as episoidic migraines (patients who experience migraine headache attacks on less than 15 days/month) or ones called chronic migraine (headache on 15 days a month or more, with criteria for migraine met on at least eight days a month).
Migraines can take a toll on your health, work and social life, but with lifestyle adjustments and medication they can be controlled.
If you think you might have migraine, talk to your doctor to help you manage it.
HOW COMMON ARE
More common than you would think. It’s a condition that affects over 2.7 million Canadians and frequently occurs between ages 30 and 49– with females twice as likely to report their diagnosis than males.
Since each attack can be different, the impact on your life may vary.
26% of Canadians reported that their migraines prevented them from partaking in activities.
34% of Canadians reported limitations in their job opportunities.
36% of Canadians reported missing at least one day of work in the past three months due to migraines.
STAGES OF A
There are four distinct phases of a migraine attack that may overlap: warning (or Prodrome), aura, headache and recovery (or Postdrome).
The Warning (Prodrome) Phase
Most migraine sufferers experience a range of symptoms well before the onset of a migraine attack. This phase can last as long as 72 hours. Some of these symptoms include:
- mood changes
- food cravings
- repetitive yawning
- stiff neck
- sensitivity to sounds
These symptoms may continue into the aura phase.
The Aura Phase
Aura is a range of temporary warning symptoms and affects around 1/3 of people with migraines. Some common symptoms are visual disturbances such as flashing lights, zig-zag patterns or blind spots. Other symptoms include:
- difficulty speaking
- tingling sensation
Auras typically last up to one hour, but in some cases even longer. In severe cases the aura can last well into the headache phase.
The Headache Phase
This phase typically lasts 4 to 72 hours and is characterized by a throbbing, pulsating pain on one side of the head, or in some cases both sides. An attack can be moderate to severe in intensity and is aggravated by physical activity. Additional symptoms during this phase include nausea and vomiting, as well as sensitivity to light, sounds, and smells.
The Recovery (Postdrome) Phase
The final phase of the migraine attack includes symptoms from the warning phase – typically exhaustion, difficulties concentrating, and a stiff neck - completing a full circle.
Figure based on information from Canadian Headache Society Guidelines (2013). Acute Drug Therapy for Migraine, Goadsby P, et al. Pathophysiology of Migraine and Dodick DW and Silberstein SD, et al. Contemporary Neurology Series, Migraine.
Honestly, we don’t exactly know why they happen. But we’re still researching and discovering new areas of the brain that are involved in migraines – like the role the neuropeptides play in an attack. That being said, there are triggers that lead to an attack, most of which are unique to each person.
Some of these common triggers are:
Acute & chronic stress
Sleep(EITHER Too much or too little)
Hormonal Fluctuation(reacting to strong lights, noises and odours)
Weather changes & environmental factors
Some food & beverages
The more you know about your migraines, the easier it will be to talk to your doctor. Use the Migraine Diary to track your experiences and help identify potential triggers.
There’s no cure for migraines, but there are treatments and techniques that can help make migraines more manageable.
There are two kinds of medications: preventative and acute.
1. Preventative Migraine Medications
The goal of preventative therapies is to reduce the frequency and severity of migraine attacks. There are seven prescription medications currently available in Canada specifically for the prevention of migraine attacks:
- Indication: Aimovig is used to prevent migraines in adults who have at least 4 migraine days per month.
- Possible side effects of Aimovig include signs and symptoms of pain, redness, and swelling at the injection site (injection site reactions), constipation, muscle spasm, itching, an, allergic reactions such as rash or swelling or sometimes, difficulty breathing.
- Indication: Ajovy is used for the prevention of migraine in adults who have at least 4 migraine days per month.
- Very common side effects may include mild to moderate, short-lasting skin reactions around the injection area (pain, localized hardening of the skin, raised red or purple skin patches, redness of skin, severe itching at the injection site). Common side effects may include itching at the injection site. Uncommon side effects may include rash at the injection site (hives, rash, dizziness, fatigue, gastrointestinal discomfort, joint pain, back pain).
- Indication: Botox is used to prevent headaches in adults with chronic migraine who have 15 or more days each month with headache that last 4 or more hours each day
- Common events reported in patients being treated for chronic migraine are headache, facial muscle weakness, drooping of the eyelids, muscle spasm, muscle tightness, injection pain, and rash.
- Indication: Emgality is a medicine used to prevent migraine in adults who have at least 4 migraine days per month
- Common side effects of Emgality are constipation, dizziness. itching, rash or injection site reactions such as itching, redness, swelling or pain
- Indication: Flunarizine is used to prevent migraine in adults with frequent and severe attacks, who have not responded satisfactorily to other treatment and/or in whom other therapy has resulted in unacceptable side effects.
- Common side effects reported with flunarizine in migraine patients are drowsiness and weight gain. The most serious side effect reported was depression.
- Indication: Sandomigran is used to prevent migraines in adults.
- The most common side effects of Sandomigran are increased appetite, weight gain, drowsiness, nausea, dry mouth, fatigue, and dizziness.
- Indication: Topamax is used to prevent migraine in adults who have 4 or more attacks per month and are not responding to acute treatment.
- The most common side effects of Topamax are co-ordination problems, difficulty concentrating, slow thinking, confusion and forgetfulness, dizziness, tiredness, tingling, headache, upper respiratory tract infection, and drowsiness.
Your doctor will determine if you are a suitable candidate for any of these medications.
2. Acute Migraine Treatments
The goals of these acute treatments are to relieve the pain and/or associated symptoms like nausea and sensitivity to light. Make sure to take your acute treatment as soon as you feel the migraine attack starting.
Common acute treatments include:
Pain medications (requiring or not a prescription):
Non-Steroidal anti-inflammatory drugs (NSAIDS) – e.g ibuprofen, naproxen
- Indication: Ibuprofen is indicated for fast and effective relief of headache pain including mild to moderate migraine and tension headache.
- The most common side effects encountered with NSAIDs are gastrointestinal (such as indigestion, heartburn, upset stomach, stomach pain), of which gastric or duodenal ulcer is the most severe.
- Indication: Naproxen relieves migraine pain.
- The most common adverse events that occurred with Naproxen were dyspepsia, nausea, heartburn, abdominal pain, dizziness, headache, and lightheadedness.
Migraine specific medications such as:
- Indication: Imitrex is used for the acute treatment of migraine attacks with or without aura, in adults.
- The most common side effects of Imitrex are sensations of heaviness, flushing, nausea or vomiting, dizziness, drowsiness, tiredness, weakness, pain, pressure or tightness in any part of the body, and unusual sensations including numbness, tingling, heat/burning, or cold.
- Indication: Maxalt is used for acute treatment of migraine attacks with or without aura, in adults.
- Common side effects of Maxalt are sensations of pain, pressure, or tightness in the chest, neck, throat, jaw, or arms, tingling, heat, heaviness or pressure, dizziness, tiredness, or feeling sick, drowsiness, and irregular or rapid heartbeats
- Indication: Axert is used for the acute treatment of migraine attacks with or without aura, in adults.
- The most common side effects of Axert are nausea, sleepiness, dizziness, tingling sensation, headache, and dry mouth.
- Indication: Zomig is used for the acute treatment of migraine attacks, with or without aura, in adults.
- Common side effects of Zomig are disturbed taste, feeling sick, vomiting, dizziness, tiredness, weakness, drowsiness, muscle aches and pains, difficulty swallowing, dry mouth, headache, and stomach pain.
- Indication: Relpax is used for the acute treatment of migraine with or without aura in adults
- Common side effects of Relpax are sensations of pain, pressure or tightness in the chest, neck, throat, jaw, or arms; shortness of breath, wheezing, heart throbbing, weakness, dizzinesss, feeling sleepy or drowsy, tingling, difficulty swallowing, nausea, and stomach pain/cramps.
- Indication: Frova is used for the acute treatment of migraine attacks with or without aura in adults.
- The most common side effects associated with Frova are dizziness, fatigue, headache, and tingling.
- Indication: Amerge is used for the acute treatment of migraine attacks with or without aura in adults.
- Common side effects with Amerge are ear, nose, and throat infections, nausea, vomiting, drowsiness, dizziness, headache, dry mouth, and feeling tired or unwell. Unusual sensations, including numbness, tingling, or feeling hot or pain in any part of the body, including chest, neck, jaw and throat.
*All trademarks and registered trademarks are the property of their respective owners. For more informatrion, please refer to the patient medication information for each respective product.
Alternative Treatments for Migraine
Not everyone wants to take medication and that’s totally fine. There are alternative or complementary therapies you can consider, such as:
- dietary therapy
- relaxation therapy
- therapeutic massage and yoga
If you feel your current medication isn’t giving you enough migraine control,
talk to your doctor to explore your options.
THE BRAIN IN THE GRIP OF A MIGRAINE:
WHAT SCIENCE TELLS US
Scientific research in recent years has generated new knowledge about the complex cascade of events inside the brain during a migraine attack.
Medical scientists used to believe that migraines were caused by changes to the brain’s blood vessels – primarily a vascular disorder. The latest evidence paints a different and much more complicated picture.
“We now understand that migraine is a neurological disease – a disorder of the brain and nervous system,” says Calgary-based neurologist Elizabeth Leroux. “The pain and other symptoms arise from a chemical and electrical ‘storm’ in that system.”
HERE IS WHAT THE LATEST SCIENCE TELLS US ABOUT WHAT IS HAPPENING WHEN YOUR BRAIN IS GRIPPED BY A MIGRAINE:
- Because of inherited differences, your brain cells (neurons) may be more sensitive to specific stimuli – some of which may be your migraine “triggers.”
- Individuals have varying triggers: menstruation, stress, weather changes, certain foods and many others.
- When the nerve cells are triggered, they send messages along nerves leading to your face, eyes and sinuses and/or other parts of your head, and also across the surface of your brain.
- This activity may lead to release of chemicals called neuropeptides, which can produce inflammation and swelling around sensitive areas in the head.
- One of those chemicals is the calcitonin gene-related peptide (CGRP), which researchers say may be a key player in migraine.
- How does all this activity affect you? Symptoms may include a painful, pulsing headache – often on one side of the head – and potentially, disturbed vision, sensitivity to light, sound and smells, and nausea and vomiting.