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. Find out how by talking to your doctor.
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 five medications currently available in Canada specifically for the prevention of migraine attacks:
- Aimovig* (erenumab)
- Botox* (onabotulinumtoxinA)
- Flunarizine* (flunarizine hydrochloride)
- Sandomigran* (pizotifen hydrogen malate)
- Topamax* (topiramate)
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.
- Over-the-counter pain medications like ibuprofen and naproxen
- Prescription pain medications and NSAIDs (i.e. prescription strength naproxen)
- Migraine specific medications such as triptans, sumatriptan succinate (Imitrex*), rizatriptan benzoate (Maxalt*), almotriptan malate (Axert*), zolmitriptan (Zomig*), eletriptan hydrobromide (Relpax*), frovatriptan succinate (Frova*) and naratriptan as naratriptan hydrochloride (Amerge*)
*All trademarks and registered trademarks are the property of their respective owners.
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
EVOLVING SCIENCE OF
Migraines are a complex and multi-faceted disorder. Debates over what causes migraines have been going on for years and a lot is still unknown. However, lots of research has been done recently to understand how migraines work and how we can manage them better. For example, we do know that migraines involve the activation and sensitization of a pathway in the brain called the trigeminal system. Talk to your doctor regularly, so you can stay in the loop.