Thu, 10 Aug, 2017
What can trigger a migraine (and how to stop them)
Dr Cathy Stephenson is a GP and forensic medical examiner.
I have suffered from migraines all my life. Thankfully they have got less and less frequent with age, but when they do hit I have to put my life on hold for a bit, unable to see properly to be able to drive or work, and with a headache that makes it impossible to think of anything else.
According to the NZ Neurological Foundation, I am far from alone – around 18 per cent of women, and 12 per cent of men, are affected, the majority falling into the 15-55 age bracket.
Some of these will only have a migraine once in a blue moon, and will be happy managing their symptoms with pain relief and anti-nausea tablets as required. However, for other migraine sufferers, the condition can be hugely debilitating, leading to numerous days off work each month, and high degrees of pain and misery.
For those in the second group, there is hope. Medication aimed at preventing migraines are now widely available, and should be considered if you feel the frequency of your migraines is impacting significantly on your life: although this is clearly a very individual perception, a rule of thumb from a medical point of view is if you have two or more migraines per month, or require pain relief on two or more days of the week, then you should think about prevention.
The first rule of prevention is to ensure you have thoroughly explored (and hopefully moderated) your migraine "triggers" – these may include lifestyle factors such as stress, anxiety, exposure to light, alcohol, or dehydration, as well as dietary ones, especially caffeine, chocolate, food additives and preservatives, and cheeses.
For women a really common trigger is the menstrual cycle, with a lot of migraines occurring just before a period. If you're not sure what things in particular seem to trigger your migraines, a really simple and effective way to find out is to keep a headache diary, and document all the factors in the two or three days leading up to an attack.
It won't take long to start seeing some patterns forming, and hopefully there will be some steps you can take that will help bring relief quickly and easily.
Once you have minimised your triggers, you could consider taking a regular "prevention" medication, with the aim of reducing the frequency and/or severity of your attacks. Preventers (also known as "prophylactics") need to be taken every day, and will usually take 2-4 weeks to show their full effect.
If they work, I would recommend staying on them for six months or more before attempting a trial off them. There are several different preventers available, so if one doesn't suit you, don't despair – just talk to your doctor about giving one of the others a trial:
Originally designed to help treat high blood pressure, this group of drugs are really effective at reducing migraines. They include the drugs atenolol, propranolol, metoprolol and bisoprolol, and it may be worth trialling more than one to find the "best fit" for you. Unfortunately people with a history of asthma can't take these medicines. Incidentally, they can also be really helpful for anxiety, so if stress is a major component of your migraines, these could be the perfect option!
This "tricyclic" antidepressant is another great option for preventing migraines. It also helps sleep and chronic pain, and is usually effective at much lower doses than would be used to treat depression. It works by modulating the pain pathways in our body. Ideally, a very low dose is used to start with, to try and avoid side effects, and titrated upwards over several weeks to get the optimal benefit.
There is increasing evidence that some natural products may be effective at preventing migraine attacks. Migradol contains vitamin B2 (riboflavin) and magnesium combined, and is certainly worth a trial. Another over-the-counter option that has had good results in clinical trials is butterbur, an extract from a ragweed plant – however there have been reports of liver toxicity associated with its use, so make sure you discuss this with your doctor and get any monitoring they recommend.
Sodium valproate and topiramate
These are both anti-convulsants used in epilepsy, and have been found to be effective in some people with migraines. However, they may have more side effects than the other medications listed, so I would reserve them to use if the others have proven ineffective.
Lastly, for women having their periods, it is worth trying to "override" the natural cycle, in the hope this will reduce the number or severity of migraine attacks. This can be done with either oestrogen supplements, or by using a progesterone contraceptive such as the depo injection.
Written by Dr Cathy Stephenson. First appeared on Stuff.co.nz.