The lowdown on migraines – The Food Medic

June 10, 2022

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This article was written by one of The Food Medic team; GP – Dr Nirja Joshi

What is migraine?

To diagnose migraine, you need a unilateral (one sided) throbbing headache with nausea or photophobia (increased sensitivity to light) or phonobhobia (increased sensitivity to sound) which lasts 4-72 hours (1).

What are the symptoms? (2)

Migraines can last over several days, of which the headache is only one feature. There is a prodromal phase in migraine where patients may feel hungry or thirsty. Patients may get an aura which affects their vision, this can look like bright or wiggly lines coming across your vision, or you may lose an area of your vision.

Another group of symptoms may happen in the aura phase of a migraine which include sensory symptoms such as pins and needles, or motor symptoms, such as one sided weakness. These symptoms can appear similar to a stroke. Patients may then experience a headache, one sided, which can last for hours or days. The patient may want to lie in a dark room, this is due to an increased sensitivity to light and sound. As mentioned above, the patient may experience nausea or vomiting. Thereafter, there can be a postdromal phase which can have symptoms such as fatigue and brain fog. A migraine ‘attack’ can last for several days, hence it is important to seek the correct treatment.

What causes them?(2)

The reason why migraines happen isn’t well understood. However one of the leading theories explaining why migraines may happen is that there are pro-inflammatory markers which make the meningeal (coverings of the brain) nerves more active. Then meningeal nerves cause a vasodilation and activation of the trigeminal nerve feeding into the thalamus and hypothalamus (parts of the brain). This leads to a syndrome of hyperstimulation, e.g. photophobia and phonophobia, which is due to the over-stimulation of the sensory cortex.

Who gets migraines?

Migraine has a prevalence of 1 in 7 people globally. Women are two to three times more likely to experience migraine than men (3).

Commonly adults are diagnosed with migraine. Adolescents or children may have symptoms presenting differently to those in adults, such as abdominal pain. Women may suffer from menstrual migraines which occur 3 days before to 2 days after menstruation. It is very unusual to develop migraines, particularly with aura, for the first time later in adult life e.g. after 40. Women who suffer with migraines often find a remission during pregnancy and after menopause (3).

How is it diagnosed?

Clinical history will be used to help to diagnose migraine. There is a lot for your doctor to consider in terms of headache. The most common type of headache is called a ‘tension headache’, this is experienced as a tight band around the forehead and often is relieved with no treatment or simple painkillers such as paracetamol.

There are other causes of headache which can be more sinister, which may involve pain around your face, eye watering or dizziness. Because headaches can be very complex, your doctor will likely ask a list of questions about how you experience your headaches, whether you have symptoms prior to a headache (such as an aura with migraine), what you do when you get a headache, how long the headache lasts and any associated symptoms.

Why is it important to get the correct diagnosis? (3)

Migraine continues to be underdiagnosed. One study showed that 1 in 4 people with migraine were diagnosed as a non-migrainous headache. This may be because patients do not seek medical help, self-medicate, or are misdiagnosed. As mentioned above, headaches can be very complex and hence this can happen. If you are concerned that you do not have the correct diagnosis for your headaches, please do speak to your GP.

The socioeconomic impact of migraine is significant. According to NICE, it is one of the top 7 most debilitating conditions (3). This impacts on patient’s work, their family and recreational activities.

The correct diagnosis will lead to the correct treatment which will ultimately help with this impact (4).

What treatments are available for migraines? (5)

People with migraines can benefit from painkillers such as paracetamol, ibuprofen and aspirin. There is also a role for anti sickness medicines if you are prone to vomiting. Some brands have combinations of these medications designed for migraines.

There are treatments to take for migraines called ‘triptans’, these medications can be taken in different forms such as tablets, injections or nasal sprays and these help relieve migraines. The treatment is best taken at the start of an attack.

There is also preventative (prophylactic) treatment available. If you have several migraine attacks a month, it’s important to discuss this with your GP. Medications such as beta-blockers, which are prescribed for various conditions, if taken daily, can reduce the frequency of migraines. Another medication called topiramate, normally used to treat conditions such as epilepsy can help with migraine attack prevention.

In more severe cases, under the care of a specialist in a hospital other treatments may be available for treatment or prevention, such as botox injections, Greater Occipital nerve injections (GON injections), CRGP monoclonal antibody treatments and new treatments such as Gepants and Ditans are being used in the US, and may be used in the UK in the near future. You can read more about the new treatments here.

It is important that women with migraine with aura do not take the combined oral contraceptive pill. Those with migraine should avoid taking simple analgesics too frequently, those who take these painkillers more than 2 days in a week could be at risk of developing medication overuse headache.

Triggers for migraine (6, 7)

Many people have identified triggers for migraine such as disturbed sleep, missed meals, dehydration and in a review of 25 studies on migraine, 58% of patients cited stress as a trigger for their migraines. Other contributory factors include excessive caffeine intake, sleep apnoea and obesity.

Often, patients may notice an attack come on after eating certain foods, or drinking red wine and consider that these were the cause of the headache.The leading theory is that during your migraine attack, you may crave certain foods and then believe the food is causing the migraine. Foods containing tyramine, nitrates or MSG are linked to migraines (7).

What to do if you think you have migraines?

Keep a headache diary. This will be helpful for your doctor. You can find an example of a headache diary and how to keep one here (8) https://migrainetrust.org/live-with-migraine/self-management/keeping-a-migraine-diary/

Please do see your doctor if you have headaches which are unusual, severe or interrupting your work or life.

If you are a migraine sufferer, you may find some helpful resources with the Migraine Trust (9) https://migrainetrust.org/

References