Migraines are a common neurological condition characterised by intense, debilitating headaches, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
It’s estimated that 4.9 million Australians live with migraine; 1 in 10 men and 1 in 3 women. Working age women are the most significantly affected, with up to 45 percent of women between 25 and 45 experiencing migraine attacks. The condition costs Australia about $35bn a year, mostly in health and welfare costs, and lost productivity.
In simple terms, migraines are caused by hyper-reactive brain activity (or more specifically hyper-reactive dysfunction in sensory processing). When exposed to too much of something or ‘triggered’, the brain overreacts and creates a storm of peptides and other chemicals which naturally occur in the body.
This overload of activity causes the migraine ‘attack’ or the physical symptoms such as light, noise and sound sensitivity, nausea, and a severe pulsating headache.
Importantly, migraine is not just a headache, nor is the term ‘migraine’ synonymous with ‘bad headache’. There are many other symptoms, and some sufferers don’t experience headache at all.
Types and phases
Migraines can be classified into several types. An aura migraine is a set of sensory disturbances that can include visual changes, such as seeing flashing lights or zigzag patterns, as well as tingling sensations or speech difficulties.
Migraines without aura are more common and don’t have these preceding symptoms.
A typical migraine attack can be divided into four phases: prodrome, aura, headache, and postdrome. The prodrome phase occurs hours or days before the headache and can include subtle symptoms like mood changes, neck stiffness, and food cravings.
The aura phase, if it occurs, typically lasts from a few minutes to an hour. The headache phase is the most debilitating, lasting from several hours to three days. Finally, the postdrome phase, often described as a ‘migraine hangover’, can leave individuals feeling drained and washed out.
Causes and triggers
The exact cause of migraines is still not fully understood, but they’re believed to result from abnormal brain activity that affects nerve signals, chemicals, and blood vessels in the brain. Genetics play a significant role, as migraines tend to run in families.
Environmental factors also contribute, with common triggers including stress, hormonal changes, certain foods and drinks, sleep disturbances, and sensory stimuli like bright lights or strong smells.
Symptoms and diagnosis
In addition to the severe, throbbing pain usually localised on one side of the head, migraines can cause a range of other symptoms. These include nausea, vomiting, dizziness, extreme sensitivity to light (photophobia), and sound (phonophobia).
Some individuals also experience sensory disturbances like tingling or numbness in the extremities or face. The severity and combination of symptoms can vary widely among individuals and even from one migraine attack to another.
Diagnosing migraines typically involves a thorough medical history and a physical examination.
Doctors may use diagnostic criteria outlined by the International Headache Society, which focus on the characteristics and frequency of headaches. In some cases, additional tests such as MRI or CT scans are performed to rule out other conditions that might cause similar symptoms.
Treatment
While there is no cure for migraines, several treatment options can help manage and alleviate symptoms. Acute treatments aim to stop the progression of a migraine once it starts, and include over-the-counter pain relievers like ibuprofen and aspirin, as well as prescription medications such as triptans and ergotamines.
Preventive treatments are used to reduce the frequency and severity of migraine attacks, including medications like beta-blockers, anticonvulsants, and antidepressants. There are six migraine-specific medications currently approved by the Australian TGA (although some are very expensive): Aimovig, Emgality, Ajovy, Vyepti, Nurtec and Aquipta.
Lifestyle modifications, such as maintaining a regular sleep schedule, staying hydrated, managing stress, and avoiding known triggers, are also crucial components of migraine management.
Life impacts
Migraines often have a profound impact on people’s personal and professional lives. The unpredictable nature of attacks and the potential for severe symptoms can lead to missed work or school days and limit social and recreational activities.
Chronic migraines (defined as having 15 or more headache days per month), can be particularly disabling. The emotional toll, including feelings of frustration, anxiety, and depression, further compounds the problem.
Although living with migraine can be very challenging, many individuals have managed to find relief and lead fulfilling lives with appropriate medical care and lifestyle adjustments.
Ongoing research continues to improve understanding of this complex neurological disorder, offering hope for improved outcomes in the future.
