Migraine advice: ‘Every day, I am trying to stop a migraine from occurring, managing a migraine or dealing with the aftermath’
My migraines are a constant burden in my life. I get migraines regularly and they don’t care that I work full-time, have small kids, or that I’m at a close friend’s wedding. They’re ruthless. I don’t know why I feel shame and embarrassment when it comes to my migraines, but I do.
very day, I am trying to stop a migraine from occurring, managing a migraine experience or dealing with the aftermath. I spend a significant amount of my life nauseous and in pain — I would love to have even one day every now and then where my neck and upper back didn’t hurt.
My three-year-old son will turn off lights without being asked in case the bright light triggers them. He’ll even ask after my head when I pick him up from creche. I would love to say I get constant and consistent sympathy. However, when you live with someone with chronic migraine, it’s irritating. It affects their life too and they’re used to seeing you nauseous and in pain.
A migraine is more than a headache. In fact, it’s possible to experience migraine without a headache. That said, the most common symptoms include a throbbing headache alongside sensitivity to light, noise, and smell as well as nausea, vomiting and lethargy.
‘Some describe it as like someone drilling into their head, while others feel the sensation of being attacked with an ice pick. So to call it pain doesn’t really hit home’
Migraine is the most common neurological condition in the world and the seventh most disabling disease worldwide. It affects 12-15pc of people and is three times more common in women than men.
It is a complex neurological condition that is different for everyone — the frequency, duration and symptoms people experience will be unique to them. It’s impossible to compare one person’s experience to another — even if two people suffer from the same type of migraine — as there are many different categories which a person may or may not fit into. Most migraine sufferers get episodic migraine. But the unfortunate few, including myself, suffer from chronic migraine.
My migraine often has four stages called prodrome, aura, headache and postdrome.
Prodrome
The prodromal stage of migraine is experienced by most people, with symptoms happening anywhere from a few hours to a couple of days beforehand. This is when the migraine begins.
During this period I yawn randomly, notice a mood change, urinate a lot, and get a sweet tooth when normally I don’t have one. Plus my neck and upper back are stiff and crack with every movement. For me, the biggest and most embarrassing thing is my inability to find words and I slur. I always know when a migraine is coming.
Once you know your symptoms, you can learn how to stop some of the attacks from occurring. For example, what can help me is stretching my back and neck, taking a walk in the shade, making myself colder, cola-flavoured ice pops and consuming an isotonic drink.
Aura
About one in three migraine sufferers get aura. This tends to last less than an hour. The changes can be positive in that they add new experiences to your life, even though the experiences are not positive. For example, aura can include seeing flashes of light or shapes, tinnitus and jerking movements. My eyesight can become blurred by clouds of fuzziness passing through my line of sight.
Negative symptoms are when there is an absence or loss of function. For example, loss of vision, hearing or difficulty moving a body part. Thankfully, all symptoms experienced during the aura phase are reversible. But like a lot of people with migraine, I have ended up in A&E being investigated for stroke. I don’t know how or why, but my headaches often wait till my kids are in bed before they explode.
Migraine headache
The migraine headache stage, if not treated, can last from four hours to several days. The pain is often, but not always, one-sided. It’s often described as throbbing or pulsating. Some describe it as like someone drilling into their head, while others feel the sensation of being attacked with an ice pick. So to call it pain doesn’t really hit home as to what people can experience. Nonetheless, the pain experienced varies from person to person, and from headache to headache.
It can be worsened by movement or physical activity. For me, my headaches start in my eyes and it feels like my brain is too big for my head. As the pain builds, so too can nausea and vomiting. Some seek darkness and silence during this time. I try to fall asleep before the migraine stops me from falling asleep.
Postdrome
Most people, but not all, experience the postdromal stage. This is often accompanied by feelings of exhaustion or mild elation. Your muscles can ache too, like you’ve been running for hours.
It’s often called the migraine hangover. Rapid head movements during this period can cause transient pain in the head. I tend to feel shell-shocked and wake up with my hands still clenched into fists with moon shapes on my palms from my nails.
If I’ve had a particularly bad migraine, it can feel like it’s gone for a while. A migraine-free day is splendid, and I get emotional just thinking about those rare days. Even as I write this, I realise how much my migraines bother me, and how much they are taking from me.
I’m sure lots of people reading this have migraine themselves, or a family member who suffers from them. According to The Migraine Association of Ireland, 12-15pc of Irish people suffer from migraines and the impact on a person’s quality of life can be quite profound.
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Orla Walsh has learned to recognise the signs and some of the triggers of her chronic migraines. Photo: Owen Breslin
What triggers migraine?
To understand triggers, imagine being 10 steps from a cliff edge. Each step brings you closer to falling over into migraine. I describe the movement forward towards migraine as the migraine brewing. The point at which you fall over the cliff into a migraine is often referred to as the migraine threshold.
Some triggers are small, some triggers are really big. One reason why people struggle to figure out their triggers, is that they don’t consider how close to the cliff edge they are — if it’s a small trigger and you’re at step one, it won’t trigger a migraine. If you’re at step nine, it will. If it’s a big trigger, it may bring you all the way from step one to the threshold of migraine.
‘I rarely leave the house without a baseball cap and sunglasses — my neighbours probably think I have notions of celebrity’
A number of different migraine triggers have been considered and tested, including psychosocial, sensory, environmental, physiological and dietary. As the stages leading up to migraine change the choices you may make, you may wrongly pinpoint a trigger.
For example, some people think chocolate is a trigger. I’m not saying it’s not, but the migraine may have already begun before you ate the chocolate, and it may have been your migraine that made you choose chocolate.
A lot of the triggers tend to be related to stress, an attack of the senses (noise, lights, smell), sleep and weather. I rarely leave the house without a baseball cap and sunglasses — my neighbours probably think I have notions of celebrity.
Another common trigger in women is oestrogen dropping before ovulation and in the lead-up to a period, as well as the big drop in oestrogen after giving birth and the steady decline in oestrogen in menopause. Again, is it your period that is making you eat the chocolate and also triggering your migraine, rather than the chocolate triggering your migraine?
Women can sometimes have relief from migraine in trimester two and trimester three of pregnancy, as well as when breastfeeding. I do, and it is simply wonderful.
Diet
Most people who suffer from migraine will know that eating regularly helps reduce the frequency. However, I have noticed many people don’t realise the importance of eating balanced meals with adequate protein and fibre, as well as spreading their food out more evenly across the day. It’s also important to avoid eating high-sugar foods on an empty stomach, when hungry or instead of a meal.
Dehydration
Drinking enough fluids is critical, and more attention to taking in electrolytes with adequate water is needed. This improves overall absorption and retention of water in the body but also ensures it goes to the right place within your body. You don’t want to swell your cells with water.
Lifestyle
Interestingly, although not yet supported by rock solid research, there is some evidence for triggers such as tyramine, aspartame and foods with vasoactive compounds.
Foods to avoid include processed meats and nitrates, aged cheeses, sulphites, tannins, raw onion, citrus fruits, chocolate and MSG. Lifestyle triggers include smoking, excess caffeine or a sharp reduction in caffeine, alcohol, inadequate sleep and stress. It’s also important to be careful how often you take pain relief.
Exercise needs to be individualised. High intensity may trigger some people, while yoga may help. I avoid yoga as it’s a trigger for me.
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Drinking enough fluids is critical for migraine sufferers. Taking in electrolytes can improve absorption, and ensure it goes to the right place within your body. Stock image
Treatment
There is lots that can be done to better manage migraine in terms of frequency, duration, severity and symptoms.
Acute migraine medication
Acute migraine medications aim to stop the progression of an attack or relieve it. Examples of acute migraine medication include analgesics e.g. aspirin, NSAIDs, paracetamol, codeine, anti-sickness medication and triptans. Unfortunately, triptans don’t work for me despite studies suggesting they resolve pain within two hours for up to 80pc of cases.
Preventative medications
Preventative medications aim to reduce the frequency of migraine attacks with a success rate of about 50-60pc. For example, beta-blockers, anti-epilepsy agents, calcium channel blockers, and anti-depressants.
Injections
Occipital nerve block is an injection around particular nerves that are located in the back of the head just above the neck area. Botox is now also used as a preventative medication. I recently had 31 injections of Botox into my scalp, neck and shoulders, hoping that it may help.
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Some supplements may interact with certain medications, so consult your doctor first. Stock image
Supplements
Riboflavin
Riboflavin, aka vitamin B2, is a water-soluble B vitamin. This means it isn’t stored in the body, and you need to eat it daily. Riboflavin helps the body cells use the food we eat and helps produce other B vitamins such as vitamin B6, which has an important role in hormone regulation.
With regards to migraines, the evidence for riboflavin is convincing. Research suggests that a supplement could potentially reduce the frequency of migraine. Small doses throughout the day may be better than large doses, due to riboflavin’s short half-life.
Magnesium
Magnesium is a mineral that helps you take energy from food and make new proteins. It’s also important for bones, muscles and nerves. Magnesium has a role in many of the physiological processes which may be involved in the onset of migraine attacks. Results from studies suggest that supplementation may help prevent migraines. The type of magnesium supplement differs from person to person, depending on what other symptoms they have.
Coenzyme Q10
Coenzyme Q10 is a substance that is naturally present in the body. It is sold in a supplement as CoQ10. It has important functions in the body and people with some diseases have reduced levels of it. Those with migraine are thought to have mitochondrial (the powerhouse of the cell) dysfunction.
The mitochondria are responsible for making energy. Small trials have found that supplementation may help decrease the frequency of migraine attacks, but more research is needed. It may interact with certain medications such as warfarin and insulin, so consult your doctor first.
Ketones
A ketogenic diet produces ketone bodies. It involves eating a diet very high in fat, low in protein and low in carbohydrates. It has been proposed to prevent migraines by restoring proper excitability to the part of the brain called the cortex. However, the research isn’t rock solid and they’re now researching to see if taking supplements of ketone bodies helps.
Vitamin E
Compounds called prostaglandins have been suggested to be key contributors to menstrual migraine. As vitamin E inhibits the release and production of prostaglandins, research suggests it may have a positive impact.
A supplement of vitamin E taken daily around the time of menstruation was shown to help reduce pain severity and duration, light and sound sensitivity and nausea.
https://www.independent.ie/life/health-wellbeing/health-features/chronic-migraines-all-you-need-to-know-about-stages-triggers-and-treatments-41911480.html Migraine advice: ‘Every day, I am trying to stop a migraine from occurring, managing a migraine or dealing with the aftermath’