Viable options for effective migraine management

More than just headaches

MIGRAINE headaches, often misunderstood and underestimated, are typically perceived as simple headaches. However, those who suffer from this condition know it to be much more than that – involving excruciating pain, hypersensitivity to their environment, bothersome accompanying symptoms and, in severe cases, affecting work productivity and quality of life.

Prince Court Medical Centre consultant neurologist and migraine expert Dr Julia Shahnaz Merican said migraine is a complex disorder causing recurring throbbing headaches usually of moderate severity, accompanied by many accompanying symptoms such as nausea, vomiting, dizziness, sensitivity to light (photophobia), and/or sensitivity to loud noise (phonophobia). These headaches are typically aggravated by movement or activity and cause avoidance of routine physical activity.

“One of the most substantial risk factors for migraines is a family history of the condition, with women being more susceptible than men. The most common age range for migraines is from the teenage years until the 50s. Teenagers, particularly after puberty, may experience more severe headaches, including menstrual migraines. In some cases, children as young as five or older may begin having recurrent abdominal pain of unknown cause called abdominal migraine, only to start to experience typical migraine headaches at puberty or early adulthood.

“Migraines manifest as moderate to severe throbbing headaches lasting at least four to 72 hours. Contrary to common belief, these headaches may not always be unilateral and can affect the back of the head and neck or around the eyes.”

Accurately diagnosing migraine

A quick screening tool such as “ID Migraine”, which comprises three simple questions, can be close to 80% accurate in diagnosing migraine with certainty. If an individual answers “yes” to two out of three of the following questions, they have a higher tendency to a migraine diagnosis:

1. Has a headache limited your activities for a day or more in the last three months?

2. Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

Julia said recording or tracking migraine occurrence using a headache diary has given many people living with migraine a greater understanding of the patterns and frequency of headache days per month. This enables recognition of triggers of which they were previously unaware. Each individual will recognise different triggers, commonly known as a change in routine, inadequate sleep, hot weather, travel, menstruation, and stress.

“Avoidance of certain triggers, whenever possible, can reduce headache frequency. The diary can be a physical journal, a monthly calendar, or one of many smartphone apps available. The number of monthly migraine days recorded is most important to the person with migraines and the doctor to advise on treatment strategies. In addition, keeping track of days when headache medications are taken is key to avoiding ‘medication overuse headaches’, which can actually cause more frequent headaches.”

Role of general practitioners and neurologists

General practitioners play a crucial role in addressing their patient’s specific needs, such as acute relief, and referring them to neurologists in case of treatment failures. Urgent consultation and investigation are recommended when headaches are occurring too frequently without an obvious cause or there is any change in the character of headaches.

The neurologist can accurately diagnose the cause of headaches by a thorough history of symptoms and physical examination. Migraine is by far the most common headache type in people seeking help from physicians. Migraine does not shorten lives but can impact quality of life.

In addition, neurologists provide relevant information and resources for migraine, keeping in mind that there are many types or variants of migraine which need to be explained. Investigations such as CT (computerised tomography) or MRI (Magnetic Resonance Imaging), brain scans and blood tests are only necessary if a more serious secondary cause is suspected. Such investigations are required when headaches are a new complaint in any individual when headaches have changed in character or become more frequent, particularly in children or persons over 50.

Newly available innovative treatment

Migraine is one of the most common neurological diseases worldwide. Researchers have found that during a migraine, the brain is flooded by chemicals released by nerves and blood vessels, including calcitonin gene-related peptide antibodies (CGRP).

New treatments can target CGRP to reduce both the frequency and intensity of migraine attacks significantly. These new treatments, also available in oral form, bring a brighter future for millions wrestling with migraine’s grip.

Managing migraines effectively involves acknowledging their complexity, dispelling common misconceptions and recognising the vital role of healthcare professionals in accurate diagnosis and comprehensive treatment. As research continues to increase the understanding of migraine, knowledge empowers individuals to make informed choices, leading to better management of this prevalent yet often underestimated condition.