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Guide Health: Dealing with migraines

Migraines often have a trigger, whether it be environmental or lifestyle

The excruciatingly painful headaches classed as migraines are considered to be the most common type of headache. About 25 per cent of women and nine per cent of men are affected with between four and six work days lost per year for each sufferer.

Migraines are thought to involve a nervous system dysfunction which results in blood vessel dilation and activation of sensory nerves. The result is the throbbing, pulsating intense pain that signals a migraine.

Migraines usually occur on one side of your head and are often accompanied by nausea, vomiting, and sound and/or light sensitivity.

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But, before you assume your headache is a migraine, make sure to rule out any other types of headaches such as a tension headache, sinus headache, cluster headache, trauma or even a vision problem.

Another migraine difference is the occurrence of an aura or of warning symptoms in about 25 per cent of sufferers.

Migraines often have triggers, that is precursors that can cause a headache. Environmental triggers include variations in temperature, bright lights, noise, weather changes, motion, odours and even changes in altitude.

Chronic stress, skipping meals, disturbed sleep and smoking are potential lifestyle triggers. Hormonal changes, for example puberty, menopause, menstruation, and pregnancy are sometimes triggers and may be the reason that more women are affected by migraines.

Emotions such as anxiety, depression, anger and excitement may also act as triggers. And foods, especially caffeine, cheese, chocolate and alcohol, have been identified as triggers as well.

Ideally, you want to identify any triggers that you may have and avoid them.

Analgesics are the mainstay of treatment, for example acetaminophen, non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, and narcotic pain relievers. Many of these are available without a prescription and many people with migraines self-treat. However, it is a good idea to be assessed because there may be a more effective option for you.

A variety of drugs that work through the nervous system can be prescribed to prevent migraine headaches, for example propranolol, amitriptyline, topiramate, valproic acid, venlafaxine, flunarizine, carbamazepine. The idea is that you take these drugs regularly to reduce the number and severity of your headaches, but you may need to try several in order to find the one or combination that works best for you.

A group of drugs known as the triptans are used to treat a migraine at the onset of pain. Rizatriptan, almotriptan, zolmitriptan, sumatriptan and naratriptan are the most commonly used with one or two doses providing relief within about two hours. However, these drugs need to be used with caution if you have cardiovascular problems and shouldn’t be used if you are pregnant. If the triptans don’t alleviate your migraine, you will certainly want to be assessed.

Migraines can be difficult to manage because of treatment failure. For example, you may only be using treatment for an acute headache and you may need preventative medication, or your medication dose may be too small or you are taking it too late. You may also be depending only on medication when you should be avoiding triggers too. Or, you may be overusing narcotic pain relievers resulting in a medication-induced headache, meaning you need more and more of a narcotic pain reliever to obtain the same pain relief, but if you stop you experience a severe rebound headache.

Of course, don’t forget the non-drug approaches like avoiding light and sound or cool compresses.

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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