- Diseases, Disorders & Conditions
The cause of your migraine revealed
Some of us are all too familiar with the debilitating symptoms of a migraine. The stiff neck. The sensitivity to bright lights and loud noises. The nausea. And, of course, the intense and throbbing headache.
In fact, 8.5 million people in the UK regularly suffer from such attacks, with 1 in 5 women and 1 in 15 men affected. Although migraines often start in early adulthood, around 1 in 10 children also experience them.
If you struggle with migraines, you’ve probably invested many evenings studying the potential triggers and tried a wide range of treatments to prevent their recurrence. But, recent study findings suggest that these triggers may be more complex than first thought.
What is causing your migraine?
Migraines are a complex neurobiological disorder that is thought to be caused by temporary changes in chemicals and blood vessels in the brain. Sufferers may be hypersensitive to stimuli that cause pain, which increases nerve cell activity and causes inflammation in the blood vessels.
We’re often told to avoid certain ‘triggers’ such as chocolate, coffee and cheese, but with so many suspects, it’s impossible to avoid them all. Instead, just be aware of common triggers and keep a journal to help you identify the ones that trouble you:
- citrus fruits
- caffeine or alcohol
- figs, raisins, plums
- nitrites or nitrates (found in bacon, hot dogs)
- ripened cheeses (cheddar, stilton, brie, camembert)
- food additives
- strong perfume
- flickering lights or loud noises
- stress or anxiety
- lack of sleep
- teeth grinding
- hormone changes
- computer screens
- changes to routine
- weather changes (high humidity, thunder and lightning storms)
It has long been clear that not everyone has the same triggers, and not every time. A cup of coffee may trigger a migraine one day, yet have little affect another. A team at the National Headache Foundation in the US recently investigated this with some pretty surprising results.
The team monitored 150 migraine sufferers for three months and discovered that many common ‘triggers’ actually did more to prevent a migraine attack than cause it; chocolate was found to trigger migraines in 10 participants but acted as a protector for 14, while caffeine triggered attacks in 3 people but appeared to prevent them in 32.
The biggest trigger of migraines was onions, which was found to increase the risk of attack in 14 participants, while only providing protective benefits for 4. These findings underline the ‘deeply personal nature of the condition’ and the importance of identifying your own personal triggers.
Another recent study found that migraines worsen as women approach menopause. Researchers studied 3664 women before and during their menopause year, all of whom had a history of migraines. They found that the frequency of migraine attacks increased by 60% as menopause approached, which was likely due to falling oestrogen and progesterone levels.
Early warning signs of a migraine
Just as the triggers are often individual, so too are the symptoms. Migraines usually develop in four stages, although not everyone experiences all four stages every time:
- Prodrome (early warning) – Many people notice small changes in the hours or days leading up to an attack, including sensitivity to light, concentration problems, irritability, fatigue, difficulty reading, increased thirst, yawning excessively, or a stiff neck. These early warning signs offer a small window to prevent the oncoming attack.
- Aura (pre-headache) – It is estimated that 25% of sufferers experience the aura phase and symptoms vary widely, often lasting from one to two hours. Visual changes include flashing lights, spots, wavy and zigzagging lines, or partial loss of sight. Other symptoms include difficulty finding words/speaking, confusion, dizziness, smelling odours that aren’t there, hiccups, and pins and needles.
- Attack Stage (headache) – The attack stage is the most debilitating part of a migraine, involving an intense, pulsating pain on one side of the head. This stage often includes nausea, vomiting, and sensitivity to bright light and loud sounds, and can last up to 72 hours.
- Postdrome (post-headache) – As the symptoms gradually begin to fade away, you will likely feel exhausted and washed out. However, a lucky few may feel a mild euphoria after the migraine has passed.
If you suffer from frequent migraines (more than 5 days each month) you should consult with your doctor. Call for emergency care if you also notice paralysis or weakness in one or both arms or one side of the face, slurred or garbled speech, seizures, double vision, or a skin rash.
How to beat migraines
There is no cure for migraines, but if you can recognise the early warning signs, you may be able to head off pain with medication and lifestyle changes before it takes hold.
- Manage triggers: The most important step is to identify your own personal triggers and avoid them as much as possible. While this is easier said than done, starting a migraine dairy can help you to track and identify potential catalysts.
- Get some sleep: There is some thought that fewer than 8 hours sleep may leave you vulnerable to other triggers, so it’s essential to establish a proper sleep routine. Set aside time each evening to unwind and prepare for bed.
- Balance oestrogen: Women experience a sharp drop in oestrogen levels before menstruation that increases the risk of migraines in the days leading up to their period, particularly during the teenage years and early adulthood. Some women find that taking birth control pills or HRT medication over a sustained period can balance hormones and relieve symptoms. However, it’s worth considering that starting or stopping birth control pills or HRT medication can trigger an attack.
- Exercise regularly: During exercise the body releases chemicals that block pain signals to the brain. Exercise also helps to achieve and maintain a healthy weight - adults who carry more belly fat are 37% more likely to suffer migraines compared to those at a healthy weight. Strenuous exercise can also trigger migraines if you are not used to it, so exercise within your limits.
- Manage stress: Stress, anxiety and depression are common emotional triggers for migraines, so look to establish some balance in your life. Use to-do-lists to help you manage your time wisely, don’t take on too much, and take time to relax.
- Eat riboflavin rich foods: 400mg of riboflavin (vitamin B2) a day has been shown to reduce migraine attacks by at least 50% over a three month period, compared to 15% for the placebo. Sufficient levels can be achieved through diet alone, by eating lean meats, eggs, legumes, leafy green vegetables, and milk. Certain breads and cereals are also fortified with riboflavin.
- Limit alcohol consumption: Red wine, beer, and sherry all contain large amounts of tyramine, which is known to trigger migraines in some people. Limit your alcohol consumption to 7 units per week.
- Don’t skip meals: It’s important to eat regularly to maintain balanced blood sugar level as fluctuations can trigger an attack. Eat lean proteins with meals to further keep blood glucose levels steady.
- Caffeine: Caffeine consumption is somewhat controversial, especially given the recent findings discussed above. While some people find caffeine to be a trigger, others find a small amount of caffeine helps to relieve pain in the early stages. As a general rule, limit your caffeine intake to 200mg a day – approx. 2 cups of coffee.
- Water: Dehydration is thought to be a significant factor in the build up to attacks. In one study, half of the participants upped their water intake by four cups per day. After two weeks, this group reported lessened headache severity and 21 fewer hours of pain, compared to the placebo group. In a separate study, participants found relief from migraines within 30 minutes of drinking 500ml of water. Researchers believe that some people may be more sensitive to dehydration than others. Stay hydrated by drinking eight glasses a day.
- Ice pack: Ice is the most common self-administered pain-relief therapy for migraines, particularly for those with aura. It offers anti-inflammatory and numbing effects to dull the sensation of throbbing pain and 75% of people who use ice therapy report some level of relief.
- Coenzyme Q10: This powerful antioxidant works as an antioxidant to mop up free radicals in the body. Taking 150mg of Coenzyme Q10 daily reduced migraine frequency by 13% after one month, and improved to 55% after three months. The average number of days with migraine headache also reduced from 7.34 at the beginning of the trial to 2.95 after three months. CoQ10 is also extremely well tolerated and no adverse effects have been reported. While CoQ10 shows benefits within a number of weeks, experts advise taking for 12 weeks for full benefits.
- Relaxation techniques: Spending just a few minutes each day on relaxation exercises can slow your heart rate, lower blood pressure, and reduce stress. These techniques work by slowing down your breathing and relaxing the body and mind. Yoga also helps to stretch muscles around the body to relieve tension that contributes to pain. During an attack, help to relieve pain by listening to calming music or applying pressure to the pulse points on the side of your forehead or neck.
- Lavender essential oil: While the scientific evidence is somewhat lacking, many people find lavender essential oil beneficial in relieving migraine attacks when inhaled or applied topically. One small-scale study involved 47 participants who were instructed to inhale lavender oil for 15 minutes when they felt the initial signs of a migraine attack and record any changes over the following two hours. During the study period, a total of 129 attacks were recorded and lavender resolved or partially resolved 71% of attacks.
- Botox: This popular wrinkle reducer was approved by the Medicines & Healthcare Products Regulatory Agency (MHRA) in 2010 to prevent chronic migraines. Botox was first investigated as a potential migraine treatment after people receiving Botox noticed a reduction in migraine attacks. Although it is not clear exactly how it works, it has become successful in the treatment of chronic migraines.
- Magnesium: Studies have found that migraine sufferers have low magnesium levels during an attack. Low levels of magnesium may also play a role in the frequency of menstrual migraines. Taking 600mg of magnesium a day for three to four months has been shown to work as an effective preventative remedy.
- Acupuncture: Acupuncture involves thin needles being inserted under the skin to realign the flow of energy and has been shown to be as effective as conventional drug treatments in preventing migraines. 160 women were recruited, half of whom were given acupuncture once a week for two months, then once monthly for an additional four months. The other half took a daily painkiller (flunarizine ) for the duration of the trial period. During the first four months of treatment, both groups experienced fewer migraines; migraine frequency reduced to 2.3 attacks in the acupuncture group, compared to 2.9 attacks in the painkiller group.
Starting a migraine diary
The easiest way to understand your own migraine pattern is to start a diary. This will help you and your doctor to identify any patterns and develop an effective treatment plan. In your migraine diary record:
- the date
- whether you had an attack
- time started / finished
- score the intensity of pain from 1 (low) to 10 (high)
- women, if you had your period
- any other symptoms such as nausea or vomiting
- any medications taken / if they were effective
- any factors that may have triggered the attack
- effect on daily activities, such as work, school or appointments
There are also online apps that help to track your symptoms and monitor potential triggers. If you can learn about your own triggers and establish a routine to manage them, you may save yourself a big headache.