Managing Migraine

    More than four million Canadians suffer from migraine. As many as one in four households may have a migraineur (a person who gets migraine headaches). And it affects three times as many women as men.
Migraine is a moderate to severe headache that makes it difficult to carry out routine activity, and it’s typically associated with intolerance to light and sound, or with nausea or gastrointestinal upset.


Some patients experience throbbing, one-sided headaches, vomiting, or an aura (a visual disturbance that may accompany a headache). However, these symptoms are not necessary for a diagnosis of migraine.
“We leave out the throbbing, the one-sided feature, and the aura from the simple definition,” says headache specialist Dr. Christine Lay, director of the Centre for Headache at Women’s College Hospital. “Otherwise patients who don’t have all of those features end up believing they don’t have migraine, and even physicians believe it’s not a migraine.”
Not knowing it’s a migraine is a very real possibility: as many as 50 per cent of migraineurs are misdiagnosed or undiagnosed. Dr. Lay notes that in North America, migraine is more common than asthma and diabetes combined.
What is migraine?
Migraine is an inherited neurobiologic condition, Dr. Lay explains.
“It’s what we call highly genetically dominant, meaning that if parents have it, or grandparents had it, there’s a good chance their children and grandchildren are at risk of getting it,” she says. “But we believe that what they inherit is what’s called a hypersensitive neuronal sentry system. So the brain of the migraineur, even outside of a migraine attack, is more sensitive to sight, sound and smells than someone who does not have migraine.”
It’s this heightened sensory nervous system that leads to problems during a migraine attack. Dr. Lay explains that a number of different chemical reactions take place in the brain in what’s called an inflammatory process. This leads to a vascular effect (an effect on the blood vessels), creating throbbing pain, and light and sound intolerance.
However, Dr. Lay explains that this process begins hours before the patient feels the headache. That’s why it’s very important to treat migraines promptly: by the time the pain arrives, the migraine is already well underway. Very effective medications are available to treat migraines.
Family history is the main risk factor for migraines. Head injury or concussion is also a potential risk factor: it may trigger migraine in someone whose migraine had become dormant.
Hormonal changes are critical triggers in women. The majority of female patients remember developing migraine – or at least headaches – in their teen years, around the time of menarche. Migraines often get worse around perimenopause and menopause because of hormonal fluctuations.
Patient education
Patients at the WCH Headache Clinic attend information sessions about managing migraines, to educate them about management and prevention.
“I developed these educational sessions because I had such a huge waiting list,” Dr. Lay says of the sessions. It was frustrating because a patient might wait a year for an appointment, during which time they could have been making lifestyle modifications that don’t require any medical intervention. Now attending a headache education session is a mandatory part of treatment at the clinic.
“There are a number of things that you can do to take control of the migraine and gain power over them that are simple lifestyle modifications,” Dr. Lay says.
The following steps can have significant benefits for migraine patients without any kind of side-effects or risks:

• Maintain good hydration
• eat a good breakfast with protein
• don’t skip meals
• maintain a sleep routine, particularly a consistent wakeup time (don’t sleep in on weekends)
• exercise regularly
• limit caffeine consumption
• cut out dyes, colours, preservatives and artificial flavours from your diet (including sweeteners)

Medication overuse
Another crucial factor that Dr. Lay wants patients to be aware of is the issue of medication overuse headache. Migraineurs are very prone to developing chronic headaches when they overuse over-the-counter pain medication such as ibuprofen and acetaminophen, or other prescription analgesics (pain medicines).
“When those medications are used two days a week on a regular basis, over time they actually increase the frequency of headache rather than decreasing it. And we call that medication overuse headache,” Dr. Lay says.
Many patients find themselves taking large amounts of these medications on a regular basis, assuming they are benign because they are over-the-counter, she explains. “Then they learn that there can actually be harmful effects of taking too much medication.”
By backing off from over-the-counter medication overuse, many patients see improvements with no other treatments.
Finally, keep track of your headaches. Mark on your calendar when you have a headache and how long it lasts. Also for women, note when you had your period, so you can see whether there’s any link to your menstrual cycle. If your calendar shows you are having three or more headaches per month, you should see a doctor about your headaches to discuss treatment, or if you are already receiving treatment, how it can be optimized.

by Patricia Nicholson