Are you one of the 10 million people in the UK, aged 15-69 years, who suffer from migraine symptoms? We feel your pain...
… As do the other one billion people worldwide affected by this debilitating condition. Migraine is one the most common disorders there is, and it costs us in more ways than one. According to the NHS, In Britain alone, the British economy loses around £4.4billion per year to migraine-related sick days. And women are the most affected.
There’s a lot more to migraines than bad headaches. ‘Migraine is a complex neurological entity which can present with physical, cognitive and emotional symptoms,’ says Dr Giorgio Lambru, consultant neurologist at London Bridge Hospital.
Sufferers are all too aware that there is no cure for this neurological disease. But medication, as well as lifestyle and diet changes, can be very effective. If you know what migraine symptoms there are, and the triggers and treatments available, it will help you take control.
- Severe, throbbing headache that usually (but not always) affects one side of the head
- Neck pain and stiffness
- Sensitivity to noise and light
- Blurred vision
- Nausea and/or vomiting
- Tiredness and/or fatigue
- Forgetfulness and difficulty in concentrating
- Different types of aura (see below)
Unusual and severe migraine symptoms
‘There are unusual symptoms, including irritability, excessive yawning, moodiness, abnormal feelings of elation or sudden bursts of energy, as well as strong food cravings and dizziness,’ says clinical nutritionist Suzie Sawyer. Those symptoms aren’t worrying, but there are other symptoms to be aware of, such as seizures or fits, confusion, or a sudden onset headache that may warn of a more serious issue.
‘Some people experience very severe and debilitating symptoms, such as an abrupt, severe headache (like a thunderclap), headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke,’ says Suzie. If you’re unsure, call 111.
Migraine symptoms may seem unrelated. You may only attribute them to the condition if you’re keeping a trigger diary.
What is an aura migraine?
Aura migraines are migraines when sufferers experience sensory or visual disturbances, along with the classic migraine symptom of a headache. ‘Migraines can be preceded in about 30 per cent of cases by visual disturbances called aura, although most migraine episodes are not associated with an aura,’ explains consultant neurologist Dr Giorgio Lambru. He adds: ‘Although migraine with aura is classified separately from migraine without aura, their management is similar.’ Some people experience aura without any pain – this is called a silent migraine.
There are different types of aura. Visual aura is perhaps the most recognised – symptoms include seeing spots, zig-zags and flashes of light, as well as hallucinations and temporary sight loss. Sensory aura can include tingling and numbness on one side of the body, slurred speech, vertigo and tinnitus and, rarely, weakness on one side of the body.
Different types of migraine
According to The Migraine Trust, the different types of migraines include:
- Common migraine (without aura)
- Migraine with aura (visual and/or sensory disturbances)
- Menstrual migraines (more than half of women with migraine report menstruation as a trigger for their migraine attacks, says The Migraine Trust)
- Chronic migraine (headache for 15 or more days a month, eight of which are migraine)
- Migraine with brainstem aura (also known as a basilar migraine, this is a rare type with neurological symptoms)
- Vestibular migraine (affects balance)
- Hemiplegic (another rare type of migraine that causes weakness down one side of the body)
- Abdominal migraine (this affects children more than adults and manifests as severe stomach pain)
What are the main causes of a migraine?
‘Migraine headaches are traditionally thought to be mostly triggered by environmental factors,’ says Dr Lambru. ‘However, the current understanding of migraine suggests that most of the physical, emotional, dietary and environmental triggers are in fact premonitory migraine symptoms, which means they’re part of the migraine which often starts hours or days before the pain is felt.’
This indicates that, for many people, what they believe is a trigger is actually a migraine in its early stages. So prompt or preventative action is very important – before the pain kicks in.
- Lack of sleep
- Tiredness and fatigue
- Poor posture, including tension in the neck or shoulders
- Over-exercising or over-exerting yourself
‘In times of emotional stress, certain chemicals are released that provoke the vascular changes that cause a migraine headache,’ says Suzie. ‘The attacks become more frequent in periods of increased stress.’
- Baked goods with yeast, such as sourdough bread, bagels, doughnuts, and coffee cake
- Caffeine and caffeine withdrawal, although, conversely studies show caffeine may also help migraines
- Citrus fruit
- Cultured dairy products, such as kefir and yoghurt
- Foods containing tyramine – found in certain cheeses and cured meats and fish
- Food and drink containing monosodium glutamate (MSG), sulphites, artificial colours, sweeteners or preservatives
- Hunger or low blood sugar
- A change in the weather, temperature or barometric pressure
- A change in routine
- Bright light
- Eye strain from digital devices
- Extreme sound or noise
- Glare from lights or flickering lights
- High winds
- Intense heat
- Smells and vapours
Sometimes it’s hard to be a woman, sang Tammy Wynette. And that’s especially true when it comes to migraine symptoms. ‘Hormones are a factor for many women, especially around menopause,’ says Dr Allder. Puberty, menstruation and pregnancy are also triggering.
‘About 70 per cent of women with migraine have a severe migraine headache during menstruation. This is either at the onset, during, or at the end of their period,’ says neurologist Dr Giorgio Lambru. ‘Menstrual-related migraine headaches are often severe, long-lasting and difficult to treat. They are thought to be caused by the sudden drop in the level of oestrogen at the onset of the menstrual period,’ he explains.
Taking hormones is an option. Dr Lambru suggests progesterone-only contraceptives. ‘They are generally safe and may improve symptoms related to menstrual migraine,’ he says.
Treatments for migraines
You may not feel like exercising if you’re in the depth of a nasty migraine. But regular physical activity can help keep migraine triggers at bay.
‘When we exercise, our body releases endorphins which are natural painkillers, says Dr Allder. ‘Some people may find that exercise relieves migraine. But most people will be unable to manage exercise with a migraine due to the intensity of pain and other related symptoms. However, exercising regularly has many benefits including helping reduce stress and improving quality of sleep, which can be migraine triggers for some people,’ he explains.
2. Abortive and preventative medicine
The medication that works for your migraine may not be what works for another. Indeed, not everyone needs medication to treat migraine symptoms – other, non-pharmaceutical options may be enough. However, if you have frequent migraines, abortive or preventative medication can be very useful.
“Preventive treatments depend on the monthly number of days with a migrainous headache,’ says neurologist Dr Giorgio Lambru. ‘The most effective abortive treatments (medication that stops symptoms quickly) are the triptans – like sumatriptan or rizatriptan – especially if taken at the very beginning of an attack.” If these treatments work for you they need to be taken for 6-12 months to allow them to rebalance the impaired brain neurochemistry responsible for frequent migraines, adds Dr Lambru.
Triptans also work for menstrual migraines, especially if taken alongside anti-inflammatories such as ibuprofen, although one thing you shouldn’t do is manage frequent migraines with painkillers. ‘Opioids like codeine are best avoided in migraine,’ says Dr Lambru. If you experience more than just menstrual migraine headaches, preventive treatment should be discussed with their doctors to avoid an excessive intake of painkillers.’
He continues: ‘The most effective preventive treatments for migraine (medication that stops migraines occurring) are the tricyclics antidepressants and beta-blockers, which can improve severity and frequency and improve deep sleep, low mood and anxiety at the same time.’ Both abortive and preventative medicine will need to be prescribed.
‘Finally, the new CGRP monoclonal antibodies have revolutionised the migraine treatment – it being the first very effective migraine-specific class of treatment of this condition,’ says Dr Lambru. ‘According to NICE, “Erenumab is a human monoclonal antibody that binds to the calcitonin gene-related peptide (CGRP) receptor, inhibiting the function of CGRP, and thereby preventing migraine attacks.” It’s administered by monthly injection as a preventative measure and is available on the NHS and privately.’
3. B vitamins and magnesium
Studies show that certain vitamins and minerals can help with the intensity or frequency of migraines; in particular B2, B6 and magnesium. ‘Low levels of magnesium have been shown to be an independent risk factor in migraine attacks and oral supplementation has been found to reduce tension headaches and migraines,’ says nutrition expert Hayley Pedrick.
‘Riboflavin (vitamin B2) has been shown to have good effect in reducing frequency and intensity of migraines,’ she continues. ‘One study of 41 paediatric and adolescent patients receiving 200mg-400mg of riboflavin daily for 3, 4 or 6 months found 68% of cases had a 50% reduction in frequency and 21% reduction in intensity at follow-up. Riboflavins benefits are possibly due to its ability to enhance mitochondrial energy.’
Then there is B6, which also may help with migraine symptoms. Hayley explains: ‘A double-blind, randomised clinical trial on using 80mg vitamin B6 (pyridoxine) has also been shown to provide support for migraine suffers. The trial followed 66 patients with migraine with aura, and pyridoxine supplementation led to a significant decrease in headache severity and the duration of the attacks,’ she says. ‘It did not, unfortunately, appear to influence frequency, though.’
Go for B-complex with magnesium – we like Viridian’s B-Complex with Magnesium (120 capsules, Amazon | £15). Alternatively, consider a vitamin drip. ‘Many people with migraines use supplements to help their symptoms. Our Energy Drip contains both B vitamins and magnesium,’ says Dr Sheena Kent, a pharmacist at Get a Drip, which has locations in and around London and in Dublin. ‘
With more and more research pointing to a link between our gut and our brain, it stands to reason that a healthy gut can have a positive effect on us neurologically. ‘Attention has turned to the role of the gut and its micro-organisms in the management of migraine,’ says Dr Richard Day, medical advisor at Bio-Kult. ‘In a recent study using 14 strains of probiotic micro-organisms found in Bio-Kult Migrea, researchers showed dramatic reductions in migraine frequency. Individuals who received the probiotic intervention saw a 40-45 per cent reduction in the frequency of migraine over the trial period.’
He adds: ‘This study is an excellent example of how probiotics can have profound and beneficial effects on distant parts of the body. As such, individuals suffering from migraine may wish to consider probiotics as an adjunct to their regular management routine.’ Try Bio-Kult’s Migréa (60 capsules, Boots | £20).
Dehydration may be more common than people realise at causing migraine symptoms. Even mild dehydration can be a trigger.
When those who suffer from migraines become run down due to not receiving enough water or fluids throughout the day you’re risking a migraine. When this happens, your brain temporarily shrinks or contracts due to the loss in fluids. You may also feel tired, weak and very thirsty. You may then feel a headache come on due to the brain pulling away from the skull, resulting in pain which we feel as migraines.
‘Reducing alcohol intake – which can cause dehydration – drinking at least 2 litres of water per day and reviewing your diet can help improve and ultimately eliminate the onset of a migraine,’ says Dr Allder.
Clinical nutritionist Suzie Sawyer is a fan of a feverfew. ‘It’s a herbal medicinal product used for the prevention of migraine headaches exclusively based upon longstanding use,’ she says. It’s so well established that it’s not unusual for doctors to recommend it.
‘The herb feverfew (Tanacetum parthenium) contains a wealth of plant compounds with anti-inflammatory and other properties, including the ability to reduce production of histamine,’ says Suzie. ‘Research suggests that the parthenolide compounds may also help reduce blood vessel constriction as well as acting on the brain’s serotonin system in a similar way to medications used to treat migraine. By inhibiting the production of inflammatory prostaglandins, the severity of attacks are reduced,’ she explains. Try MigraHerb Feverfew (30 capsules, Holland & Barrett | £7.99).
Yes, you read it right. Botox can not only smooth out wrinkles, it can work as a treatment for migraines.
‘For chronic migraine, Botulinum toxin A (Botox) is a very effective and well-tolerated injectable treatment, which allows patients not to take daily tablets,’ says Dr Lambru. However, this treatment is only available on the NHS if you have chronic migraines (described as a headache for 15 or more days a month, eight of which are migraine). If you can afford it, go private. The London Migraine Clinic offers a migraine treatment with Botox and consultation for £465 (or £795 if you go the extended treatment which includes Botox in the neck).
9. Massage or osteopathy
If postural issues are causing your migraines, another option is physical manipulation. ‘Working from home during the pandemic has meant sitting at makeshift desks on chairs not meant for all-day working, resulting in the vulture posture causing a huge amount of poor posture-related problems,’ says Ali Cullen, nutritional practitioner for A. Vogel Herbal Remedies. ‘Anything that happens in the lower back will also impact on the neck, which then travels into the head and can cause tension.’ This tension can lead to migraine symptoms.
While a one-off massage can help relieve tension around the neck, shoulders and face, a course of treatments may be better. ‘Osteopathy can help with the symptomatic presentation of your migraines as well as understanding your migraine pattern,’ says Kemmy. ‘The main goal is to eliminate or reduce the amount of migraines that you have,’ she explains. ‘Firstly, I would ask the individual to do a diary of their migraines to look for triggers. Then I will monitor how it changes after each treatment. Each individual responds to treatments differently, so it’s important to tailor this to the person.’
Kemmy continues: ‘A treatment may include mobilising your cervical spine (neck), releasing the sub occipital (smaller muscles at the back of your neck), and releasing tension build-up in your jaw. And soft tissue techniques to work on the muscles surrounding your neck. If appropriate I would end by adjusting the top of the neck.’
When to seek medical advice for a migraine
If you suspect you’re getting migraine symptoms always seek medical advice. A doctor will rule out other conditions and provide information on – and access to – treatments.
For example, ‘if the migraines are arterial [basilar] they should seek further investigation as this could be a more serious matter,’ says Kemmy. ‘If a woman has hormonal migraines, seeking advice on improving hormone levels to reduce their migraine pattern could be highly beneficial,’ she adds.
Speak to your GP or, for more advice, visit The Migraine Trust.
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