Manage monthly migraines

Half of all female migraine sufferers find attacks are triggered by hormones – but there are ways to help prevent them

You’ll know how debilitating an attack can be if you’re plagued by migraines. You try to soldier on, but you can end up losing entire days lying in a darkened room while the world goes on without you. The World Health Organization (WHO) classified migraine among the top 20 most disabling lifetime conditions, on a par with clinical depression, and that’s not surprising when you consider typical symptoms are severe pain, often on one side of the head, with nausea, pins and needles and sensitivity to light, noise and smells. Ten per cent of sufferers have a warning ‘aura’ – visual disturbances that occur for up to an hour before the headache strikes. An attack can last anything from four to 72 hours.

Hormone connection
We don’t know why some people get migraines and others don’t. But they affect three times more women than men, normally starting during the teens or early 20s and declining following the menopause. Interestingly, when migraine does occur in children, girls are no more likely to suffer than boys. The ratio only changes with the onset of puberty – suggesting a strong hormonal link. The hormone/headache connection was first documented back in the sixteenth century. In the 1970s, Australian research suggested migraine could be triggered by a drop in oestrogen levels. This is consistent with the second part of the menstrual cycle, when oestrogen builds then declines once bleeding starts. My research at the City of London Migraine Clinic over the past 20 years has confirmed menstrual migraines exist, and often last longer and are more intense than those not connected with periods. They are not a symptom of pre-menstrual syndrome (PMS), which normally subsides once bleeding starts, but an entirely different mechanism. Half of all female migraine sufferers experience attacks around the time of their period, but only 10 per cent have menstrual migraines alone – the majority will also have migraines at other times, unrelated to their cycle. Other triggers Non-menstrual migraines, in both women and men, can have a huge variety of triggers, and these can vary from one migraine to the next. The most common contributory factors include dehydration and going for too long without eating. Others may include bright flickering lights, loud noises, strong smells, changes in weather, disruption to your sleep, or bouts of intense exercise in an unfit person, and many more possibilities. There’s rarely one single cause, but usually a combination of triggers that build up until a person’s threshold is reached and the migraine sets in.

The drugs do work
Migraine sufferers can feel they’re not taken seriously, and feel guilty for taking time off work or away from the family. Perhaps as a result of this, the majority don’t bother to seek medical advice. Yet recent research found 87 per cent of sufferers say their migraine affects their partner and 71 per cent say it has an impact on their children, so it’s important to take steps to tackle migraines. When you’re in the full throes of an attack – hormonal or otherwise – you need medication. Several remedies can successfully tackle an attack. Simple painkillers often do the trick – aspirin and ibuprofen more effectively than paracetamol. What’s important is to take them as soon as you sense a migraine coming on – don’t wait to see how bad it gets. Studies show that as a migraine progresses, digestion slows down, making it more difficult for drugs to be absorbed. Try taking 600–900mg (more than you’d take for a normal headache) of soluble aspirin, dissolved in a sweet,
fizzy drink. The bubbles will help you to absorb the drug more effectively and the drink will raise your blood-sugar level. As long as you’re not sensitive to aspirin, it’s safe to take this remedy for
10–15 days each month. Any more and you risk analgesic headaches – caused by the medicine itself. The gold standard class of drugs used to treat migraine are called triptans. They’re not painkillers but work on the brain chemicals involved in migraine. Most have to be prescribed by a doctor and come in formulations such as nasal sprays, suppositories and injections as well as tablets. If regular migraines are seriously disrupting your life, you may also be prescribed a course of preventative (prophylactic) medicine, which sometimes breaks the cycle. Scientists are working on a promising new class of drugs called ‘CGRP antagonists’, which block the brain chemicals released during migraine, preventing an attack. These should be trialled and licensed for use by 2010.

Your prevention plan
The first step for anyone who wants to manage their migraines is to keep a diary. Note what days in the month you experience headaches, migraines, and when your period is. Keep the diary for three months and it should be easy to spot if you’re suffering from menstrual migraines – they will occur in the two days before and first three days of your period. If you tend to suffer at other times of the month, too, you can start to look at what factors may have combined to produce these attacks. Perhaps a late night, followed by skipping breakfast, and a stressful day with more caffeine than usual? Make your diary more detailed to spot the patterns. Once you’ve identified the possible triggers for your condition, you can work on trying to minimise them. If it seems menstruation is a trigger, see your doctor to discuss hormonal-based treatments that offer protection by preventing the drop in oestrogen levels, such as the combined oral contraceptive pill, oestrogen supplements, patches or gel, or hormone replacement therapy (HRT). As with most medical conditions, the healthier, fitter and less stressed you are, the better. When it comes to food, the best advice is to follow a balanced, natural diet. Eat little and often to keep your blood-sugar levels balanced to prevent hunger; always eat breakfast; and drink one to two litres of water daily. Many people mistakenly believe all migraine sufferers should cut out all possible food and drink triggers, including cheese, red wine, chocolate and caffeine. In fact it’s a myth that these are common triggers, especially on their own. But by all means experiment. I’ve had some patients say caffeine worsens their migraine, while others swear a strong coffee can stop an attack in its tracks. If caffeine is a trigger for you, try switching to herbal teas such as chamomile or peppermint. Some people find nutritional and herbal supplements can help. There have been clinical trials in support of magnesium, co-enzyme Q10 and vitamin B2. Some find the herb feverfew helps. It’s a matter of finding what suits you. I’ve known people who have found acupuncture, reflexology, homeopathy and herbal medicine helpful. If you suspect long hours spent slumped at your desk may be a trigger, you could try massage, physiotherapy, osteopathy or posture-related disciplines such as Alexander technique. But if a therapy doesn’t appear to be working for you, try something else. Taking time to relax each day is important. A few drops of lavender essential oil in a warm bath is a good way to unwind after a busy day. While there will probably never be a one-size-fits-all treatment for migraines, there certainly is a way for all sufferers to manage their condition and vastly improve their quality of life.

- To create your own plan, visit www.migraineactionplan.co.uk.
- For information and support, contact the Migraine Action Association: 0870 050 5898; www.migraine.org.uk.
- For an appointment at the City of London Migraine Clinic, call 020 7251 3322 or visit www.colmc.org.uk.

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Is it a migraine?
If you have a headache plus two or more of the following symptoms, it’s likely to be a migraine:
- You feel nauseous
- You’re bothered by bright light
- You’re unable to carry out normal daily activities

DR ANNE MacGREGOR
is director of clinical research at the City of London Migraine Clinic, an independent registered medical charity and social enterprise (www.migraineclinic.org.uk).