Migraines explained

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According to Headache Australia, one in five Aussie women suffer from migraines; they’re a seriously painful business. And not just because they hurt like hell.

They also suck time and quality from your life, put a limit on your pleasure (anything from skydiving to orgasms to chocolate can be no-nos, depending on your triggers), and are linked to a higher risk of everything from endometriosis, stroke, heart attacks, anxiety and depression.

On the plus side, migraines aren’t fatal – they just feel like it. Cop one and you can expect nausea, vomiting, throbbing pain on one side of your head and a threshold to light and sound that makes a hungry Rottweiler look like a picture of tolerance.

“Migraines are like epilepsy – they’re an intermittent disability,” says Headache Australia CEO, Gerald Edmunds. That’s what makes them different to a normal headache, he says. “Have an attack and you’re disabled; totally off the air. You can’t do anything until it passes.”

Experts disagree about why headaches happen, and although a cure remains elusive, migraines are beginning to reveal their secrets.

THE DEPRESSION LINK

Now, they’re saying, this kind of headache might be less about your brain, and more about your state of mind. Traditionally considered a result of dodgy internal wiring (often genetic) which fires when exposed to certain triggers (coffee, cheese, chocolate, hunger, computer monitors), researchers are starting to change their tune.

Several studies conducted at Monash University, Melbourne, in conjunction with depression initiative Beyondblue, have found a strong link between migraines and depression – which suggests that what goes on in our mind directly affects what goes on in the grey matter of our brain.

“It’s complicated,” says Professor Paul Martin, head of psychology at Griffith University, Qld. “But what we’ve shown is that depression can lead to migraines, migraines can lead to depression, and that they sometimes both seem to occur at once.”

In any case, there’s no denying the link between the physical and psychological – and that’s the important bit, he says. The “nocebo” effect (where a patient’s pessimistic expectations, like “I’ll never get rid of these bloody headaches” can actually cause them to have more migraines) is well known, Professor Martin says. “And even though headaches are triggered by a huge range of factors, by far the most common is stress.”

He recalls one of his patients, a 34-year-old who’d suffered migraines since she was 14. “Eventually she confessed that her headaches had started shortly after she found her father dead in front of the TV,” he says. “Not surprisingly, her headache problem was embedded in that history. That’s not something you’d just treat with a pill.”

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A bit of an unusual example, you might say, but science shows he’s onto something. In 2007, research published in Behavior Therapy saw long-time headache sufferers (with a 4-year-long average history of migraines: holy hell) experienced an average headache reduction of 68 per cent when they were treated by psychologists, using a combination of cognitive behavioural therapy (CBT), stress management and relaxation skills.

Twelve months later, the result had increased to a 77 per cent reduction – “more than double the best results achieved by [the drug] amitriptyline,” Professor Martin points out. Amitriptyline is the best preventive medication for migraines available, a 2010 review in the BMJ found – but when 41 migraine sufferers were assigned to receive either mitriptyline or CBT in a landmark study published in the Journal of Consulting and Clinical Psychology, the results were once again in favour of psychology. The amitriptyline group lowered their headaches by just 27 per cent – CBT patients saw a 56 per cent reduction.

FACE IT, HEAD ON

Of course, try telling a migraine sufferer it’s all in their head and they just might clock you one. Most migraineurs can list their triggers without blinking: caffeine, alcohol, certain foods, sweeteners, sunlight, smells, sleep, exercise, sex, weather and medication have all been implicated in the past, and the list doesn’t end there. Hormones are another kicker, adds Edmunds.

“Research indicates that women make up around two-thirds of all migraine sufferers, and we think that’s in large part due to changing hormones in the menstrual cycle,” he says. Then there’s your family history to blame.

“You’d be hard pressed to find a medical expert who doubts that there’s a genetic basis to a proportion of migraine headaches,” says Dr Dale Nyholt, a neurogeneticist at Queensland’s Institute of Medical Research who’s been studying these crazy head pounders for the past two decades. "Something like 50 per cent of first-degree relatives of a migraine sufferer also have migraines.”

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All of which are true, concedes Professor Martin. “But when statements like ‘migraines are genetic’ are made, people think they’re doomed. And that’s rubbish. If it was just in your genes, you’d be having migraines as soon as you’re out of the womb.”

It might not be easy to understand why migraines happen, but they do happen for a reason, he says, “and it’s possible to get on top of them”. Better still: there are things you can do starting today.

See a psych “Doctors always want to separate physical from psychological and the reality is, you can’t,” says Professor Martin. “Migraines aren’t just a physical condition, you need to address the psychological level as well.” He strongly recommends seeing a psychologist for a check-up.

Keep a diary According to Dr Nyholt, the best step you can take is to keep a diary. “Do it over a couple of months and write down as many details as you can,” he says. “Where and when you get your migraine attacks, what you’ve eaten, how much sleep you’ve had… it’s really the only way to start.”

Rewire your thinking Headache management guidelines by the University of California, Berkeley, US, include starting your own CBT. To start, they suggest learning to identify internal negative self-talk (“I always get migraines”) and making it positive (“Migraines are manageable and curable”).

Stop avoiding your triggers This might seem counterintuitive, but a 2010 review in Current Pain and Headache Reports found that learning to cope with your triggers is twice as effective as avoiding them altogether. “No stress researcher would ever say, ‘The way to cope with stress is avoid stress’,” says Professor Martin. The same goes for your triggers. “Obviously there are some triggers best avoided (dehydration, car fumes…), but the majority are things you can desensitise yourself to. Stress, eyestrain, noise, tiredness, weather… with repeated exposure in small amounts, you can learn to cope with those.”

See a neurologist “They’ll sit down with you and try out different medications,” says Dr Nyholt. (Well, not literally. But you know...) Be prepared to test more than one type. “Often, you’ll need to try out several medications, different mixtures and differing amounts, because migraines are complex and what works for each person is different.”

Rethink the OTC The third most common type of headache in the world is a “medication overuse headache” (MOH), caused by your body withdrawing from regular headache medication (why they’re also called “rebound headaches”). “Self medicating your migraines is the worst thing you can do,” says Edmunds. “People who take over-the-counter medication for long periods can not only end up with rebound headaches, but all sorts of other problems, like kidney issues and ulcers.” See a doctor.

Get Botoxed Seriously struggling with the pain? After several years of studies, research in the Journal of Headache and Pain confirms injecting Botox into certain “trigger points” around the face, head and neck can help reduce the frequency and severity of migraines. “But don’t go to a cosmetic doctor or a GP for treatment. You need a specialist,” warns Edmunds. “And beware – it’s going to cost you about $1000.” Now that hurts.

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