Migraine in a Nutshell

What is Migraine?

Migraine is:

• The most common reason for neurology referral in the outpatient setting.
• The third most common disease worldwide, with a global prevalence (one-year prevalence) estimated at 15 per cent in both genders in the Global Burden of Disease (GBD) Survey.
• The third cause of disability in under 50s.
• Three times more common in females because of its association with monthly hormonal changes.
• Collectively, the seventh-highest cause of years lived with disability.

What is the main cause of Migraine?

Today, it is widely understood that brain chemicals (neurotransmitters) such as serotonin and hormones like estrogen, often play a key role in pain sensitivity for migraine sufferers.

One aspect of migraine pain theory explains that migraine pain happens due to waves of activity by groups of excitable brain cells.

Is Migraine inherited?

According to the American Migraine Foundation, an individual with one parent with migraine has a 50 per cent chance of developing migraine at some stage in life. This risk rises to 75 per cent if both parents have a diagnosis of migraine.

Migraine and pregnancy

Migraine frequency increases usually in the first trimester but then it starts to become less frequent later in pregnancy.

Chronic Migraine

If you have at least 15 days with headaches each month, then you suffer from chronic migraine.

Migraine and its association with stroke

If someone suffers from migraine with aura, the individual is twice as likely to have a stroke in their lifetime, that is, compared to those without migraine.

Having said that, the overall risk linked to migraine is still very low, and people are far more likely to have a stroke because of other risk factors such as age, smoking, high blood pressure, diabetes and high cholesterol.

Sometimes a migraine attack can present like stroke, similar to a numbness or weakness in one side of your body and/or speech disturbances.

This type of migraine attack is called “Complex Migraine” or “Hemiplegic Migraine”.

Distinguishing a complex migraine from a genuine stroke is usually challenging, and it requires a thorough neurological assessment by Neurologist, in addition to radiological investigations.

Migraine triggers

Unfortunately, you will not be able to pinpoint any specific cause or trigger for most of your migraine headaches but any of the following factors could be a potential cause for some of your migraine attacks;

• Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.
• Alcoholic drinks, in particular red wine.
• Stress and sleep deprivation.
• Sensory stimuli such as sun light, loud noises, strong smelling stimulators such as perfumes and deodorants.
• Physical exertion.
• Weather changes.
• Medications such as vasodilators which are used for heart conditions.

 

Migraine treatments

Abortive treatments such as Triptans cannot be used more than six to eight tablets /month because they can cause medication overuse headache.  Other abortive treatments include high dose Aspirin, Panadols and Nonsteroidal anti-inflammatory drugs.

If you have at least three days of migraine in a month then you should start preventive treatments.

It’s important to note, preventive treatments are NOT pain killers. You should take preventors on daily basis aiming to reduce the frequency and intensity of your migraine headaches. Preventers include tablets and/or injection treatments.

If you suffer from chronic migraine then you are eligible to be treated with either three monthly injections of Botox (31 small injections on the forehead, scalp and shoulder skin) or monthly self-injections of recently available injection treatments such as AJOVY or EMGALITY.

The goal of treatment with Botox and other injections is to reduce the frequency of headaches by at least 50 per cent by six months. If not, you will not be eligible to this treatment through PBS.

VYEPTI is another injection treatment which will be available to use in Australia in near future through non-PBS access. This treatment will involve three monthly intravenous injections of the drug and its mechanism of action is very similar to other two available treatments (AJOVY and EMGALITY).

These injections inhibit a peptide in brain called CGRP (Calcitonin Gene-related Peptide), which is a protein that is released around the brain and it causes intense inflammation in the coverings of the brain (the meninges), and for most migraine patients, causes the pain of a migraine attack.

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