Migraine is not just a bad headache. It is a series of chemical and electrical changes in the brain, starting in the brainstem then extending through the rest of the brain.
We refer to migraine as a ‘threshold disorder’ and everyone has a different threshold depending on their genetics, environment etc. Lots of factors combine to reach this threshold point and as soon as the brain tips over its threshold a migraine begins.
There are 4 stages to a migraine
- Prodrome – feeling ‘off’, brain fog, yawning, change in mood. Lasts between minutes and days.
- Aura – occurs for 20-30% of migraine sufferers: visual changes (lights, glare, flashes, spots, blindness), numbness, tingling, nausea
- Resolution – a washed out feeling after the pain has passed
Migraines have triggers – food, smells, not enough sleep, sleeping too much, alcohol, coffee, noises, hormones. Every migraine sufferer has different triggers.
Migraines should be investigated by your GP and a neurologist. Together they can develop an appropriate medication plan.
Have a Plan
- Become familiar with your migraines – keep a diary to track your symptoms, identify triggers and record your response to medication
- Avoid your triggers
- Have an acute migraine plan – treat it early, once the headache starts there is already significant chemical change in the brain
- Drink water, eat, sleep
- Take anti-inflammatories – voltaren, aspirin, nurofen
- If no relief, take a second dose of anti-inflammatories
- If there is still no relief take a dose of triptan medication (by prescription)
For severe pain, or migraines lasting over 2-3 days, some hospitals have migraine management units in their emergency departments (Cabrini, Alfred)
Treatment with Medication
There is NO evidence that paracetamol or panadeine have any effect on migraine. These medications can cause a rebound headache – a headache after your original headache has passed.
Migraines usually respond to anti-inflammatory drugs which stop the chemical changes in the brain. Start with voltaren or nurofen. If ineffective these can be followed with triptans, as prescribed by your doctor.
Prescription and nutritional preventers are available, but these are individualised for each case.
Treatment with Osteopathy
Due to the chemical and electrical changes involved in migraine, once the pain has set in there is often little that manual therapy can do.
Musculoskeletal pain is one of the factors that can feed into the ‘migraine centre’ of the brain and contribute to a migraine starting. Osteopaths may help to reduce the musculoskeletal pain in an attempt to prevent a migraine from starting.
Every migraine is different, and some patients find that osteopathy during a migraine is really helpful. Find out what works for you.
This information in no way replaces the advice of your doctor. This post is based on a presentation by Associate Professor David Williams for Headache Australia 2016.
For more information on migraine visit http://chronicmigrainehelp.com.au