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The most common triggers and best treatments - all you need to know about migraines

They can be debilitating and often misunderstood, writes the psychologist Iain Mays, but new research offers hope for sufferers

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Real headache: migraine is a complex condition

Real headache: migraine is a complex condition

Getty Images/iStockphoto

Real headache: migraine is a complex condition

Everyone either knows someone who suffers from migraine, or struggles with migraine themselves. Most people don't realise how serious and incapacitating migraine can be. But with the help of studies we can learn more about this neurological disease.

1. It's more than just a headache

Public perception usually reduces migraine to a headache, perhaps because migraines are transient, non-communicable, non-fatal and are classified across a spectrum from episodic to chronic migraine.

Migraine, however, can be so much more than a headache as documented by the latest edition (third) of the International Classification of Headache Disorders. There are multiple diagnoses of this condition such as migraine with aura, hemiplegic migraine and retinal migraine.

The majority of people with migraine are classified as having migraine without aura, but even within this diagnosis there can be different experiences. The many symptoms in the diagnosis of migraine include sight, smell, sound, touch, and physical sensations like hemiplegia and nausea.

2. Migraine packs a punch

Results from the most recent Global Burden of Disease Study, a global research programme that assesses 328 diseases in 195 countries, estimated migraine to be the second leading cause of years lived with disability worldwide in 2016, causing an estimated 29 to 62.8 million years lived with disability. In the UK an estimated six million people experience migraine, along with roughly 86 million work days a year lost as a result.

3. Migraine takes time to diagnose

The role of the GP as gatekeeper for referral, diagnosis and management of major health conditions including migraine is more important than ever.

The transient nature of migraine means it can take time to diagnose and compiling a headache diary for three months is recommended. This can help improve diagnostic accuracy by distinguishing between different types of primary headache disorders, such as tension-type headache or cluster headaches, or secondary disorders such as medication overuse syndrome.

4. There is a genetic link in migraine

There is a strong hereditary component in migraine. Results are varied but approximately 50% of migraineurs are estimated to have a first-degree relative with migraine. While specific research into migraineurs with and without aura is considered to have heritable phenotypes ranging from 33-57%.

5. There are new treatments

The last two years has seen increased preventative and acute treatment options for migraine.

The field of neuromodulation has been advocated in certain instances and involves the use of devices like gammaCore, Cefaly and Nerivio that discharge electrical or magnetic currents to interrupt and suppress migraine.

In other cases, the arrival of Calcitonin Gene-Related Peptide (CGRP) monoclonal antibody treatments has been hailed as a new era in headache disorders. With most preventive medication for migraine being originally developed for other conditions, it explains the excitement for these migraine-focused drugs.

Since 2018, four of these preventive drugs have been approved for the use of migraine by the FDA in the US, one of which (erenumab) was the subject of recent controversy in the UK because it had been approved for use by the NHS in Northern Ireland and in Scotland, subject to a funding request, but not in its Welsh and English counterparts.

6. Different factors are believed to affect progression from episodic to chronic migraine

Episodic and chronic migraine are common classifications used to describe the migraine spectrum. Chronic migraine is classified as a headache occurring 15 days or more per month for three months on which at least eight days per month have the features of migraine, while episodic migraine can be classified as headaches occurring less than the above.

Multiple factors have been considered for their potential contribution in the progression from episodic to chronic migraine. A review of literature documented strong evidence for 10 or more headache days per month, moderate evidence for depression and five or more headache days per month and low quality evidence for medication overuse and allodynia (increased pain response) contributing to progression to chronic migraine.

Importantly, given the limited data and low quality research in the area, the researchers called for confirmation of these findings and further consideration of other possible risk factors with future studies.

7. Social media can help migraine management

Technology, specifically communication and information via the internet and social media, has bolstered how migraine is diagnosed and managed.

Reviewing social media allows for instant news and accessible insight from migraine advocates, patients and professionals, and organisations. The simple act of following a migraine association on Twitter or Facebook allows for open and frank discussion with migraineurs with similar experiences. A recent qualitative study of 20 migraineurs has reported that social media in migraine can be used to validate the illness experience, reduce feelings of isolation and provide reassurance.

The caveat to the benefit of social media is that it is unregulated, allowing opinions on a drug, healthcare professionals or organisations to be construed as statements of fact. Limited research has investigated possible factors impacting migraineurs like social comparison, self-esteem or mood.

8. Research on triggers is ongoing

Most people report experiencing at least one trigger in migraine, but what triggers for one may not for another. Take caffeine, for example. A recent prospective study of 98 participants suggested three or more servings could be associated with increased odds of having a migraine. While other research has considered the possibility that smaller levels of caffeine act as a preventative measure for migraine.

The most exhaustive review to date of 85 studies including 27,122 participants and 420 unique triggers, found stress was the most commonly reported trigger for all types of primary headache disorder (ie migraine, tension-type headache, etc). Stress was followed by sleep, emotions, weather, visual and hormonal triggers.

9. Psychology can help with migraine management

Given that the highest reported triggers for headache disorders were stress, sleep and emotions, psychological input with some migraineurs could be merited.

There is limited research to definitively support psychological interventions in reducing migraine frequency. However, a case can be made for psychology helping people manage migraine. For instance, maintaining a diary for three months or more can take effort for anyone in the normal chaos of life. To face up to the stimulus that may be causing them pain, distress or even disability takes daily flexibility or fortitude whatever the preference.

Belfast Telegraph