The mystery of Migraines

Migraine can be one of the most crippling and overwhelming pains you will ever experience. The constant piercing sensation slowly overcoming your head, the full body aches and dizziness, the complete fatigue and exhaustion from sleepless nights. Migraine is not simply an extreme headache; it is a collection of symptoms (mostly neurological) that compile what is believed to be the sixth most disabling and third most prevalent disease in the world1.

What is a migraine?

There are many theories about what actually happens in the body during migraine. These at present, include a combination of the following1-4;

  • Narrowing and/or widening of the blood vessels around the brain and head
  • Calcitonin Gene-Related Peptide (CGRP) and Substance P (SP) are both vasodilators that have been strongly identified with the presence of migraines
  • Dysfunction of the ion channels in the brain (ion channels help determine what substances enter a cell, or not)
  • Inflammation

Migraine symptoms

Generally lasting anywhere from four to 72 hours (or even longer in extreme cases), migraine sufferers experience an array of associated symptoms greatly impacting their quality of life and ability to function at a normal level. These symptoms can typically include1-4;

  • Throbbing headache
  • Nausea + vomiting
  • Sensitivity to light, sound and/or smell
  • Generally unilateral (one-sided) in presentation, though one third of sufferers experience bilateral (both sided) symptoms
  • Often worse on exertion
  • Poor concentration, clumsiness, troubles with balance
  • Localised weakness, numbness, tingling
  • Scalp tenderness
  • Blurred vision

Depending on the individual, these symptoms can come and go seemingly randomly, and for chronic sufferers, migraines can occur most days.

Migraine causes

A number of factors including family history/genetic predisposition, hormonal influences (particularly oestrogen fluctuations), stress and dietary precipitants have all been closely linked with the condition. On a lesser scale, dysfunction of the tempero-mandibular joint (where your jaw attaches to you skull), inadequate or excessive sleep, weather changes and neck pain/trauma have also been acknowledged as triggering factors for migraine sufferers 2, 4.

“Migraine is a moving target: symptoms can change from one attack to the next, and many sufferers have more than one type.” – Migraine Research Foundation.

As a result of this uncertainty, it is difficult to develop effective preventative treatment.

Possible migraine treatments

1. Lifestyle

Currently, the most common prescription or advice for migraine sufferers is focused around the identification and removal of individual triggers. Whether these are dietary causes, lifestyle factors, stress or sleeping patterns; finding factors that influence your migraines can be a crucial step in improving the recurrence of ‘attacks’ and your overall quality of life.

Keeping a ‘migraine journal’ is a really simple way to start tracking your symptoms. It can sometimes feel as though your episodes are completely random but you may be surprised at patterns that emerge.

 2. Acupuncture

A 2017 Comparative Literature Review found acupuncture has had a positive effect on migraine and is the most “safe and cost-effective” means of treatment with long-lasting effects5, 6. Acupuncture has been found to reduce frequency, intensity and associated symptoms of migraine and the side effects are minor, if any.

Numerous studies have demonstrated acupuncture to effectively influence the anti-inflammatory pathways of the body7 and it is this influence on the relevant mediators, receptors and signaling pathways that is thought to elicit change in migraine sufferers5. More specifically, acupuncture has been shown to down-regulate dominant vasodilators CGRP and SP, thus demonstrating evidence of positive effect in the treatment of migraine5.

It’s important to note here; like any form of treatment, or medication – acupuncture is dose dependent. The studies available at this stage, whist positive, outline that the minimum recommended course of acupuncture for migraine has been identified as six treatments in order to provoke positive effect6. Additionally, it has been highlighted that there is a “larger effect size when 16 or more treatments (are) given compared to 12 treatments or less”5.

3. Medication

Unfortunately due to the poor understanding of migraine, prescribing the correct medication for sufferers can prove difficult with many opting no medication at all as the side effects can be more unbearable than the migraine itself. Recently, in the US, a migraine specific intervention has been developed that targets the vasodilator CGRP. The challenge is that “none of the new CGRP drugs prevent all migraine attacks, and not everyone responds to these drugs”1. Whilst still under medical review in Australia, the drug would involve a monthly injection and without Pharmaceutical Benefits Scheme support, is predicted to be beyond the affordability of the average migraine patient.

Do you suffer from migraines? Have you tried any of the following?

+ Keep a migraine journal

+ Endeavour to identify YOUR triggers

+ Monitor sleep patterns; aim for a regular routine and seven to nine hours per night

+ Acupuncture + Chinese Medicine; remember adequate dose is important!

The effects of migraine are debilitating and it’s essential to ensure accurate diagnosis. If your symptoms are unchanging it’s always important to get checked by your GP. Perhaps most severe includes the exclusion of possible tumors/structural disorders of the brain and focal epilepsy. In more sinister cases such as these X-Ray, CT, MRI and PET scans are used to confirm the correct diagnosis.

 

REFERENCES:

1 Migraine Research Foundation 2019, About migraine, (viewed January, 2019), https://migraineresearchfoundation.org/about-migraine/.

2 Beers, MH & Berkow, R 1999, The Merck manual of diagnosis and therapy, Merck Research Laboratories, USA.

3 Foroughipour, M, Golchian, AR, Kalkor, M, Akhlaghi, S, Farzadfard, MT & Azizi, H 2014, ‘A sham-controlled trial of acupuncture as an adjunct in migraine prophylaxis’, Acupunct. Med, vol. 32, pp. 12-16.

4 Colledge, NR, Walker, BR & Ralston, SH 2010, Davidson’s Principles & Practice of Medicine, 21st Ed. Churchill Livingstone, China.

5 McDonald, J. & Janz, S. 2017, The Acupuncture Evidence Project: A Comparative Literature Review.

6 Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, et al. ‘Acupuncture for the prevention of episodic migraine’. Cochrane Database Syst Rev. 2016 (6):Cd001218

7 McDonald JL, Cripps AW, Smith PK, Smith CA, Xue CC, Golianu B. ‘The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model.’ Evid Based Complement Alternat Med. 2013;2013:591796.

 

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