Migraine Treatment

• Migraine is a common cause of headache, affecting around 1 in 5 Australians
• But it’s more than just a headache- there are particular criteria needed to make the diagnosis, so it’s important to see a doctor to be certain
• Common symptoms include a recurring severe throbbing headache that lasts between 4 and 72 hours. It tends to involve one side of the head (though it can involve the entire head) and is often made worse by movement or routine daily activities. Nausea, vomiting, and an aversion to light (photophobia) or sound (phonophobia) are common symptoms, and some people also get an “aura” before the headache starts
• Migrainous headaches may vary in severity, frequency and can have a major impact on daily life

• The cause is not entirely clear.
• However, a common theory is that blood vessels in parts of the brain become narrower (go into spasm) which causes the aura.
• The blood vessels are then thought to open wide (dilate) soon afterwards, which accounts for the headache.
• There may also be a genetic factor involved as it often occurs in several members of the same family.

• The diagnosis is usually made by a doctor on the basis of typical symptoms and clinical examination.
• There are no specific tests
• Further investigations such as a brain scan and blood tests may be organised to rule out other causes.
• The diagnostic criteria for classical migraine are:
  • (A) at least 5 attacks must have occurred over time, fulfilling B-D below
  • (B) attacks last 4 to 72 hours (this includes episodes treated with medication or untreated)
  • (C) Headaches have at least two of the following features:
    • involve one side of the head
    • pulsing or throbbing
    • moderate to severe pain
    • headache is worsened by routine physical activity
  • (D) at least one of the following symptoms comes with the headache
    • nausea and/or vomiting
    • sensitivity to light (photophobia) or sensitivity to noise (phonophobia)
  • (E) no other cause can be found for the headache
• The diagnostic criteria are a little different for other types- e.g if there is an aura,  or the rarer Basilar, Hemiplegic and Ocular forms.

It’s not always possible to identify a trigger, but the following things may cause migrainous headaches in some people:

• Dietary factors- cheese, chocolate, red wine, citrus fruits, and foods containing an additive called tyramine.
• Excessive dieting.
• Psychological factors- stress/anxiety, depression and sleep disturbances.
• Environmental triggers- bright lights, loud noises or strong smells.
• Medications- for example HRT and the contraceptive pill.
• Menstruation and the menopause.

• Aside from avoiding triggers,  sufferers may get relief from medications such as painkillers and triptans.
• However, if attacks are happening several times a month, a daily preventive medication may be recommended by your doctor.

Yes, there are various types, which have typical symptoms:

• Migraine without aura- ‘common migraine’

The most common type consists of a severe throbbing one-sided headache. There may be associated symptoms of nausea, vomiting, light sensitivity and blurred vision.

• Migraine with aura- also called ‘classical migraine’

Similar to a common Migraine but the headache is accompanied by an aura which occurs up to 60 minutes before the headache.

• Menstrual Migraine

This may occur with or without aura, and is associated with menstruation

• Abdominal Migraine

This usually occurs in children and consists of recurrent abdominal pain in children who may or may not have an associated headache. Commonly, children who have Abdominal Migraine go on to develop migraine in their teenage years.

• Hemiplegic Migraine

This is associated with weakness in the arm and leg on one side of the body. It may look very similar to a stroke- so if it happens for the first time, or the diagnosis is not certain, immediate medical attention should be sought.

• Ocular Migraine

This causes temporary loss of all or part of the vision in one eye with or without the presence of a headache. You should call an ambulance if you get a sudden loss of vision (particularly if it occurs for the first time) as there are various serious conditions that need to be ruled out.

• Basilar Migraine

This is rare-symptoms include headache at the back of the head with associated visual disturbance, dizziness, loss of balance, jerky eye movements, trouble hearing and slurred speech

You should call an ambulance if you get these symptoms as there are various serious conditions that need to be ruled out.

• Sensitivity to light (photophobia)
• Nausea or vomiting
• Sensitivity to sounds (phonophobia)
• Aura – this is a group of symptoms that may happen before a migrainous headache/attack.
• Common aura symptoms may include:
  • Visual disturbances such as zig zag lines, flashing lights, shimmering or flickering spots, or even blind spots.
  • Sensory disturbances such as olfactory hallucinations (experiencing a smell that isn’t there); numbness affecting the face, arms or legs; rarely weakness down one side of the body or speech disturbances. Anyone who experiences these symptoms for the first time should seek emergency medical attention as it could be a stroke.

An attack may consist of defined phases:

1. A warning or prodromal phase may occur – there may be sensations or signs that a migraine is about to happen. Changes in mood and appetite may occur, as well as nausea, fatigue, yawning, difficulty finding words, diarrhoea or constipation.
2. About 20-30% of people may experience an aura. The most common aura symptoms are visual disturbances such as bright zigzag lines, blind spots that may move or gradually expand, flashing lights.  Aura affects vision in both eyes (though it may seem to affect one only) and can last from 5 to 60 minutes.  Less commonly, an aura can affect sensation in the face or limbs, or speech. 
3. A headache phase.
4. A resolution phase as the headache gradually fades.

Migrainous headaches are usually severe and throbbing. They tend to involve one side of the head (though not always) and last between 4 and 72 hours. They are often worsened by movement or routine physical activity.

Using pain relief or triptans too often may cause medication overuse headache.

If you take pain relief or triptans on most days, this may be a factor in your headaches and you should see your doctor for further assessment.  

Further useful information can be obtained at

•  headacheaustralia.org.au
• healthdirect.gov.au