Migraine basics
Migraine disease is a disabling, neurological condition
It’s one of the leading causes of disability in the world and affects 2–3 times as many women as men. In New Zealand, approximately 642,000 people live with migraine disease.
Migraine is more than just a headache. A migraine attack is a complex neurological event that involves different parts of the brain, leading to a range of symptoms. These include nausea and vomiting, fatigue, dizziness, speech difficulties, visual disturbances, neck and shoulder pain, numbness and tingling of your face or limbs, skin sensitivity, sensitivity to light and sound, brain fog and more.
Migraine attacks usually last for between two hours and three days. Some symptoms may start about 24 hours before you get head pain, and end about 24 hours after you stop having head pain. One migraine attack may look and feel very different to another, both for the same person and between different people with migraine.
Types of migraine
Migraine is a spectrum disorder and affects everyone differently. A key feature of migraine that’s used to classify the disease is the number of days a month in which a headache occurs, for any part of the day.
The frequency of headache days a month defines episodic and chronic migraine types. Migraine can also be classified by the symptoms people experience during an attack.
Migraine phases
There are four phases of a migraine attack: prodrome, aura, headache and postdrome. Not everyone experiences each phase.
For those with chronic migraine, these phases can blur into each other and you may experience some kind of migraine symptom most or every day.
Recording the number of ‘crystal-clear days’ (days with no migraine symptoms at all), as well as the number of headache days you have each month, can be useful measures of the impact of migraine on your life.
Learn about the different phases of migraine.
Migraine triggers
While the exact cause of migraine attacks remains the subject of ongoing research, it’s widely accepted that certain triggers can set them off.
Both internal and external factors can cause migraine attacks, such as hormonal fluctuations in women around menstruation, pregnancy and menopause, fasting, sleep disturbances, weather changes and alcohol. Some factors which are commonly thought to be triggers, such as certain foods, flickering lights or strong smells, are more likely to be part of the prodromal phase of migraine.
It can be difficult to identify what causes a migraine attack, particularly when attacks are caused by a combination of different factors. In many instances, the cause of an individual attack is unknown.
Understanding migraine triggers is important for both people with migraine disease and the health professionals who treat them.
Managing known triggers such as hormonal changes, stress and sleep is part of the management of migraine disease. However, focusing on avoiding triggers isn’t always recommended, because some supposed triggers are not actually causing migraine attacks, some triggers can’t be avoided and paying too much attention to triggers can increase anxiety, fear and guilt to the extent that it impacts quality of life.
Learn more about migraine triggers below.
Medication options
Pain relief medications, anti-nausea drugs and triptans, a family of medications specifically designed to treat migraine, can be used during an attack.
Preventive medications can be taken every day to help minimise attacks. Examples include beta-blockers, some antidepressants, antiepileptics and medications for high blood pressure.
Migraine-specific preventive medications called calcitonin gene-related peptide (CGRP) monoclonal antibodies are taken less frequently, usually monthly. Access in Aotearoa is limited and they are not funded by Pharmac.
Botox injections can be an effective preventive treatment for chronic migraine but are not always available or funded.
For women with hormone-related migraine, treatment with oestrogen and progesterone or contraception that suppress ovulation may help prevent migraine attacks by preventing hormone fluctuations.
Some other options can be used when people end up in the emergency department with severe attacks that don’t respond to the usual medication or when vomiting means medications aren’t effective.
Non-medication options
Non-medication options for migraine include:
- supplements, such as magnesium, vitamin B2 (riboflavin) and co-enzyme Q10
- neuromodulation devices
- behavioural therapies like mindfulness, meditation, relaxation and biofeedback
- lifestyle changes including good sleep patterns, maintaining a regular routine and regular exercise, such as walking and yoga.
Learn more about migraine
Association of Migraine Disorders
What is migraine?
American Migraine Foundation
Migraine essentials
National Headache Foundation
Migraine 101
Migraine and Headache Australia
Migraine - a common and distressing disorder
The Migraine Trust
Types of migraine
The Migraine Trust
Stages of a migraine attack
Global Healthy Living Foundation
Stages of a migraine attack
Migraine Again
What is migraine? World-leading doctor answers your questions
Managing Your Migraine
Dr Katy Munro, National Migraine Centre, UK
Association of Migraine Disorders
What causes migraine disease?
