What I learnt from a headache specialist

The New Zealand Pain Society is an organisation that promotes education and training in all areas of pain management and research. It regularly organises webinars for members, and on 10 August 2023 hosted Migraine Foundation Aotearoa New Zealand (MFANZ) to present an “Update on migraine and its management and survey insights on living with migraine in Aotearoa New Zealand.”

Dr Rosamund Hill, neurologist and headache specialist and member of MFANZ’s clinical advisory group, presented on migraine and its treatment, and Dr Fiona Imlach, one of MFANZ’s cofounders, presented results from the 2022 Migraine in Aotearoa New Zealand Survey, highlighting the impacts of migraine on people in NZ and difficulties in accessing appropriate migraine healthcare.

Many of us who live with migraine know a lot about the disease, but there’s always more to learn. Hearing from a specialist, who sees people with migraine every day and is immersed in the literature about what works, is like taking a geologist to Gemstone Beach – they can immediately pick out the precious stones from the rock and sand.

Some of the gems from this talk

  • Migraine is a disease where the brain has a sensitivity to certain stimuli that is genetically inherited.

  • The hunt for migraine triggers, especially external triggers such as food, is usually fruitless. This is because many so-called triggers may actually be manifestations of the brain activation early in a migraine attack. For example, during the migraine prodrome, there may be a craving for chocolate or sugar, which is then thought to have triggered an attack, but the craving was actually a part of the attack.

  • However, hormonal changes are known to be associated with migraine attacks and suppression of ovulation in women can be a useful migraine treatment.

  • According to a meta-analysis in 2021, nearly half of COVID-19 survivors had headache at initial infection, persisting in 8-15% in the subsequent 6 months. COVID-19 headache is often diffuse and oppressive but may have migrainous features.

  • It’s a common fallacy that you have to have aura to have a diagnosis of migraine – in fact, only 20–30% of people with migraine experience aura.

  • Both Epilim (sodium valproate) and Topamax (topiramate) are not advisable to use in women of child-bearing potential.

  • Botox™ can be effective for 50–70% of people with chronic migraine (headache on 15 days or more a month) but there’s limited access to this in the public health system.

  • Triptans work for about 80% of people with migraine so new medicines like the gepants are needed to give people other options for treating acute attacks.

  • The risk of serotonin syndrome by combining a triptan with certain antidepressants (e.g. fluoxetine, paroxetine, venlafaxine) is very low and antidepressant use is not a contraindication to triptan use.

For the opportunity to hear and ask questions of a headache specialist and a pain specialist, come along to our Auckland event on 16 August. Tickets on sale here: https://www.eventfinda.co.nz/2023/talking-migraine/auckland/epsom