Migraine Management

Migraines

Migraines are a common neurovascular condition which can be distressing and lead to disabling symptoms and extensive reductions in quality of life, reduced social activities and work capacity. If diagnosed and treated by a health professional symptoms and medication intake can be reduced and quality of life and sense of control can be improved.

What are the symptoms?

Although not all migraines are the same, typical symptoms include:
•Moderate to severe pain, usually on one side of the head, but switching in successive migraines
•Lasting between 4 and 72 hours
•Pulsing and throbbing head pain
•Aggravated by movement
•Inability to perform regular activities
•Nausea and vomiting
•Increased sensitivity to light and sound

Other symptoms that may be experienced include:
•Visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots
•Tingling, pins and needles or numbness or even one-sided limb weakness
•Impairment of speech or  verbal understanding
•Difficulty in concentrating, confusion
•Sensitivity to smell
•Diarrhoea

What is the cause?

The exact mechanism of migraines is unknown however, they are generally thought to be caused by a combination of blood vessel enlargement and the release of chemicals from surrounding nerves which leads to inflammation, pain and further expansion of the cranial arteries.

How do you diagnose it?

Migraines can be diagnosed by a neurologist or other trained health professional through general health assessment and review of the above symptoms. The International Headache Society uses the following criteria to diagnose migraines without aura:
•5 or more attacks
•4 hours to 3 days in duration
•At least 2 of unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of routine physical activity
•At least 1 additional symptom such as nausea, vomiting, sensitivity to light, sensitivity to sound.

Can they be treated?

Medical (speak with your GP or neurologist)
•Medications can be taken once the pain has begun (abortive therapies) and others can be taken on a daily basis to reduce the frequency of attacks (preventative therapies)
•Simple analgesics (e.g. paracetamol), stronger narcotic-type analgesics (e.g. oxycodone) and non-steroidal anti-inflammatory medications can be used to reduce the pain
•Anti-emetics may also be taken to control symptoms such as nausea and vomiting

Behavioural
•Keeping a headache diary-Increases your understanding of headache patterns and triggers
•Trigger identification-Identifies what sets off and makes your headaches worse
•Functional assessment-Identifies why you in particular have experienced headaches, why they started when they did and what keeps  them going
•Relaxation, mindfulness and visualisation-reducing your physiological arousal from stress and anxiety
•Cognitive behavioural restructuring-Identifying unhelpful thoughts linked to distressing emotions and developing more helpful thoughts
•Exposure and/ or avoidance of headache triggers-Increasing tolerance to headache triggers or reducing dehydration, establishing a regular sleep routine, reducing alcohol consumption
•Stress and anxiety management-developing coping plans to manage stressful situations and behavioural experiments to overcome situational fears
•Depression management-Increasing activities to improve mood
•Lifestyle modification-Establishing regular exercise regimes and developing hobbies and interests
•Conflict resolution skills-Developing assertive communication skills
•Anger management-Coping with anger provoking situations

Prognosis

Migraines most commonly occur in the 20s and 30s, and tend to decline after the age of 40.  Migraine frequency, intensity and duration can be reduced through the right care and treatment. Behavioural treatments can reduce the amount and frequency of medication used.

Referral

At Active Health Clinic we have a Health Psychologist Dr Moira Callan who has considerable experience in working with the behavioural Migraine management and Tension-type headaches.  She is a treating clinician in the ‘Behavioural management of the triggers of recurrent headache: Avoidance versus coping’ research project being undertaken at Monash University. Moira is a registered Medicare and Workcover Psychologist with significant experience in Cognitive Behavioural Therapy (CBT) and Acceptance Commitment Therapy (ACT) with adolescents and adults. She has a long standing interest and experience in working with clients who have ‘invisible’ conditions such as chronic pain, recurrent headaches and migraines and chronic fatigue syndrome.

For more information or to make an appointment with Moira, please call 0435 794 772 or email: moira@activehealthclinic.com.au.