The Most Common Questions People Ask About Their Migraine

causes of migraine migraine attacks migraine relief migraine specialist migraine treatment Dec 10, 2021

If you are experiencing migraine attacks, then you know how debilitating they can be. That's why it's essential to work with a knowledgeable team about diagnosing and treating migraine headaches.

It's also important to know that you are not alone. There are many support networks out there for you, including the team here at Melbourne Headache Solutions.

This blog post will answer the most common questions that people ask about their migraine condition.

What exactly is a Migraine?

Migraine is a neurological condition affecting the brain, but it can cause symptoms throughout the entire body that can range from severe head pain, nausea and vomiting to temporary paralysis of parts of the body.

A migraine is classically described as an intense, throbbing headache usually on one side of the head accompanied by nausea and sensitivity to light or sound. However, there can be a huge range of symptoms, and no two people’s migraine are the same.

Migraine symptoms can last from hours up to days and make it difficult for those who experience them to enjoy life fully. Two-thirds of people living with migraine are unable to work during a migraine attack because they're too debilitated.

The symptoms that people may get can range dramatically, and often these symptoms are misdiagnosed. For example, migraine symptoms can be mistaken for a sinus infection because of the pressure accompanying a migraine. A combination of misdiagnosis and delayed diagnosis means that it's often several years before people get a correct diagnosis and the right type of help.

What Causes Migraine?

It is now widely accepted that the underlying cause of migraine is a hyperactive or sensitised brainstem. The brainstem is part of the central nervous system that connects the brain to the spinal cord, and it is housed in the upper part of the neck. It directly connects to the trigeminal nerve, which is the nerve responsible for producing the pain associated with a migraine attack.

How does the brainstem become sensitised?

The brainstem is a crucial part of the central nervous system that acts as a relay station. Numerous pieces of the nervous system converge to allow communication between all the different parts of the body in the brain. For example, the trigeminal nerve joins with the nerves from the upper part of the neck in the brainstem. We call this the trigeminocervical nucleus (TCN). The TCN is what we call the migraine hub, as this is the starting point of the trigeminal nerve. The trigeminal nerve is responsible for pain sensation in the head and the face.

This is where a great deal of research has been undertaken over the past decade, and we know that the following are the significant factors of feeding to sensitise brainstem:

The upper part of the neck has direct nerve connections into the migraine hub / TCN
Stress, depression and anxiety activate pathways that feed into the brain stem
Food sensitivities and intolerances can cause widespread neuroinflammation (sometimes the only symptoms from this is migraine)
Nutritional deficiencies ( magnesium coenzyme Q10 and vitamin B's are all highly correlated to migraine and can sensitise the brainstem)
Sleep disturbances
The jaw and other chronic pain syndromes
Hormones imbalances
Electrolyte imbalances

Migraine is a complex disorder, which means it is likely that you have several of the above factors occurring, and this is why it can be so challenging to get on top of. Many people attempt to self diagnose what is causing their migraine and often they are on the right track, but unfortunately, it's only a piece of the puzzle that they are working on.

Essentially people get stuck on finding the one thing that is causing it when in reality it is several. So often, they only get a small amount of relief from making one change and because it doesn't solve the problem, they move on to the next thing.

What works best is that you need to identify all the factors that combine to cause your brain stem to become sensitised and address them all in a coordinated fashion. This can be tricky to work out on your own - even doctors can have trouble with this.

How is Migraine Diagnosed?

Migraine is typically diagnosed by a doctor based on an individual's headache history. Sometimes they also use tests such as MRI that look for other conditions which may cause similar headaches. In these cases, he/she will rule out some underlying causes of migraines before making any diagnosis of a chronic disease like epilepsy or stroke.

Migraine care starts with a detailed history of the patient's symptoms, including:

when migraines appear and how often they happen;
when they first started;
triggers; and
general health and lifestyle questions such as diet, stress and other medical issues.

The diagnosis of migraine is a clinical diagnosis, meaning it is based on characteristics rather than any specific tests, scans, or biomarkers.

At least five episodes lasting four to 72 hours that include at least one of the following:

Nausea and/or vomiting
Photophobia (light sensitivity)
Phonophobia (noise sensitivity)
Head pain with at least two of these characteristics:
Unilateral location (occurring on only one side)
Pulsating quality
At least moderate in severity
Aggravated by routine physical activity

Migraine can be diagnosed without a headache. The most common type of migraine is a migraine with a headache. However, those who never experience pain could still have other symptoms, such as an aura (sensory disturbances before or after the migraine begins).

There's also a question over the unilateral (one-sided) headache. Many patients with migraine - maybe even most - start out with one-sided pain, but the headache ends up on both sides of their head. The difficulty in getting an accurate diagnosis of migraine is that it is based on your symptoms. The symptoms you have can vary dramatically and can mimic other medical conditions.

When experiencing a migraine attack, the severity of pain can vary. It often occurs in the form of pressure or pressing pain rather than pulsations as classically described. The symptoms can also change over time.

This means that often the diagnosis is delayed - often up to 5 years. The longer it takes to properly diagnosed, the harder it becomes to treat. Therefore it's essential to see a headache expert to be correctly diagnosed and a management plan set up for your particular case.

Should I keep a headache diary?

It's hard to keep track of your headaches when you are living with migraine attacks. To help diagnose and manage your condition, we recommend keeping a migraine diary. This will allow you to follow how well treatments work and see what triggers a headache. It also helps note any patterns or changes that might be happening within your body so that we can find out why you're getting these symptoms. I would also recommend keeping a food diary at the same time to assess potential food sensitivities or nutritional deficiencies that have a strong correlation with migraine.

Recording details of your migraine attacks or headache can be useful. It can help:

your doctor make a diagnosis
you recognise triggers and warning signs
assess whether your acute or preventive medication is working
show any patterns to attacks.

A headache diary can include information on a range of things. However, it's often best to keep it simple and record basic information. This can include:

Date, day of the week
How long the attack lasted
How bad the attack was. This can either be recorded as mild, moderate or severe or on a scale of 0-10.
Other symptoms that you get alongside the headache such as dizziness, vertigo, sensitivity to light, sound, smells or any symptoms that affect your movement (e.g. numbness).
The medication you take, including if you take a second dose, and any side effects.
What has occurred in the past 48 hours that may be a trigger, such as stressful events, foods that you have eaten, and your menstrual cycle.

What Doctor Should I See to Receive an Official Diagnosis?

Ideally, your regular GP should be your first port of call. It's important to rule out any other condition that might be causing your symptoms, as, on very rare occasions, the symptoms can be caused by a serious medical disorder such as a tumour. They can also recommend acute medication, which is important to help control symptoms when they arise.

Unfortunately, once they have their diagnosis of migraine and acute pain relief, many patients do not investigate further why the migraine attacks are occurring. This means that nothing is done to prevent the next migraine attack from coming. The condition's underlying cause is still there, and too many people migraine episodes will continue to occur. For some people, the episodes are infrequent, say two or three times per year. This management strategy is ok; however, some people continue to get migraine episodes weekly or monthly, which significantly impacts their lives.

It would help if you worked with a practitioner who has experience in helping people with migraine identify everything that is combining to make your brain stem sensitised. Most people miss this step and end up relying on medication. As they are not targeting the underlying cause of their migraine, they end up living with migraine for decades. It generally becomes worse over time and harder to treat the longer that the symptoms are there.

Are There Tests for Migraine?

The simple answer is: NO. Research is looking for specific patterns of brain structure and function that are diagnostic of migraine. However, we don't have any tests or scans that will reliably diagnose migraine at this stage. Also, because there are many different causes of migraine, there cannot be a single test.

However, like many health conditions, taking a careful medical history and performing a physical examination by a headache/migraine expert is all that is needed to reach a diagnosis of migraine.

However, a migraine diagnosis by itself is not enough. You must be able to understand what is causing the migraine to occur so you can address each of these factors to minimise the chance that you were suffering from future attacks of migraine.

At Melbourne Headache Solutions, we have a systematic approach to assessing migraine patients to identify all the factors that might be contributing to your migraine.

Essentially we become your migraine detective. Often people try to do this themselves, but with so many different causes and symptoms, it becomes challenging to do it on your own. Expert guidance can mean the difference between ongoing chronic migraines and remission.

Why do you get other strange symptoms such as sensitivity to bright lights, sounds and nausea?

Most migraine patients describe low-intensity light as "glaring" or "painful" during a migraine attack, making photophobia one of the cardinal diagnostic criteria.

This all has to do with the hypersensitivity of the brain. Everyone receives the same light input via their eyes into their brain. However, a person with migraine has a more sensitised brain, so the same amount of light can produce intense pain or trigger a migraine attack. This process is mediated again by the trigeminal nerve, which supplies sensory nerve fibres to the eye.

It may also be affected by another part of the brain - the hypothalamus. The hypothalamus is an essential regulatory part of the brain that controls homeostasis (this means maintaining optimal function of your internal body). The hypothalamus is involved in different daily activities like eating or drinking, controlling the body's temperature and energy maintenance, and in the process of memorising and in stress control.

Several clinical features point towards the hypothalamus as being responsible for at least part of the migraine, especially the prodrome ( before the classic migraine symptoms such as yawning, tiredness and mood changes, and the association of attacks with the menstrual cycle.

Nausea is often associated with migraine. There is a direct connection between the brain and the stomach via the vagus nerve, allowing the brain and the stomach to talk to each other in real-time 24/7.

The migraine hub and the vagus nerve are connected in the brainstem. Hence, it makes sense that any problem in the brain can affect the gut ( just think about what stress does to your stomach).

And also the other way around- for some people, gut issues are the start of their migraine problems. A strong Body of Evidence links the gut to many brain conditions such as migraine Alzheimer's, and psychological conditions such as depression and anxiety.

During a migraine attack, the digestive system actually slows down significantly. Doctors refer to this as gastric stasis or delayed stomach emptying. The undigested food that waits in the stomach is most likely a cause of nausea and vomiting during an attack. Sometimes the digestive system slows in the intestines, too, leading to constipation.

Migraine induced nausea can be just as disabling as the head pain itself and sometimes even more so. Treating the symptoms of an attack, either over the counter or with prescriptions, can help lessen the burden of migraine.

Ginger has been used to aid digestion and calm the stomach for centuries. It can be brewed in tea and is a great alternative to plain water, coffee or tea for people with migraine. It has been proven to be very effective for helping nausea and is highly recommended to be part of your daily routine, not just when you are experiencing nausea.

What is the link between migraine and hormones?

In most cases, it is oestrogen that is most responsible for triggering migraine pain and headaches. Before your period, you get a drop in your oestrogen, which is standard for all women who have their period. In people without migraine, this goes unnoticed. However, if you are vulnerable to migraine, then this may be enough to trigger a migraine.

For many women, their hormones are an obvious trigger, and they either think nothing can be done or try to manipulate their hormones with medication such as OCP. Occasionally this works, but other times it makes it worse as this is the REAL underlying cause.

Some women may have an imbalance in their oestrogen and progesterone levels which is called oestrogen dominance. The term "oestrogen dominance" is an oversimplification of a complicated balance between the female sex hormones but is commonly used to describe the imbalance. Sometimes there is too much oestrogen due to diet, stress, or excess xenoestrogens.

Xenoestrogens are endocrine disruptors, which are chemicals that alter the normal function of hormones. Common sources of xenoestrogens are food, plastic, skincare products, building supplies, pesticides, alcohol and contraceptives.

If you have a migraine that typically occurs around your period, often there will be other symptoms of oestrogen dominance such as severe PMS symptoms ( abdominal/pelvic pain, breast tenderness, bloating, anxiety, depression, digestive issues, palpitations, food cravings, irregular bleeding, and weight gain). These symptoms may all be linked to your migraine and can give you clues about what you need to do to get on top of your migraines.

What's the Best Treatment for Migraine?

The best migraine treatment ultimately depends on the underlying factors that are contributing to your migraine. This will be different for everybody. It is essential to have a comprehensive understanding of these underlying factors so you are best placed to address them. Most people simply have a medical diagnosis of migraine without a clear understanding of the underlying factors, so many people end up suffering for decades relying on medication.

Taking the time to understand what day is underlying factors is truly the key to finding the proper treatment for your particular migraine. Medication has its place, but it is unlikely to solve your migraine condition by itself.

For acute pain relief during a migraine attack, common migraine medication can be quite effective in the early days. They will help reduce the symptoms associated with migraine. They range from over-the-counter painkillers to migraine-specific prescriptions.

Headache Australia has some great information regarding migraine medications, and your GP or neurologist is best placed to make recommendations for medical management of migraine.

Taking a holistic approach to managing your migraine attacks is recommended. This means that you can use medication for your acute symptom relief but also look at addressing your migraine's underlying causes. The people that adopt this strategy suffer substantially fewer migraine episodes, and if they do occur, the impact is significantly less. Many people find that lifestyle changes put migraine into remission and improve many other aspects of health, including having more energy losing weight and better mood.

As a general rule, people with migraine should investigate the following as a starting point. This list is by no means comprehensive, as migraine can be very complex.

However, it is very difficult to achieve a great outcome without addressing these factors:

stress management strategies and coping with anxiety and depression
a good sleep routine
identifying any food sensitivities or gut issues
ensuring a healthy diet composed primarily of plants and healthy fats, And eliminating processed foods
supplementation with magnesium vitamin B and coenzyme Q10
movement everyday
seeing a headache expert to assess if the neck is contributing to your migraines

These are simple things that can be incredibly powerful to improve the health of your nervous system and reduce the impact of migraine. Some people will need more detailed advice and treatments, but unless you cover the basics of good brain health, additional treatments will not be as effective.

At Melbourne Headache Solutions, we take a holistic approach to help you manage your migraines more effectively. Our role is to identify the underlying causes of your migraine and give you the right advice to save you from guessing what you have to do.

Sometimes, success simply comes down to having 100% clarity on precisely what you need to do in a step-by-step fashion.