Migraines. They’re either a regular occurrence in your life or something you can’t quite get your head around.
But if you’re part of the 12 per cent of the population that regularly suffers symptoms of the neurological disease – that percentage rises to as high as 18 per cent for the female population in the US, according to the Migraine Research Foundation – you’ll know that migraines are not only very real, but they’re much more than simply a bad headache.
“A migraine is an idiopathic headache disorder, that is, it stems from an unknown cause. It is characterised by moderate to severe headache attacks that are often unilateral and pulsating. Migraines are aggravated by physical activity, and accompanied by symptoms such as nausea, vomiting, photophobia and phonophobia [sensitivity to light and noise, respectively],” explains Dr Anne Vehmas, consultant neurologist at Novomed Centres.
Despite their prevalence, there is yet to be a clear-cut cure for the condition, with mainstream western medicine primarily taking an abortive approach, easing symptoms as they arise with pharmaceuticals. But what preventive measures – old and new – are out there?
Diet and nutrition
Considering science hasn't pinned down the definitive root cause of migraines yet, it's no surprise a one-size-fits-all panacea hasn't been determined. What experts do know, however, is that “genetics and environment play a role”, says Dr Amin Abdullah, specialist in neurology at Medcare Hospital, Al Safa.
“Everyone has different triggers, but there are common culprits that affect large numbers of people; stress, good or bad, certain foods, skipping meals, alcohol, changes in weather or barometric pressure, and hormonal changes in women.”
For frequent sufferers, monitoring and pinpointing triggers is crucial, and diet is the easiest and most effective place to start. After doing the obvious things to look out for your health – cutting back on processed meals, opting for fresh nutritious foods – actively seeking certain nutrients and vitamins, and avoiding others, can make a substantial difference.
“Some foods can trigger migraine attacks, such as nitrites in meat, ethereal oils in citrus and spices, and chocolate,” says Vehmas. “People deficient in vitamins D, B2, Q10 and folate seem predisposed to migraine attacks. Avoiding these triggers is helpful.”
As for what you should be eating more of, increasing your intake of magnesium – found in dark leafy greens, black beans, lentils and mackerel – has been proven effective in the battle against migraines. The findings of a 1996 study, which demonstrated that regular consumption of the macromineral can reduce the frequency of the neurological condition by 41.6 per cent, remain unchallenged.
Biofeedback stress reduction
It's hard to think of many conditions that aren't improved by getting more sleep, which is certainly the case for migraines. But it turns out there's a Goldilocks effect when it comes to catching some Zs, as studies have demonstrated that oversleeping can be as triggering as undersleeping for the migraine-prone – reminding us just how much our bodies crave routine.
Fluctuations in cortisol levels, when moments of high stress are followed by periods of relaxation, can likewise prove damaging. But, as ever, prescribing a good night's sleep and a stress-free life is easier said than done. Instead, Vehmas says psychobiological treatments may help some migraine patients.
“Biofeedback [skin surface temperature manipulation] is one of the behavioural medicine techniques proven to reduce headaches and improve the quality of functioning,” states The American Migraine Foundation website.
Across the 25 years of researching and testing the practice, it has been found to reduce the frequency and severity of migraines by as much as 60 per cent. Currently, it is the most commonly used and widely accepted drug-free treatment.
During a “training session”, electrodes are attached to the skin's surface, which send signals to a monitor that can feedback heart and breathing rate, blood pressure, skin temperature and muscle activity – and how they change in stressful situations. With time and commitment to the training, patients can become aware of their own physiology, allowing them to self-regulate the mind-body connection to ultimately reduce migraine triggers.
Electrical and magnetic nerve stimulation
With migraines linked to the dysfunction of the sympathetic nervous system – the part that increases heart rate, blood pressure and breathing rate – one mode of attack by medical professionals is to target the system directly.
“Neurostimulation treatments have shown promising results to treat migraines,” says Vehmas. Of these, transcutaneous electrical nerve stimulation (Tens) and transcranial magnetic stimulation (TMS) are two of the most popular.
Tens employs low-voltage currents that can reduce pain by blocking the transmission of pain signals and raising endorphin levels. While the first Tens unit was made in 1974, the use of electric shocks to reduce pain dates back thousands of years, with the ancient Egyptians recognising the power of electrical catfish residing in the Nile.
More than ancient folklore, a 2018 paper evaluating the results from numerous studies in The Journal of Headache and Pain concluded that Tens resulted in a “significant reduction of monthly headache days and painkiller intake”.
TMS, meanwhile, applies magnetic pulses to targeted regions of the brain with the aim of forming new neural pathways, in turn regulating and boosting overall mood. Monitoring how effective this approach is in 2018, specialists from Mayo Clinic concluded: “Four pulses emitted from this device twice daily reduced the frequency of headache days by about three days per month, and 46 per cent of patients had at least 50 per cent or less migraine attacks per month on the treatment protocol.”
While the above tips and treatments have been in use for decades, acupuncture's history stretches back by about 3,000 years. The ancient Chinese practice has been called upon across millennia to heal several mental and physical ailments, including migraines. The alternative therapy involves inserting thin needles into the skin, which is said to balance energy levels.
Although there's been little explanation as to whether acupuncture pressure points and meridians exist in scientific terms, it hasn't stopped researchers from proving the practice can lessen the effects of migraines.
A 2016 review by the Cochrane Library database, which looked at 22 clinical trials with 4,985 participants, concluded that “there is evidence that acupuncture reduces the frequency of headache in individuals with migraine, and that the effect may be similar to that observed with preventive medications”. The combined data showed that the frequency of headaches decreased by 50 per cent to 60 per cent for those receiving acupuncture.
Medication and monoclonal antibodies
Those in the midst of a migraine attack are likely to opt for symptom-relieving treatments – of which simple analgesics (pain medication) and anti-emetic (anti-sickness) preparations are the go-to.
Yet only in extreme cases is preventive medication advised by specialists. “Preventative migraine medication should be used only if migraine attacks occur more often than several times a month,” advises Vehmas. Such drugs include candesartan and lisinopril that impact the renin-angiotensin hormonal system, beta blockers that reduce blood pressure and regulate heart rhythms, and tricyclic antidepressants, which impact neurotransmitter levels.
But what's the latest approach in the world of pharmaceuticals? “Monoclonal antibodies,” says Abdullah, explaining that the relatively new drug targets the calcitonin gene-related peptide that has been linked to migraine onset. Usually administrated with a monthly injection, monoclonal antibodies, studies by the American Academy of Neurology have shown, can decrease migraine days by 66 per cent each month.
Yet with Vehmas noting that “10 per cent to 20 per cent of the patients reported migraine attacks to stop entirely with biological medication”, it seems a one-size-fits-all cure might not be such a distant dream, after all.