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What happens in my brain when I get a migraine? And what medications can I use to treat it?

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p>Migraine is many things, but one thing it’s not is “just a headache”.</p> <p>“Migraine” <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1029040/">comes from</a> the Greek word “hemicrania”, referring to the common experience of migraine being predominantly one-sided.</p> <p>Some people experience an “aura” preceding the headache phase – usually a visual or sensory experience that evolves over five to 60 minutes. Auras can also involve other domains such as language, smell and limb function.</p> <p>Migraine is a disease with a <a href="https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30322-3/fulltext">huge personal and societal impact</a>. Most people cannot function at their usual level during a migraine, and anticipation of the next attack can affect productivity, relationships and a person’s mental health.</p> <h2>What’s happening in my brain?</h2> <p>The biological basis of migraine is complex, and varies according to the phase of the migraine. Put simply:</p> <p>The earliest phase is called the <strong>prodrome</strong>. This is associated with activation of a part of the brain called the hypothalamus which is thought to contribute to many symptoms such as nausea, changes in appetite and blurred vision.</p> <figure class="align-center "><img src="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=1 600w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=2 1200w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=600&amp;h=485&amp;fit=crop&amp;dpr=3 1800w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=1 754w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=30&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=2 1508w, https://images.theconversation.com/files/608985/original/file-20240723-17-rgqc7v.jpg?ixlib=rb-4.1.0&amp;q=15&amp;auto=format&amp;w=754&amp;h=610&amp;fit=crop&amp;dpr=3 2262w" alt="" /><figcaption><span class="caption">The hypothalamus is shown here in red.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/brain-cross-section-showing-basal-ganglia-329843930">Blamb/Shutterstock</a></span></figcaption></figure> <p>Next is the <strong>aura phase</strong>, when a wave of neurochemical changes occur across the surface of the brain (the cortex) at a rate of 3–4 millimetres per minute. This explains how usually a person’s aura progresses over time. People often experience sensory disturbances such as flashes of light or tingling in their face or hands.</p> <p>In the <strong>headache phase</strong>, the trigeminal nerve system is activated. This gives sensation to one side of the face, head and upper neck, leading to release of proteins such as CGRP (calcitonin gene-related peptide). This causes inflammation and dilation of blood vessels, which is the basis for the severe throbbing pain associated with the headache.</p> <p>Finally, the <strong>postdromal phase</strong> occurs after the headache resolves and commonly involves changes in mood and energy.</p> <h2>What can you do about the acute attack?</h2> <p>A useful way to conceive of <a href="https://www.migraine.org.au/factsheets">migraine treatment</a> is to compare putting out campfires with bushfires. Medications are much more successful when applied at the earliest opportunity (the campfire). When the attack is fully evolved (into a bushfire), medications have a much more modest effect.</p> <p><iframe id="Pj1sC" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/Pj1sC/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe></p> <p><strong>Aspirin</strong></p> <p>For people with mild migraine, non-specific anti-inflammatory medications such as high-dose aspirin, or standard dose non-steroidal medications (NSAIDS) can be very helpful. Their effectiveness is often enhanced with the use of an anti-nausea medication.</p> <p><strong>Triptans</strong></p> <p>For moderate to severe attacks, the mainstay of treatment is a class of medications called “<a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1678146819/Factsheet_15_2023.pdf?1678146819">triptans</a>”. These act by reducing blood vessel dilation and reducing the release of inflammatory chemicals.</p> <p>Triptans vary by their route of administration (tablets, wafers, injections, nasal sprays) and by their time to onset and duration of action.</p> <p>The choice of a triptan depends on many factors including whether nausea and vomiting is prominent (consider a dissolving wafer or an injection) or patient tolerability (consider choosing one with a slower onset and offset of action).</p> <p>As triptans constrict blood vessels, they should be used with caution (or not used) in patients with known heart disease or previous stroke.</p> <p><strong>Gepants</strong></p> <p>Some medications that block or modulate the release of CGRP, which are used for migraine prevention (which we’ll discuss in more detail below), also have evidence of benefit in treating the acute attack. This class of medication is known as the “gepants”.</p> <p>Gepants come in the form of injectable proteins (monoclonal antibodies, used for migraine prevention) or as oral medication (for example, rimegepant) for the acute attack when a person has not responded adequately to previous trials of several triptans or is intolerant of them.</p> <p>They do not cause blood vessel constriction and can be used in patients with heart disease or previous stroke.</p> <p><strong>Ditans</strong></p> <p>Another class of medication, the “ditans” (for example, lasmiditan) have been approved overseas for the acute treatment of migraine. Ditans work through changing a form of serotonin receptor involved in the brain chemical changes associated with the acute attack.</p> <p>However, neither the gepants nor the ditans are available through the Pharmaceutical Benefits Scheme (PBS) for the acute attack, so users must pay out-of-pocket, at a <a href="https://www.migraine.org.au/cgrp#:%7E:text=While%20the%20price%20of%20Nurtec,%2D%24300%20per%208%20wafers.">cost</a> of approximately A$300 for eight wafers.</p> <h2>What about preventing migraines?</h2> <p>The first step is to see if <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043428/Factsheet_5_2023.pdf?1677043428">lifestyle changes</a> can reduce migraine frequency. This can include improving sleep habits, routine meal schedules, regular exercise, limiting caffeine intake and avoiding triggers such as stress or alcohol.</p> <p>Despite these efforts, many people continue to have frequent migraines that can’t be managed by acute therapies alone. The choice of when to start preventive treatment varies for each person and how inclined they are to taking regular medication. Those who suffer disabling symptoms or experience more than a few migraines a month <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1915327">benefit the most</a> from starting preventives.</p> <p>Almost all migraine <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">preventives</a> have existing roles in treating other medical conditions, and the physician would commonly recommend drugs that can also help manage any pre-existing conditions. First-line preventives include:</p> <ul> <li>tablets that lower blood pressure (candesartan, metoprolol, propranolol)</li> <li>antidepressants (amitriptyline, venlafaxine)</li> <li>anticonvulsants (sodium valproate, topiramate).</li> </ul> <p>Some people have none of these other conditions and can safely start medications for migraine prophylaxis alone.</p> <p>For all migraine preventives, a key principle is starting at a low dose and increasing gradually. This approach makes them more tolerable and it’s often several weeks or months until an effective dose (usually 2- to 3-times the starting dose) is reached.</p> <p>It is rare for noticeable benefits to be seen immediately, but with time these drugs <a href="https://pubmed.ncbi.nlm.nih.gov/26252585/">typically reduce</a> migraine frequency by 50% or more.</p> <hr /> <p><iframe id="jxajY" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/jxajY/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe></p> <hr /> <h2>‘Nothing works for me!’</h2> <p>In people who didn’t see any effect of (or couldn’t tolerate) first-line preventives, new medications have been available on the PBS since 2020. These medications <a href="https://pubmed.ncbi.nlm.nih.gov/8388188/">block</a> the action of CGRP.</p> <p>The most common PBS-listed <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1708566656/Factsheet_16_2024.pdf?1708566656">anti-CGRP medications</a> are injectable proteins called monoclonal antibodies (for example, galcanezumab and fremanezumab), and are self-administered by monthly injections.</p> <p>These drugs have quickly become a game-changer for those with intractable migraines. The convenience of these injectables contrast with botulinum toxin injections (also <a href="https://www.migraine.org.au/botox">effective</a> and PBS-listed for chronic migraine) which must be administered by a trained specialist.</p> <p>Up to half of adolescents and one-third of young adults are <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/147205/jan13818.pdf">needle-phobic</a>. If this includes you, tablet-form CGRP antagonists for migraine prevention are hopefully not far away.</p> <p>Data over the past five years <a href="https://pubmed.ncbi.nlm.nih.gov/36718044/">suggest</a> anti-CGRP medications are safe, effective and at least as well tolerated as traditional preventives.</p> <p>Nonetheless, these are used only after a number of cheaper and more readily available <a href="https://assets.nationbuilder.com/migraineaus/pages/595/attachments/original/1677043425/Factsheet_2_2023.pdf?1677043425">first-line treatments</a> (all which have decades of safety data) have failed, and this also a criterion for their use under the PBS.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227559/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/mark-slee-1343982">Mark Slee</a>, Associate Professor, Clinical Academic Neurologist, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a> and <a href="https://theconversation.com/profiles/anthony-khoo-1525617">Anthony Khoo</a>, Lecturer, <a href="https://theconversation.com/institutions/flinders-university-972">Flinders University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-my-brain-when-i-get-a-migraine-and-what-medications-can-i-use-to-treat-it-227559">original article</a>.</em></p> </div>

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Women get far more migraines than men – a neurologist explains why, and what brings relief

<p><em><a href="https://theconversation.com/profiles/danielle-wilhour-1337610">Danielle Wilhour</a>, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a></em></p> <p>A migraine is far <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/">more than just a headache</a> – it’s a debilitating disorder of the nervous system.</p> <p>People who have migraines experience severe throbbing or pulsating pain, typically on one side of the head. The pain is often accompanied by nausea, vomiting and <a href="https://theconversation.com/migraine-sufferers-have-treatment-choices-a-neurologist-explains-options-beyond-just-pain-medication-181348">extreme sensitivity to light or sound</a>. An attack may last for hours or days, and to ease the suffering, some people spend time isolated in dark, quiet rooms.</p> <p>About 800 million people worldwide <a href="https://doi.org/10.1001/jama.2021.21857">get migraine headaches</a>; in the U.S. alone, <a href="https://americanmigrainefoundation.org/resource-library/what-is-migraine/">about 39 million</a>, or approximately 12% of the population, have them regularly.</p> <p>And most of these people are women. More than <a href="https://www.npr.org/sections/health-shots/2012/04/16/150525391/why-women-suffer-more-migraines-than-men">three times as many women</a> as compared to men get migraines. For women ages 18 to 49, migraine is the leading <a href="https://doi.org/10.1186/s10194-020-01208-0">cause of disability throughout the world</a>.</p> <p>What’s more, research shows that women’s migraines are <a href="https://doi.org/10.1007/s10072-020-04643-8">more frequent, more disabling and longer-lasting</a> than men’s. Women are more likely than men to <a href="https://doi.org/10.1007/s10072-015-2156-7">seek medical care and prescription drugs</a> for migraines. And women who have migraines <a href="https://doi.org/10.1186/s10194-021-01281-z">tend to have more mental health issues</a>, including anxiety and depression.</p> <p><a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29586">As a board-certified neurologist</a> who specializes in headache medicine, I find the gender differences in migraines to be fascinating. And some of the reasons why these differences exist may surprise you.</p> <figure><iframe src="https://www.youtube.com/embed/lorXYK2OtAA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">A variety of medications and therapies offer relief for migraines.</span></figcaption></figure> <h2>Migraines and hormones</h2> <p>There are several factors behind why men and women experience migraine attacks differently. These include hormones, genetics, how certain genes are activated or deactivated – an <a href="https://www.psychologytoday.com/us/basics/epigenetics">area of study called epigenetics</a> – and the environment.</p> <p>All of these factors play a role in shaping the structure, function and adaptability of the brain when it comes to migraines. The hormones <a href="https://www.healthline.com/health/womens-health/estrogen-vs-progesterone#functions">estrogen and progesterone</a>, through different mechanisms, play a role in regulating many biological functions. They affect various chemicals in the brain and may contribute to <a href="https://doi.org/10.1093/brain/aws175">functional and structural differences</a> in specific brain regions that are involved in the development of migraines. Additionally, sex hormones can <a href="https://doi.org/10.1007/s10072-020-04643-8">quickly change the size of blood vessels</a>, which can predispose people to migraine attacks.</p> <p>During childhood, both boys and girls have an <a href="https://doi.org/10.1177/0333102409355601">equal chance of experiencing migraines</a>. It’s estimated that about <a href="https://www.ncbi.nlm.nih.gov/books/NBK557813/">10% of all children will have them</a> at some point. But when girls reach puberty, their likelihood of getting migraines increases.</p> <p>That’s due to the <a href="https://doi.org/10.3389/fmolb.2018.00073">fluctuating levels of sex hormones</a>, primarily <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/estrogens-effects-on-the-female-body">estrogen</a>, associated with puberty – although other hormones, including <a href="https://my.clevelandclinic.org/health/body/24562-progesterone">progesterone</a>, may be involved too.</p> <p>Some girls have their first migraine around the time <a href="https://doi.org/10.1002/jnr.23903">of their first menstrual cycle</a>. But migraines are often most common and intense <a href="https://doi.org/10.1136%2Fbmj.39559.675891.AD">during a woman’s reproductive and child-bearing years</a>.</p> <p>Researchers estimate about 50% to 60% of women with migraines <a href="https://americanmigrainefoundation.org/resource-library/menstrual-migraine-treatment-and-prevention/">experience menstrual migraines</a>. These migraines typically occur in the days leading up to menstruation or during menstruation itself, when the <a href="https://doi.org/10.1007/s10194-012-0424-y">drop in estrogen levels can trigger migraines</a>. Menstrual migraines can be more severe and last longer than migraines at other times of the month.</p> <p>A class of medicines that came out in the 1990’s – <a href="https://www.healthline.com/health/triptan-migraine#side-effects">triptans</a> – are commonly used to treat migraines; certain triptans can be used specifically for menstrual migraines. Another category of medications, called <a href="https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids">nonsteroidal anti-inflammatory drugs</a>, have also been effective at lessening the discomfort and length of menstrual migraines. So can a variety of birth control methods, which help by keeping hormone levels steady.</p> <h2>Migraine with aura</h2> <p>But women who have <a href="https://www.mayoclinic.org/diseases-conditions/migraine-with-aura/symptoms-causes/syc-20352072">migraine with aura</a>, which is a distinct type of migraine, should generally avoid using estrogen containing hormonal contraceptives. The combination can increase the risk of stroke because estrogen can promote <a href="https://doi.org/10.1016/j.thromres.2020.05.008">the risk of blood clot formation</a>. Birth control options for women with auras include progesterone-only birth control pills, the Depo-Provera shot, and intrauterine devices.</p> <p>Auras affect about 20% of the people who have migraines. Typically, prior to the migraine, the person most commonly begins to see dark spots and zigzag lines. Less often, about 10% of the time, an inability to speak clearly, or tingling or weakness on one side of the body, also occurs. These symptoms slowly build up, generally last less than an hour before disappearing, and are commonly followed by head pain.</p> <p>Although these symptoms resemble what happens during a stroke, an aura tends to occur slowly, over minutes – while strokes usually happen instantaneously.</p> <p>That said, it may be difficult and dangerous for a nonmedical person to try to discern the difference between the two conditions, particularly in the midst of an attack, and determine whether it’s migraine with aura or a stroke. If there is any uncertainty as to what’s wrong, a call to 911 is most prudent.</p> <figure><iframe src="https://www.youtube.com/embed/Tn91p-PY2h8?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">If you’re a woman and your migraines happen at the same time every month, it might be menstrual migraines.</span></figcaption></figure> <h2>Migraines during pregnancy, menopause</h2> <p>For women who are pregnant, migraines can be particularly <a href="https://www.stanfordchildrens.org/en/topic/default?id=headaches-in-early-pregnancy-134-3">debilitating during the first trimester</a>, a time when morning sickness is common, making it difficult to eat, sleep or hydrate. Even worse, missing or skipping any of these things can make migraines more likely.</p> <p>The good news is that migraines generally tend to lessen in severity and frequency throughout pregnancy. For some women, they disappear, especially as the pregnancy progresses. But then, for those who experienced them during pregnancy, migraines tend <a href="https://americanmigrainefoundation.org/resource-library/postpartum-headache/">to increase after delivery</a>.</p> <p>This can be due to the decreasing hormone levels, as well as sleep deprivation, stress, dehydration and other environmental factors related to caring for an infant.</p> <p>Migraine attacks can also increase during <a href="https://my.clevelandclinic.org/health/diseases/21608-perimenopause">perimenopause</a>, a woman’s transitional phase to menopause. Again, fluctuating hormone levels, <a href="https://www.verywellhealth.com/perimenopause-and-migraines-4009311">particularly estrogen, trigger them</a>, along with the chronic pain, depression and sleep disturbances that can occur during this time.</p> <p>But as menopause progresses, migraines generally decline. In some cases, they completely go away. In the meantime, there are treatments that can help lessen both the frequency and severity of migraines throughout menopause, including <a href="https://www.webmd.com/menopause/menopause-hormone-therapy">hormone replacement therapy</a>. Hormone replacement therapy contains female hormones and is used to replace those that your body makes less of leading up to or after menopause.</p> <h2>Men’s migraines</h2> <p>The frequency and severity of migraines slightly increase for <a href="https://doi.org/10.1177/0333102409355601">men in their early 20s</a>. They tend to slow down, peak again around age 50, then slow down or stop altogether. Why this happens is not well understood, although a combination of genetic factors, environmental influences and lifestyle choices may contribute to the rise.</p> <p>Medical researchers still have more to learn about why women and men get migraines. Bridging the gender gap in migraine research not only empowers women, but it also advances understanding of the condition as a whole and creates a future where migraines are better managed.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207606/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/danielle-wilhour-1337610">Danielle Wilhour</a>, Assistant Professor of Neurology, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/women-get-far-more-migraines-than-men-a-neurologist-explains-why-and-what-brings-relief-207606">original article</a>.</em></p>

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The new migraine drug that can target pain before it starts

<p>The latest in migraine treatments has been launched in Australia. It is part of a new class of medication specifically designed to target the condition.</p> <p>The new drug is called Vyepti, it is a part of a group of drugs which block a molecule in the brain known as calcitonin gene-related peptide, which becomes elevated during an attack.</p> <p>The anti-CGRPs, as the group of medications are known, are the first medicines developed to specifically target migraine attacks.</p> <p>Vyepti works slightly differently from any anti-CGRPs already available. It comes in the form of an infusion every three months, rather than a monthly self-administered injection. It also works to prevent attacks, rather than treating them once they arrive.</p> <p>"Being an intravenous therapy, we do achieve bioavailability very quickly at the end of the 30-minute infusion and benefits can be seen as early as day one," according to neurologist and migraine specialist Dr Nicole Limburg.</p> <p>"It's been game-changing for patients, the benefits they've been able to achieve."</p> <p>One of those patients is mum Emma Treadgold, who has regular migraine attacks which leave her bed ridden for days.</p> <p>"Having migraines adds a bit of a spanner in the works, I'm lucky I have a fantastic supportive husband," she told 9News.</p> <p>"It really does affect every area of your personal and professional life."</p> <p>Vyepti has helped her attacks, but at the moment the medication comes with a large price tag, about $1800 every three months.</p> <p>There is currently a submission to subside the treatment on the PBS to make it more accessible.</p> <p>"What works for one person may not work for another, so it's really important to give people of all demographics access to different medications they can try," Ms Treaddgold said.</p> <p>Carl Cincinnato from Migraine and Headache Australia said as more migraine-specific drugs become available patients should speak to their doctor about their options.</p> <p>"We want our community to have access, fair access to affordable treatments," he said.</p> <p>"It's actually different now, we have treatments designed specifically for migraines so it's a good opportunity to speak to your doctor about it."</p> <p>Migraines are the most common brain disease in the world. Around 71% of sufferers are women and the condition costs the economy more than $3.5 billion a year.</p> <p>Patients are frequently prescribed medications originally developed for other conditions, such as anti-depressants, anti-epileptic drugs, blood pressure medications and even Botox.</p> <p><em>Image: Nine News</em></p>

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Migraine patients set to save hundreds after costly drug revision

<p><span style="font-weight: 400;">The addition of migraine-preventing medication to the Pharmaceutical Benefits Scheme (PBS) has been hailed as a step in the right direction by advocacy groups.</span></p> <p><span style="font-weight: 400;">Emgality is used to prevent migraines in adults and is injected once a month by the patient.</span></p> <p><span style="font-weight: 400;">It can cost up to $1000 a month, but from June 1 eligible individuals will pay just $41.30 a script or $6.60 if they are a concession holder.</span></p> <p><span style="font-weight: 400;">Raphaella Crosby, the founding member of patient advocacy group Migraine Australia said the addition of the treatment to the PBS is a step in the right direction but that there’s still more work to do.</span></p> <p><span style="font-weight: 400;">“It does kind of pave the way because now that we’ve got one of these new medications on the PBS, there’s not much argument for listing the other ones,” Ms Crosby said.</span></p> <p><span style="font-weight: 400;">However, Ms Crosby said the number of people eligible for treatment would be limited by strict criteria.</span></p> <p><span style="font-weight: 400;">To be eligible, a person must meet the definition of suffering from chronic migraines, be under the care of a neurologist, have tried three older medications that failed, and not have received botox (a common treatment for migraines) under the PBS.</span></p> <p><span style="font-weight: 400;">“The line between episodic and chronic migraine is nonsense, it’s an arbitrary line that somebody drew at some point. It has no clinical meaning,” Ms Crosby said.</span></p> <p><span style="font-weight: 400;">According to research by Deloitte Access Economics in 2018, 4.9 million Australians live with migraines.</span></p> <p><span style="font-weight: 400;">Migraines disproportionately affect women as well, with 45 percent of women aged between 25 and 45 living with very active migraines that affect their ability to work, Ms Crosby said.</span></p> <p><span style="font-weight: 400;">“When the government talks about getting women back to work, to deny these drugs to women who aren’t completely debilitated by them is a bit counterproductive,” she said.</span></p> <p><span style="font-weight: 400;">“Because essentially what the restrictions are saying is ‘you need to be completely debilitated by your migraine before we’ll give you something that works’.”</span></p> <p><span style="font-weight: 400;">Emgality, made by pharmaceutical company Eli Lilly, belongs to a group of medications that block a particular protein associated with migraines, called calcitonin-gene-related peptide (CGRP).</span></p>

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12 reasons you might have a migraine (besides hormones)

<p>You consume “trigger” foods<br />According to Headache Australia, foods such as cheese, chocolate and processed meats may trigger migraine headaches. However, the foods that cause migraines often differ depending on the individual; surprising foods such as snow peas, olives, and soy sauce have reportedly triggered migraines in some people. Be your own expert by keeping a log of the foods you have eaten before a migraine attack. Doing so can help you determine which foods to avoid in the future.</p> <p>You drink sugary or caffeinated drinks<br />Sugary, caffeinated and alcoholic drinks are also on the ‘Migraine triggers’ list. These drinks can result in dehydration and also contain preservatives that increase blood flow to the brain, both common causes of migraines.</p> <p>Your sleeping patterns have changed<br />Many migraine sufferers find that missing sleep or getting too much sleep can trigger a migraine attack. If the migraines are temporary, there’s probably no need to make a change, but if they persist it might be time to regulate your sleeping pattern.</p> <p>You’re at risk of a stroke<br />If migraines are unusual for you, they could be a sign that you are having a stroke. “Migraine headaches can masquerade as a stroke because they have the same neurological symptoms,” Ralph Sacco, MD, professor of neurology at the University of Miami, told Reader’s Digest. “I tell people to treat it like a stroke and call for help; let us figure it out.” Vision problems and numbness in your arms and legs are also migraine symptoms that could signal a stroke.</p> <p>You’re stressed out<br />Yes, it’s true – stress at home or work could be causing that intense, throbbing migraine pain in your skull. But here’s the good news: research has shown that meditation could be a solution to chronic migraines. One study at the Wake Forest Baptist Medical Centre found that adults with migraines who participated in a meditation and yoga program for eight weeks had shorter and less debilitating migraine headaches than those who received standard medical care. The members of the first group also tended to have less frequent and less severe migraine attacks, and reported having a greater sense of self-control over their migraines.</p> <p>You’re sensitive to sensory stimulation<br />Flickering lights and strong-smelling perfumes could be triggering your migraine. A study published in Nature Neuroscience found that when the membranes around the central and nervous system get irritated, pain receptors are stimulated in the brain. For sensitivity to light, wearing sunglasses – even at night – can limit this irritation.<br />You have hidden heart problems<br />Studies have found that those who suffer from frequent migraines could be more prone to vascular problems like heart attacks and heart disease. Researchers stress the importance of maintaining a healthy lifestyle that lowers high blood pressure and cholesterol, as well as quitting smoking.</p> <p>You’re dehydrated<br />Migraines can strike when your body loses too much water. Make sure you are drinking the recommended 2.5 to 3.5 litres of water per day to decrease your risk of a migraine attack.</p> <p>You have a brain tumour<br />If nausea, vomiting, motor weakness or changes in memory, personality or thinking accompany your migraine, you could be at risk for a brain tumour or brain cancer. Talk to your doctor right away if your migraine worsens.</p> <p>You’re near bad weather<br />Certain weather patterns are associated with the onset of migraines, according to researchers at the University of Cincinnati. Their study found that migraines were 28 percent more likely to occur when lightning struck, perhaps due to electromagnetic changes.</p> <p>You have caffeine withdrawal<br />Although caffeine withdrawal is commonly known as a migraine trigger, researchers aren’t quite sure what causes the headache. Some believe it may be due to a signalling chemical, called adenosine, whose receptors are typically blocked by caffeine intake. But caffeine headaches don’t normally occur unless the individual has been used to drinking many cups of coffee a day, according to everydayhealth.com. Thankfully, caffeine withdrawal only lasts for a few days, and cutting back on caffeine gradually instead of quitting cold turkey can limit the painful side effects of withdrawal.</p> <p>You’re genetically inclined to have migraines<br />Sometimes, all you can do is chalk up your migraines to your genes. A 2013 study at the University of California linked migraines with a certain genetic mutation in humans. It found that a significant proportion of migraine sufferers in the families they studied either had the mutation or were the offspring of a mutation carrier.</p> <p class="p1"><em>Written by Brooke Nelson. This article first appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/12-reasons-you-might-have-a-migraine-besides-hormones"><span class="s1">Reader’s Digest</span></a>. For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.com.au/subscribe"><span class="s1">here’s our best subscription offer</span></a>.</em>​</p>

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The potato trick to help get rid of neck pain and migraines

<p>An expert has revealed an unlikely item that serves to relieve neck pain and migraines.</p> <p>Those dealing with neck stiffness could use humble potatoes to treat themselves, said Stephen Makinde, the clinical director of Perfect Balance Clinic in London.</p> <p>“We’ve seen an increase in the number of clients with neck problems and migraines associated with neck stiffness since the start of the coronavirus lockdown,” Makinde told the <em><a href="https://www.dailystar.co.uk/health/bizarre-baking-potato-trick-could-22096583">Daily Star</a></em>.</p> <p>The problem could be attributed to increased use of electronic devices during the pandemic, which affects the upper back, he said.</p> <p>“If you are looking down, which you do when working on a laptop, what tends to happen is the head starts to hang forward and that puts a lot of strain on the upper back,” he said.</p> <p>“This can often cause a burning sensation in the trapezius muscles and affects other muscles in the neck, the spine and the nerves.”</p> <p>Makinde said lying down with tennis balls placed underneath the back of the head can help loosen muscles, release tension and help “reset the neck position”.</p> <p>“Tennis balls are really useful for this, but most people don’t have tennis balls at home,” he said.</p> <p>“So baking potatoes work well, too. You just sellotape them together and lie down flat, with the potatoes placed underneath the back of your head.</p> <p>“This is a really easy and useful thing people can do at home to release their neck tension and the pressure around there themselves.”</p> <p>In an interview with <em><a href="https://7news.com.au/sunrise/on-the-show/coronavirus-australia-how-to-prevent-back-and-neck-pain-when-working-from-home-c-1059473">Sunrise</a></em>, Australian Chiropractors Association President Dr Anthony Coxon also recommended getting up and moving every half an hour as well as increasing the height of the screens we are using.</p>

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How does a piece of bread cause a migraine?

<p>Migraine is the <a href="http://doi.org/10.1186/1129-2377-14-1">third most prevalent illness</a> in the world and causes suffering for tens of millions of people. In fact, nearly <a href="http://doi.org/10.1212/wnl.58.6.885">1 in 4 U.S. household</a> <a href="http://doi.org/10.1111/head.12878">includes someone with migraines</a>.</p> <p>Migraine is not just a headache but also includes a collection of associated symptoms that can be debilitating. These include nausea, vomiting, light sensitivity and dizziness. Often people struggle to determine what triggers their migraines. It can be environmental, hormonal, genetic, secondary to an underlying illness, or <a href="https://americanmigrainefoundation.org/resource-library/migraine-and-diet/">triggered by certain foods</a>, such as cheese, red wine or chocolate. One food that has received a lot of <a href="http://doi.org/10.3988/jcn.2017.13.3.215">attention in recent years is gluten </a> - a protein found in wheat, rye and barley.</p> <p>As a registered dietitian and board-certified neurologist who specializes in headache management, I often will have my patients try a gluten-free diet.</p> <h2>Celiac disease vs. gluten sensitivity</h2> <p>When someone suffers from <a href="https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease">celiac disease</a> – a digestive disorder caused by an autoimmune response to gluten – there is a clear link between <a href="http://doi.org/10.1111/j.1526-4610.2012.02260.x">migraine headaches and gluten</a>. <a href="https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/">Gluten triggers immune cells to release antibodies</a> to attack substances the body sees as foreign.</p> <p>When someone without celiac disease eats gluten, it goes into the gastrointestinal tract where food is broken down and the nutrients are absorbed. In the case of celiac disease, that person’s immune system sees the gluten as a foreign substance (like a virus or bacteria that shouldn’t be there) and attacks it with a specific antibody – called transglutaminase (TG) 2 serum autoantibodies – to destroy the gluten.</p> <p>The problem is the person’s own healthy tissues gets destroyed in the process. In other words, when people who are sensitive to gluten consume it, the immune system sees this protein as an invader and creates antibodies to capture and destroy the protein. If the protein is sitting in the GI tract or has been absorbed by other organs, the antibodies go looking for it and attack whatever <a href="http://doi.org/10.1038/cmi.2010.65">tissue is harboring the gluten protein</a>.</p> <p>This triggers an inflammatory reaction that puts the body in high alert that injures various healthy organs. Organs then release molecules that cause blood vessels to become leaky and release water, electrolytes and protein into the tissues and cause swelling.</p> <p>This is an inflammatory response that affects the whole body, not just the brain. In addition to headaches, it can cause broader symptoms including gastrointestinal problems, fatigue and learning difficulties, just to name a few.</p> <h2>Step by step, how gluten leads to migraines</h2> <p>But just looking at a gluten-intolerant person’s inflammatory response doesn’t provide the whole picture on gluten’s link to migraine.</p> <p>In recent years scientists have gained a better understanding of how and why migraines occur. Migraine is now considered <a href="https://ghr.nlm.nih.gov/condition/migraine#inheritance">a genetic condition</a> that is found commonly within families.</p> <p>Early theories suggested migraines occurred because of enlargement or dilation of the blood vessels. But now neurologists realize this isn’t the whole story. We now know the cascade that leads to a migraine involves the nerves in the trigeminovascular pathway (TVP) – the collection of nerves that control sensation in the face as well as biting and chewing.</p> <p>When TVP is activated by the presence of gluten, for example, it causes the release of many chemicals including histamine, a substance that immune cells produce when responding to injury, allergic and inflammatory events. The TVP nerves also produce a recently discovered trigger for migraines; a protein called <a href="http://doi.org/10.1111/head.13081">calcitonin gene-related peptide</a> (CGRP).</p> <p>When CGRP is released it causes the dilation of blood vessels in the meninges – the layer of tissue protecting the brain. As the blood vessels dilate they leak water and proteins into the <a href="http://doi.org/10.1038/s41582-018-0003-1">meninges which causes swelling and irritation</a>. The swelling activates the trigenimial nerves which relay messages to other regions of the brain, including the thalamus which creates the perception of pain that is associated with a migraine.</p> <p>Within the past year a new class of medications has gained FDA approval for migraine prevention. These medications are called <a href="http://doi.org/10.1002/brb3.1215">CGRP monoclonal antibodies</a> and have proven to be an effective preventative treatment. They stop the protein CGRP from getting into its receptor.</p> <h2>What to do about food triggers</h2> <p>In both gluten sensitivity, or celiac disease, and migraine, there is an inflammatory process occurring within the body. I hypothesize that the inflammatory response to gluten makes it easier to activate the trigeminovascular pathway, thus triggering a migraine. There has never been a large study of how exactly gluten triggers migraines, and this is something I hope to explore in future studies.</p> <p>Typically, a food trigger will cause a migraine to start within 15 minutes of exposure to that substance.</p> <p>If someone tests positive for celiac, or wheat allergy, then the answer is simple: remove gluten from the diet. So the question arises when someone tests negative should we still eliminate gluten? It is often worth a try, because there is a condition called non-celiac gluten sensitivity.</p> <p>If someone does not have celiac disease but suffers from symptoms of gluten sensitivity, an elimination trial of gluten is often helpful for reducing migraine frequency or severity. The reason I suspect is that removing gluten will reduce chances of an inflammatory response that will activate the trigeminal nerves and trigger pain. Gluten elimination for migraines is still experimental.</p> <p>We need to treat the whole person in medicine. This includes looking at potential triggers for headache and doing an elimination diet can be of benefit. There are so many gluten-free products currently on the market, it makes removing gluten from the diet easier.</p> <p><em>Written by <span>Lauren Green, Clinical Assistant Professor of Neurology, University of Southern California</span>. Republished with permission of </em><a rel="noopener" href="https://theconversation.com/how-does-a-piece-of-bread-cause-a-migraine-126421" target="_blank"><em>The Conversation</em></a><em>. </em></p>

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The breakthrough migraine medication set for approval

<p>An online Migraine World Summit has revealed that millions of Australian migraine sufferers may not be getting high enough doses of medicine to reduce their pain.</p> <p>But a new class of medicine expected to get FDA approval in the US this year could be the solution for three million Aussie migraine sufferers.</p> <p>Australian neurologist Professor Peter Goadsby revealed at the Summit that a typical 70kg migraine sufferer needs 900 milligrams of aspirin to relieve their pain, not the standard 600 milligram dose.</p> <p>Similarly, medications prescribed to beat migraines such as blood pressure medication propranolol and anti-epileptics are often not given in high enough doses to fix the issue.</p> <p>Dr Richard Lipton from the Montefiore Headache Centre also revealed that patients also need to understand that their migraine medication can actually cause headaches as well, if it is taken too often.</p> <p>Medication-overuse headaches occur when a person uses drugs such as codeine, barbiturates or triptans more than twice a week, reported the <a href="https://www.dailytelegraph.com.au/lifestyle/health/the-new-breakthrough-migraine-medications-set-for-approval/news-story/a1f29bfb92c6e3fd00904f31f9f64880" target="_blank"><span style="text-decoration: underline;"><strong>Daily Telegraph</strong></span></a>.</p> <p>However, a new migraine treatment called Calcitonin gene-related peptide (CGRP) inhibitors is currently going through the FDA approval process and could be the solution for migraine suffers.</p> <p>This medication, which is the first new migraine treatment in almost 30 years, has shown in trials that it can cut the number of migraine attacks in half.</p> <p>The medication, which is injected once-a-month, blocks CGPR molecules released in the brain that have been linked to migraine headaches.</p> <p>The drug reduced the number of attacks by 50 per cent or more in up to 50 per cent of people.</p> <p>Professor Lars Edvinsson from Lund University, who is behind the research, says it has very few side effects.</p> <p>Professor Goadsby explained that around half of those who suffer from migraines are never diagnosed because they think they need to have visual disturbances or aura for it to be a “true migraine”.</p> <p>Only 25-30 per cent of migraine sufferers have a visual disturbance or aura as a side effect.</p> <p>Do you regularly suffer from migraines? Tell us in the comments below? </p>

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The shocking truth about migraines

<p>Three million Australians suffer migraines, the third most debilitating medical condition in the world, according to the World Health Organisation.</p> <p>Some say that migraine sufferers should harden up, take a pill, and just get on with it.</p> <p>But the fact is “you can’t pop a pill and get over it,” says Gerald Edmunds, Secretary General of Headache Australia and the Brain Foundation.</p> <p>“The prevailing attitude that people should simply ‘pop a pill’ only adds to the complexity of this issue; medication overuse is rife,” he tells news.com.au.</p> <p>What non-sufferers need to realise is that migraines are far more than a “big headache”.</p> <p>A migraine is a crippling neurological condition which can cause paralysis, pain, vomiting, speech and vision problems during an attack. It’s highly disabling, and can last for days.</p> <p>And at the moment there’s no cure as neurologists don’t know yet what causes migraines.</p> <p>“There is a stigma associated with migraine, and a lack of understanding in the community about how far reaching it’s impact is,” Edmunds, who does not suffer migraines, says.</p> <p>“An attack causes significant disruptions. Sufferers can’t attend events. They miss work. People trivialise it as a headache they don’t realise how difficult it is for those in the grip of an episode to do anything else. It’s a disability in that it prevents you from doing normal things for a time.”</p> <p>Edmunds wants headache sufferers to register with Headache Australia’s <strong><span style="text-decoration: underline;"><a href="https://www.headacheweek.org.au/national-headache-register/" target="_blank">national headache register</a>.</span></strong></p> <p>“We have 10,000 people, but if we can get to one million we can exert political pressure for more research and new treatments,” he says.</p> <p> </p>

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What can trigger a migraine (and how to stop them)

<p><em><strong>Dr Cathy Stephenson is a GP and forensic medical examiner.</strong></em></p> <p>I have suffered from migraines all my life. Thankfully they have got less and less frequent with age, but when they do hit I have to put my life on hold for a bit, unable to see properly to be able to drive or work, and with a headache that makes it impossible to think of anything else.</p> <p>According to the NZ Neurological Foundation, I am far from alone – around 18 per cent of women, and 12 per cent of men, are affected, the majority falling into the 15-55 age bracket.</p> <p>Some of these will only have a migraine once in a blue moon, and will be happy managing their symptoms with pain relief and anti-nausea tablets as required. However, for other migraine sufferers, the condition can be hugely debilitating, leading to numerous days off work each month, and high degrees of pain and misery.</p> <p>For those in the second group, there is hope. Medication aimed at preventing migraines are now widely available, and should be considered if you feel the frequency of your migraines is impacting significantly on your life: although this is clearly a very individual perception, a rule of thumb from a medical point of view is if you have two or more migraines per month, or require pain relief on two or more days of the week, then you should think about prevention.</p> <p>The first rule of prevention is to ensure you have thoroughly explored (and hopefully moderated) your migraine "triggers" – these may include lifestyle factors such as stress, anxiety, exposure to light, alcohol, or dehydration, as well as dietary ones, especially caffeine, chocolate, food additives and preservatives, and cheeses.</p> <p>For women a really common trigger is the menstrual cycle, with a lot of migraines occurring just before a period. If you're not sure what things in particular seem to trigger your migraines, a really simple and effective way to find out is to keep a headache diary, and document all the factors in the two or three days leading up to an attack.</p> <p>It won't take long to start seeing some patterns forming, and hopefully there will be some steps you can take that will help bring relief quickly and easily.</p> <p>Once you have minimised your triggers, you could consider taking a regular "prevention" medication, with the aim of reducing the frequency and/or severity of your attacks. Preventers (also known as "prophylactics") need to be taken every day, and will usually take 2-4 weeks to show their full effect.</p> <p>If they work, I would recommend staying on them for six months or more before attempting a trial off them. There are several different preventers available, so if one doesn't suit you, don't despair – just talk to your doctor about giving one of the others a trial:</p> <p><strong>Beta-blockers</strong></p> <p>Originally designed to help treat high blood pressure, this group of drugs are really effective at reducing migraines. They include the drugs atenolol, propranolol, metoprolol and bisoprolol, and it may be worth trialling more than one to find the "best fit" for you. Unfortunately people with a history of asthma can't take these medicines. Incidentally, they can also be really helpful for anxiety, so if stress is a major component of your migraines, these could be the perfect option!</p> <p><strong>Amitriptyline</strong></p> <p>This "tricyclic" antidepressant is another great option for preventing migraines. It also helps sleep and chronic pain, and is usually effective at much lower doses than would be used to treat depression. It works by modulating the pain pathways in our body. Ideally, a very low dose is used to start with, to try and avoid side effects, and titrated upwards over several weeks to get the optimal benefit.</p> <p><strong>Migradol </strong></p> <p>There is increasing evidence that some natural products may be effective at preventing migraine attacks. Migradol contains vitamin B2 (riboflavin) and magnesium combined, and is certainly worth a trial. Another over-the-counter option that has had good results in clinical trials is butterbur, an extract from a ragweed plant – however there have been reports of liver toxicity associated with its use, so make sure you discuss this with your doctor and get any monitoring they recommend.</p> <p><strong>Sodium valproate and topiramate</strong></p> <p>These are both anti-convulsants used in epilepsy, and have been found to be effective in some people with migraines. However, they may have more side effects than the other medications listed, so I would reserve them to use if the others have proven ineffective.</p> <p>Lastly, for women having their periods, it is worth trying to "override" the natural cycle, in the hope this will reduce the number or severity of migraine attacks. This can be done with either oestrogen supplements, or by using a progesterone contraceptive such as the depo injection.</p> <p><em>Written by Dr Cathy Stephenson. First appeared on <a href="http://www.stuff.co.nz/" target="_blank"><strong><span style="text-decoration: underline;">Stuff.co.nz</span></strong></a>.</em></p>

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Migraines caused by a lack of this essential nutrient

<p>Anyone who regularly suffers migraines can tell you just how painful and debilitating they can be, given there are very few effective treatments. However, researchers may have just found the reason why some people are more sensitive to these dreaded headaches than others, and the answer lies in your diet.</p> <p>Magnesium is a nutrient crucial for a number of health reasons, but particularly when it comes to supporting the nervous system, immunity and bone strength. And now, scientists believe there’s a strong link between low levels of magnesium and migraine risk.</p> <p>“Migraine is widely thought of as a disorder of brain excitability,” Dr Richard Lipton of the American Migraine Foundation told <a href="http://www.self.com/wellness/2016/08/magnesium-deficiency-migraines" target="_blank"><strong><span style="text-decoration: underline;">SELF</span></strong></a>. “That means that under the right circumstances, attacks can be triggered – drinking a lot of red wine, not getting enough sleep, a woman’s period – because the nervous system is sensitive.</p> <p>“The thought is that when levels of magnesium are low, that makes nerve cells more prone to release excitatory chemicals like glutamate and that might contribute to the state of brain excitability in general.”</p> <p>As a result of a more excitable brain, Dr Lipton says, our risk of migraine increases. To lower the chances of an attack, he recommends aiming for a magnesium intake of 500mg a day, whether through diet or supplements.</p> <p>Unfortunately, though you might be tempted to reach for the dark chocolate (which is high in magnesium), Dr Lipton warns chocolate can actually be a trigger for migraines. Instead, you should opt for sources like leafy greens, pepitas, almonds, avocados and figs.</p> <p>Tell us in the comments below, do you suffer migraines? What’s the most effective treatment you’ve found?</p> <p><strong>Related links:</strong></p> <p><a href="/news/news/2016/08/103-year-old-secret-to-long-life/"><span style="text-decoration: underline;"><em><strong>103-year-old reveals her surprising secret to a long life</strong></em></span></a></p> <p><a href="/news/news/2016/08/unhealthy-foods-that-are-actually-good-for-you/"><span style="text-decoration: underline;"><em><strong>5 “unhealthy” foods that are actually good for you</strong></em></span></a></p> <p><a href="/news/news/2016/08/shocking-effect-of-a-bad-nights-sleep/"><span style="text-decoration: underline;"><em><strong>The shocking effect a bad night’s sleep can have</strong></em></span></a></p>

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Surprising migraine triggers

<p>If you suffer from migraines, you know that they’re a lot more than just a headache. They can cause nausea, vomiting, blurred vision, pain, and more, and can be entirely debilitating. As it turns out, anything from your diet to your lifestyle could be affecting your health. If you suffer from migraines, consider some of the following surprising migraine triggers, as listed by Dr Robert Mathews of Cremorne Medical in NSW, Australia.</p> <p><strong>Surprising migraine triggers:</strong></p> <ul> <li>Stress</li> <li>Lack of sleep: A lack of sleep or a disrupted sleep schedule can contribute to the onset of migraines.</li> <li>Viral infections</li> <li>Menstruation (in women)</li> <li>Caffeine: “Found in coffee and chocolate, [caffeine can be a [migraine] trigger]” Dr Mathews says.</li> <li>Painkillers: “Sometimes taking pain killers too frequently can paradoxically trigger migraines.”</li> <li>Weather changes: “[An] unusual trigger is a change in barometric pressure such as sudden weather changes.”</li> <li>Additionally: “People who are overweight and snore have a higher risk of developing chronic migraines,” Dr Mathews warns.</li> </ul> <p>While avoiding these triggers can help to discourage migraines, Dr Mathews also shared some key everyday advice to help prevent their onset:</p> <p>“The best medicine is often the simplest, such as getting eight hours sleep per night, managing your stress levels through regular exercise, relaxation, and eating a healthy diet. Hydration is also really important, make sure you are having at least six glasses of water per day,” Dr Mathews recommends.</p>

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Riboflavin helps treat migraines

<p>In recent times, nutritional supplements and alternative therapies have become popular methods of treating migraines. If you or someone you know suffers from migraines, you’ll understand why people are willing to try something different to find a way to fight back against the crippling headaches.</p> <p>One of the nutritional supplements on the rise is riboflavin – a B vitamin found in some everyday foods like almonds, mushrooms, spinach and whole grains. In 2012, the American Headache Society and American Academy of Neurology guidelines for prevention of episodic migraine listed riboflavin as a level B drug. This means that it is considered “probably effective” for migraine prevention.</p> <p>Having acknowledged that, it’s important to note that only two randomised controlled studies that examine the use of riboflavin in preventing headaches have taken place. In one study, 55 participants received either a sugar pill placebo or 400mg of riboflavin during the testing period of three months. The riboflavin was reported to reduce the number of headaches by at least 50 per cent in 59 per cent of the group receiving riboflavin.</p> <p>The second study used a very small dose of riboflavin in the placebo (as riboflavin alters the colour of urine, and scientists worried people would know if they were taking the placebo or not). In that study, 44 per cent of the placebo group reported a 50 per cent or greater reduction in migraines, compared with 42 per cent in the riboflavin group. It’s possible that even the small amount of riboflavin in the placebo (25mg) had an effect on the migraines.</p> <p>However, as with any medical issues, you should consult with your doctor before beginning any kind of new treatments. Until you do, adding a few extra almonds to your diet couldn’t hurt.</p>

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