Migraine disease | Māhunga ānini

People living with migraine disease have triggers that cause migraine attacks. Learning what triggers your migraine attacks and finding ways to avoid or reduce these triggers is an important part of managing migraine disease.

There are many different trigger factors that may start a migraine attack or episode. Keeping a diary of when you have a migraine episode and what may have started it is a useful way to work out your triggers.

Some foods such as chocolate, brown vinegar, cheese, citrus fruits, onions and MSG (monosodium glutamate) can be a trigger for some people. Food may be considered a trigger for a migraine episode if an attack occurs within 6 hours of eating and you don't get migraine attacks when you don't eat that food. 

Women and migraine disease

Female hormone fluctuations, the oral contraceptive, menopause and pregnancy may affect migraine.

• Migraine attacks often happen around your period (menstruation) or at other regular times of your cycle (menstrual migraine).
• Many women find migraine disappears during pregnancy.
• Oral contraceptives containing oestrogen may change migraine frequency.
• Some women get migraine during menopause.

Non-migraine headache is also a common feature of pre-menstrual syndrome.

Some people can feel some warning signs that tell them a migraine might be coming soon. We call these warning signs that can occur days before the headache starts "prodromal symptoms". About 8 in 10 people get prodromal symptoms. Examples of prodromal symptoms include:

• feeling tired, fatigue
• repetitive yawning
• restless or irritability
• anxiety
• food cravings, feeling hungry or thirsty
• difficulty concentrating
• dizziness 
• sensitivity to light or sound

Some people have changes in their senses of sight, smell,  hearing, and touch. These changes are part of the "aura phase" that people can get just before the headache starts. Only about 1 in 4 people experience an aura. If you’ve never had an aura, this doesn’t mean you don’t have a migraine.

Examples of aura symptoms include:

• problems with vision (seeing zig-zag lines, flashing lights or spots in your vision)
• hearing loss or ringing sound in your ears
• tingling or numbing feelings in your body.

When the headache starts, it is a strong pain, usually on one side of your head. You may feel sick or vomit (be sick), get tingling around your mouth, have trouble talking or feel dizzy or weak.

Learning the warning signs of a migraine can help you treat it quickly.

The following are common with migraine attacks and don't usually happen during a tension headache:

• aura
• headache on one side
• high sensitivity to light and noise
• nausea (feeling sick) or vomiting (being sick).

These symptoms are very particular to migraine disorder. Your doctor may do other tests if they are concerned your headaches may have another cause. However, a migraine attack are not a sign of a stroke or a tumour, and your doctor will reassure you of this.

Migraine disorder can't be cured but you can relieve symptoms during an attack and prevent further attacks. Migraine varies between people and so does the treatment. Some things are commonly known to trigger migraine attacks in some people. Avoiding these triggers can reduce how often and how severe your migraine attacks are. 

Medicines

Medicines for the treatment of migraine is aimed at stopping symptoms and preventing future attacks fall into a few categories:

• Pain-relieving medicines, which are taken during a migraine attack to help stop symptoms that have already begun.
• Medicines for nausea (feeling sick) or vomiting (being sick).
• Medicines to prevent migraine attacks, which are taken regularly to reduce how often and how severe your migraine attacks are.

The type of medicine you need depends on many things, including how often, severe and disabling your migraine attacks are. It may take time to work out the best treatment for you. You may need to try different types or combinations of medicines before you find the most effective ones. Read more about medicines for migraine.

Medication-overuse headache can occur if you use pain relief medicines to treat headaches and migraines over a long time. If you have been using triptans, paracetamol, NSAIDs or opioid medicines regularly for three months or more and you are having headaches more than 15 days per month then you may be experiencing medication-overuse headache. It may feel like a tension-type headache or migraine-like attack.

Medication-overuse headache is sometimes called medication adaptation headache or rebound headache. Headaches often improve within 2 months of withdrawal of the overused medicine, but can feel worse before improvement is seen. If you think you might have medication adaptation headache it is really important to keep a detailed history of your headaches and how often you are taking medicines for the headaches. You can use a headache diary(external link) to help you keep a record of this. You can also talk to your healthcare provider about medicine to prevent migraines. See the section below.

To avoid medication adaptation headache:

• triptans should not be used for more than 10 days per month
• paracetamol and NSAIDs should not be taken for headaches on more than 15 days per month

Here are some simple measures that you can try to ease your symptoms.

• Lie in a quiet, cool, dark room.
• Avoid moving around too much.
• Put a cold flannel on your neck or forehead.
• Avoid drinking tea, coffee or orange juice.
• Try to relax by listening to music or through meditation.
• Don't read, watch TV or drive.
• Sleep through the attack.

Not all migraine attacks have an obvious trigger, but sudden changes in daily routine can be a trigger. This includes a missed meal, a late night or doing more strenuous exercise than you normally do.

To reduce your chance of having a migraine attack you may find it helpful to make the following lifestyle changes:

• Have regular meals.
• Drink enough water/fluid to stay hydrated.
• Do relaxation and exercises for stress (eg, meditation and yoga).
• Aim for a regular sleep pattern and make sure you have enough sleep (but avoid long sleep-ins).
• Don't do sudden strenuous exercise.
• Limit caffeine intake to no more than 2 cups of coffee a day.

Addressing other conditions that may be causing your migraine attacks is also important. These include stress, anxiety, depression, hormonal changes and head or neck trauma. If these are problems, talk to your doctor. They may be able to help you work out how to manage these things.

Cognitive behavioural therapy (CBT), coping strategies and relaxation training are helpful for many people with migraine, especially if attacks are associated with anxiety or stress. 

Preventive medicines

Preventive medicines are taken daily to prevent migraine attacks from happening. They are not used to treat a migraine attack. Medicines to prevent migraine attacks are an option if you:

• have at least 2 migraine attacks a month
• have significant disability despite suitable treatment for migraine attacks
• cannot take suitable treatment for migraine attacks.

Preventative medicines aim to reduce how long and severe your migraine attacks are and how often you get them. They can help to reduce disruption to your daily activities that happens with migraine, and reduce overuse of pain relief medicines. They must be taken every day to work well. They may take a few weeks to start working. Read more about preventive medicines for migraine.

You will keep having migraine attacks but will not come to any harm. However, migraine attacks are likely to happen again and again and these can be very disruptive and debilitating.

For videos of people sharing their personal stories, visit Migraine Again(external link).

Migraine Foundation Aotearoa NZ(external link) New Zealand's only not-for-profit supporting people living with migraine in Aotearoa.
Migraine Foundation Aotearoa NZ support group(external link) A Facebook support group for people living in New Zealand to connect with others.
Migraine Down Under(external link) A blog written by a New Zealander living with migraine
Migraine NZ(external link) A patient body advocacy group founded to support and fight for all New Zealanders living with migraine.
Migraine NZ Chat Group(external link) Facebook support group