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  • David Wadsworth

Five Migraine Game Changers

Migraine headaches can be very debilitating. Read on to learn 5 game changing things you can act upon to stay on top of this condition.

 



What are the big game changers for managing migraines?

 

There is no “magic pill”

Because migraine is such a complex condition with multiple factors and mechanisms generating pain, there isn’t ever going to be a single simple solution. 

 

Action item: expect to need to do multiple things and make multiple changes if you want to get on top of migraine. 

 


Address the big picture.  Sort ALL the contributing factors out where possible, not just treat acute headaches! 


This is where skilled manual therapy comes in.

 

Action item: if your body has multiple issues such as neck symptoms, thoracic symptoms, or more widespread issues then dealing with all of this is helpful.

 

How does this work? 

Think of your brain like the master electrical switchboard – if there are multiple circuits “lighting it up” then decreasing the constant irritation from ALL sources helps

By reducing the constant stream of negative neural input to the central nervous system (i.e. brain and/or spinal cord), sensitivity of the neurons in the brain is minimised and thus helps reduce migraine attacks, not to mention sorts out your neck and other pains!

 

When should you sort all of this out – when you’re not in the middle of a migraine!  Come in for treatment between attacks to deal with the seemingly less urgent (yet vitally important) contributing factors. Book a consult at Pain Solutions Queensland asap. 

 

 

Epigenetic risk factors for migraine are similar to all chronic pain conditions or diseases, so sort them out & stay on top of them every day


By staying on top of these factors every day you begin to form new positive habits which makes staying on top of things easier and easier (often it will take at least 6 weeks to get good at new habits – but that’s a short space of time in the life of a migraine sufferer!).

 

Action item: risk factors include things like being overweight, poor dietary and exercise choices.  Simply put, eat a healthy diet all the time, exercise appropriately (including strength work and aerobic exercise), and avoid highly negative habits like smoking, and you are likely to improve (Onan et al 2023).  For some people who have neck issues, this requires professional assistance to get neck strengthening right, as a weak neck is very easy to overload and cause a flare up of your symptoms.



Recognise & Manage Migraine Triggers

Migraine triggers differ between people.  The two most common factors are stress and sleep. 


Action item: Work out your migraine triggers and actively minimise them!  As an example, sleep disturbance can trigger a migraine attack in over 50% of migraine sufferers (Andreou & Edvinsson 2019), so developing a wind-down routine each evening and practising this every day (rather than only doing it when you’ve had a tough or stressful day) is best practice.  Why?  Because practising wind-down skills like meditation is far more effective when you aren’t already wound up and stressed, making it more likely you can use these skills effectively to sleep better on those hectic days we all have from time to time.

Similarly, if there is a dietary component such as excess caffeine, chocolate or other foods that you know can trigger attacks, then make a proactive choice to consume different foods that promote excellent health and don’t trigger migraines.

 

Implement timely acute management of a migraine attack

This will help to reduce central sensitisation and helps to prevent worsening by ensuring your attacks don't go "thermonuclear" every time. Consider if preventative medication might be indicated.


Action item: book an appointment with your doctor about medical management.  No single strategy works every time for everyone, and your needs may evolve over time (hopefully a positive change leading to less frequent headaches and reduced need for medication).   Your doctor should include advice about:

  • Avoidance of certain medications (which over time make your headaches worse as they cause a Medication Overuse Headache);

  • When to take proven migraine medication to manage acute headaches. 


Current recommendations include a stepped-care approach using 3 lines of medication for an acute migraine attack (Onan et al 2023):


Front line medication: Non-steroidal anti-inflammatories such as Nurofen +/- paracetamol in the first 15-20min of becoming aware of an upcoming migraine. 

  • Why? – this helps reduce peripheral sensitisation of the trigeminal nerve that is currently thought to initiate the migraine wind-up.


Second-line medication: triptans (best scientific evidence for migraine acute attacks).

  • Why? – if taken in the first 60-120mins it tends to minimise central sensitisation of the brain. If you allow central sensitisation to progress it is likely to lead to more migraine attacks in the future.  Preventing it from happening makes managing migraines easier going forward.


Third-line medications: these are newer drugs that may be trialled if the above 2 options are not effective.


Preventative medications: Depending on your unique circumstance, your medical practitioner may recommend medication to help prevent migraine.  These are typically medications not specifically designed for migraine but have been found to assist in managing migraine and other chronic pain conditions.  There are several options here and finding one that works for you may take some careful trials with the guidance of your doctor. 

 

There you have it – 5 straight forward things that have proven benefit in managing migraines and reducing the frequency and severity of attacks. 

 

As you may have gathered a key goal is preventing development of Chronic Migraine (this is someone who has a migraine more than 15 days / month – basically most days of their life!), and that is something I can help you with at Pain Solutions Queensland


It requires some commitment to making positive changes and sticking with them but it can certainly be done, and the sooner the better as the more chronic and severe the migraines become, the harder it is and the longer it takes to make a positive impact.

 


References:

Andreou AP & Edvinsson E (2019): Mechanisms of migraine as a chronic evolutive condition. The Journal of Headache and Pain 20:117

 

Onan D et al (2023): Debate: differences and similarities between tension-type headache and migraine. The Journal of Headache and Pain.24:92 

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