What is Migraine? Migraine is a Neurological Disease. Migraine Headaches: Info

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1 In This Info Kit Migraine Headaches: Info Types, Triggers and Prevention of Headaches Non-drug Treatments Trigger Avoidance Migraine Trigger Journal List of Other Wellness Info Kits

2 Migraine Headaches: Info What is Migraine? Just about everyone gets headaches. But migraine is not just a bad headache. It is an extremely debilitating collection of neurological symptoms that usually includes a severe recurring intense throbbing pain on one side of the head (although in 1/3 of migraine attacks, both sides are affected). Attacks last between 4 and 72 hours and are often accompanied by one or more of the following: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Of course, everyone is different, and symptoms vary by person and sometimes by attack. Migraine is a syndrome, a collection of symptoms which arise from a common cause. A syndrome may occur in a complete form, with all of the typical symptoms, in a less complete form, with some symptoms, or in specific groupings of symptoms. Migraine is classified according to the grouping of its symptoms. Since symptoms vary widely, migraine is often misdiagnosed. Many people who suffer from migraine begin by treating themselves with over-thecounter medications. Sufferers sometimes consult their doctor as symptoms become more severe and disabling. Doctors diagnose migraine by analyzing the symptoms, conducting medical tests and eliminating other possible causes of the headache. Diagnosis is not always easy, however. Migraine is a moving target: symptoms are hard to evaluate and can change from one attack to the next. Migraine is a Neurological Disease Many people fail to realize that migraine is a neurological disease, like epilepsy. Every 10 seconds, someone in the United States goes to the emergency room with a headache or migraine. Migraine sufferers visit the emergency room because of the severity of the pain or the fear of unremitting pain, drug reactions or side effects from headache medications, severe nausea or vomiting, dehydration, and/or stroke-like neurological symptoms that might accompany the headache. Migraine ranks in the top 20 of the world's most disabling medical illnesses. Amazingly, over 10% of the population, including children, suffers from migraine. Nearly 1 in 4 U.S. households includes someone with migraine. In addition to the attack-related disability, many sufferers live in fear knowing that at any time an attack could disrupt their ability to work or go to school, care for their families, or enjoy social activities. More than 90% of sufferers are unable to work or function normally during their

3 migraine attacks. While most sufferers experience attacks once or twice a month, about 14 million people experience headaches on a near-daily basis. About 18% of American women and 6% of men suffer from migraine. This translates to about 36 million people in the United States alone! American employers lose more than $13 billion each year as a result of 113 million lost work days. Women and Migraine Over 27 million women are affected by migraine in the United States today. Three times as many women as men suffer from migraine in adulthood. In childhood, boys are affected more than girls, but after adolescence, when estrogen influence begins in young girls, the risk of migraine and its severity rises in females. Estrogen adversely influences the brain receptors that play a role in migraine development. About half of affected women have more than one attack each month, and a quarter experience 4 or more severe attacks per month. More severe and more frequent attacks often result from fluctuations in estrogen levels % of American women get menstrual migraine. The vast majority of these women also have migraine at other times of the month. Menstrual migraine is an attack that occurs up to 2 days before and up to 3 days after menstrual onset. It is usually more severe and harder to control than other types of migraine. Treatment Migraine treatment has changed dramatically over the years. In the past, doctors often diagnosed patients with disabling head pain as neurotic and dismissed their complaints as psychiatric in nature. Later, researchers believed that the dilation and constriction of blood vessels in the head were the primary source of the pain. Early migraine medications focused on the blood vessels as the principal target for treatment. The current theory of the source of migraine pain reflects the advances in technology that help us understand how the brain works. Researchers now believe that migraine is a disorder involving nerve pathways and brain chemicals. There is also evidence that links a number of genes to migraine, so that genetics is undoubtedly involved. Migraine can often be managed with proper diagnosis and treatment. There are three principle approaches to treatment: acute, preventive, and complementary. Acute treatment uses drugs to relieve the symptoms of attacks when they occur. Preventive treatment uses drugs taken daily to reduce the number of attacks and lessen the intensity of pain. Complementary treatment, which does not use drugs and is mostly used for prevention, includes biofeedback, relaxation techniques, acupuncture, exercise,

4 and proper rest and diet. In some patients, life-style changes and other non-drug treatments can help avoid the triggering of attacks. Even with the correct diagnosis, treating migraine can be very difficult. There are well over 100 drugs, surgical treatments and devices used to prevent or treat migraine symptoms and choosing one or a combination that might work is time consuming and frequently requires expert help from doctors or centers specializing in the treatment of migraine. Chronic Migraine and Chronic Daily Headache About 4% of the U.S. population, around 14 million people, suffers from Chronic Daily Headache, which is when headaches occur on 15 or more days per month. Chronic daily headache is an umbrella category that consists of four different types of headaches: chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Approximately 2% of the population suffers from chronic migraine, which is when migraines occur on 15 or more days per month. Those who suffer from chronic migraine use a combination of acute, preventive, and complementary treatments to try to control or lessen the disabling pain. Depression, anxiety, and sleep disturbances are common for those with chronic migraine. These sufferers are often significantly disabled, and their overall quality of life is greatly diminished. Although there are many contributing factors to the progression from episodic migraine to chronic migraine, medication overuse is the most common. Over-the-counter as well as prescription drugs can cause overuse headaches. Overuse is defined as using pain killers, triptans, or certain other medications more than 2-3 days per week, week after week and month after month. This can create a headache-worsening pattern that results in more headaches and the resulting need to take more medicine. Not only is the pattern itself harmful, but while in this cycle, other effective treatments often do not work. The only way out of this cycle is to stop the pattern of overuse, which should be done under a doctor s care. Researchers are currently investigating the role of opiates and pain-killers in the progression to chronic migraine. Exercise and Migraine Exercise programs are frequently recommended to promote health, control weight, and prevent disease. But migraine sufferers typically are less physically active than those who don t suffer. They often avoid exercise, worrying that the exercise itself will aggravate or trigger a migraine.

5 Sufferers who follow certain common-sense guidelines can improve their quality of life and increase their aerobic endurance and flexibility without aggravating or triggering their migraines. Here are some tips: Keep your exercise low-impact. Use equipment like stationary bikes or ellipticals that minimize pounding movements. Try yoga, isometric or band exercises. When using a treadmill, increase the incline rather than the speed to minimize pounding movements. Stretching and weight-bearing exercises are fine, but be careful of the neck area. This is a very tender and vulnerable spot that directly affects migraines. Drink water and stay hydrated. Dehydration is a very common migraine trigger. Take it slowly. Work up to longer and more intense exercise as your body gets stronger. Listen to your body if an exercise aggravates your migraines, don t do it! But don t abandon exercise. Consult a trainer or physical therapist for alternatives. Source: Migraine Research Foundation

6 Types, Triggers, and Prevention When to See a Doctor Not all headaches require a physician's attention. But headaches can signal a more serious disorder that requires prompt medical care. Immediately call or see a physician if you or someone you're with experience any of these symptoms: Sudden, severe headache that may be accompanied by a stiff neck. Severe headache accompanied by fever, nausea, or vomiting that is not related to another illness. "First" or "worst" headache, often accompanied by confusion, weakness, double vision, or loss of consciousness. Headache that worsens over days or weeks or has changed in pattern or behavior. Recurring headache in children. Headache following a head injury. Headache and a loss of sensation or weakness in any part of the body, which could be a sign of a stroke. Headache associated with convulsions. Headache associated with shortness of breath. Two or more headaches a week. Persistent headache in someone who has been previously headache-free, particularly in someone over age 50. New headaches in someone with a history of cancer or HIV/AIDS. Diagnosing Your Headache How and under what circumstances a person experiences a headache can be key to diagnosing its cause. Keeping a headache journal can help a physician better diagnose your type of headache and determine the best treatment. After each headache, note the time of day when it occurred; its intensity and duration; any sensitivity to light, odors, or sound; activity immediately prior to the headache; use of prescription and nonprescription medicines; amount of sleep the previous night; any stressful or emotional conditions; any influence from weather or daily activity; foods and fluids consumed in the past 24 hours; and any known health conditions at that time. Women should record the days of their menstrual cycles. Include notes about other family members who have a history of headache or other disorder. A pattern may emerge that can be helpful to reducing or preventing headaches.

7 Once your doctor has reviewed your medical and headache history and conducted a physical and neurological exam, lab screening and diagnostic tests may be ordered to either rule out or identify conditions that might be the cause of your headaches. Blood tests and urinalysis can help diagnose brain or spinal cord infections, blood vessel damage, and toxins that affect the nervous system. Testing a sample of the fluid that surrounds the brain and spinal cord can detect infections, bleeding in the brain (called a brain hemorrhage), and measure any buildup of pressure within the skull. Diagnostic imaging, such as with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), can detect irregularities in blood vessels and bones, certain brain tumors and cysts, brain damage from head injury, brain hemorrhage, inflammation, infection, and other disorders. Neuroimaging also gives doctors a way to see what's happening in the brain during headache attacks. An electroencephalogram (EEG) measures brain wave activity and can help diagnose brain tumors, seizures, head injury, and inflammation that may lead to headaches. Headache Types and Their Treatment The International Classification of Headache Disorders, published by the International Headache Society, is used to classify more than 150 types of primary and secondary headache disorders. Primary Headache Disorders, including Migraine Primary headache disorders are divided into four main groups: migraine, tension-type headache, trigeminal autonomic cephalgias (a group of short-lasting but severe headaches), and a miscellaneous group. MIGRAINE If you suffer from migraine headaches, you're not alone. About 12 percent of the U.S. population experience migraines, one form of vascular headaches. Vascular headaches are characterized by throbbing and pulsating pain caused by the activation of nerve fibers that reside within the wall of brain blood vessels traveling within the meninges. Blood vessels narrow, temporarily, which decreases the flow of blood and oxygen to the brain. This causes other blood vessels to open wider and increase blood flow. Migraines involve recurrent attacks of moderate to severe pain that is throbbing or pulsing and often strikes one side of the head. Untreated attacks last from 4 to 72 hours. Other common symptoms are increased sensitivity to light, noise, and odors; and nausea and vomiting. Routine physical activity, movement, or even coughing or sneezing can worsen the headache pain. Migraines occur most frequently in the morning, especially upon waking. Some people have migraines at predictable times, such as before menstruation or on weekends

8 following a stressful week of work. Many people feel exhausted or weak following a migraine but are usually symptom-free between attacks. A number of different factors can increase your risk of having a migraine. These factors, which trigger the headache process, vary from person to person and include sudden changes in weather or environment, too much or not enough sleep, strong odors or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, low blood sugar, skipped meals, tobacco, depression, anxiety, head trauma, hangover, some medications, hormonal changes, and bright or flashing lights. Medication overuse or missed doses may also cause headaches. In some 50 percent of migraine sufferers, foods or ingredients can trigger headaches. These include aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, monosodium glutamate, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. Keeping a diet journal will help identify food triggers. Who Gets Migraines? Migraines occur in both children and adults, but affect adult women three times more often than men. There is evidence that migraines are genetic, with most migraine sufferers having a family history of the disorder. They also frequently occur in people who have other medical conditions. Depression, anxiety, bipolar disorder, sleep disorders, and epilepsy are more common in individuals with migraine than in the general population. Migraine sufferers-in particular those individuals who have premigraine symptoms referred to as aura-have a slightly increased risk of having a stroke. Migraine in women often relates to changes in hormones. The headaches may begin at the start of the first menstrual cycle or during pregnancy. Most women see improvement after menopause, although surgical removal of the ovaries usually worsens migraines. Women with migraine who take oral contraceptives may experience changes in the frequency and severity of attacks, while women who do not suffer from headaches may develop migraines as a side effect of oral contraceptives. Phases of Migraine Migraine is divided into four phases, all of which may be present during the attack: Premonitory symptoms occur up to 24 hours prior to developing a migraine. These include food cravings, unexplained mood changes (depression or euphoria), uncontrollable yawning, fluid retention, or increased urination. Aura. Some people will see flashing or bright lights or what looks like heat waves immediately prior to or during the migraine, while others may experience muscle weakness or the sensation of being touched or grabbed. Headache. A migraine usually starts gradually and builds in intensity. It is possible to have migraine without a headache.

9 Postdrome (following the headache). Individuals are often exhausted or confused following a migraine. The postdrome period may last up to a day before people feel healthy. Types of Migraine The two major types of migraine are: Migraine with aura, previously called classic migraine, includes visual disturbances and other neurological symptoms that appear about 10 to 60 minutes before the actual headache and usually last no more than an hour. Individuals may temporarily lose part or all of their vision. The aura may occur without headache pain, which can strike at any time. Other classic symptoms include trouble speaking; an abnormal sensation, numbness, or muscle weakness on one side of the body; a tingling sensation in the hands or face, and confusion. Nausea, loss of appetite, and increased sensitivity to light, sound, or noise may precede the headache. Migraine without aura, or common migraine, is the more frequent form of migraine. Symptoms include headache pain that occurs without warning and is usually felt on one side of the head, along with nausea, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to light, sound, or noise. Other types of migraine include: Basilar-type migraine mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head. Hemiplegic migraine is a rare but severe form of migraine that causes temporary paralysis-sometimes lasting several days-on one side of the body prior to or during a headache. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families the disorder is called Familial Hemiplegic Migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate. Menstrually-related migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura (which is much more common during menses than migraine with aura), pulsing pain on

10 one side of the head, nausea, vomiting, and increased sensitivity to sound and light. Migraine without headache is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain. Headache specialists have suggested that fever, dizziness, and/or unexplained pain in a particular part of the body could also be possible types of headache-free migraine. Ophthalmoplegic migraine an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil, and double vision that may last for weeks, long after the pain is gone. Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches. Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that sufferers need to be hospitalized. Migraine Treatment Migraine treatment is aimed at relieving symptoms and preventing additional attacks. Quick steps to ease symptoms may include napping or resting with eyes closed in a quiet, darkened room; placing a cool cloth or ice pack on the forehead, and drinking lots of fluid, particularly if the migraine is accompanied by vomiting. Small amounts of caffeine may help relieve symptoms during a migraine's early stages. Drug therapy for migraine is divided into acute and preventive treatment. Acute or "abortive" medications are taken as soon as symptoms occur to relieve pain and restore function. Preventive treatment involves taking medicines daily to reduce the severity of future attacks or keep them from happening. The U.S. Food and Drug Administration (FDA) has approved a variety of drugs for these treatment methods. Headache drug use should be monitored by a physician, since some drugs may cause side effects. Taking headache relief drugs more than three times a week may lead to medication overuse headache (previously called rebound headache), in which the initial headache is relieved temporarily but reappears as the drug wears off. Taking more of the drug to treat the new headache leads to progressively shorter periods of pain relief and results in a pattern of recurrent chronic headache. Headache pain ranges from moderate to severe and may occur with nausea or irritability. It may take weeks for these headaches to end once the drug is stopped. Everyone with migraine needs effective treatment at the time of the headaches. Some people with frequent and severe migraine need preventive medications. In general, prevention should be considered if migraines occur one or more times weekly, or if

11 migraines are less frequent but disabling. Preventive medicines are also recommended for individuals who take symptomatic headache treatment more than three times a week. Physicians will also recommend that a migraine sufferer take one or more preventive medications two to three months to assess drug effectiveness, unless intolerable side effects occur. Natural treatments for migraine include riboflavin (vitamin B2), magnesium, coenzyme Q10, and butterbur. Non-drug therapy for migraine includes biofeedback and relaxation training, both of which help individuals cope with or control the development of pain and the body's response to stress. Coping with Headache Headache treatment is a partnership between you and your doctor, and honest communication is essential. Finding a quick fix to your headache may not be possible. It may take some time for your doctor or specialist to determine the best course of treatment. Avoid using over-the-counter medicines more than twice a week, as they may actually worsen headache pain and the frequency of attacks. Visit a local headache support group meeting (if available) to learn how others with headache cope with their pain and discomfort. Relax whenever possible to ease stress and related symptoms, get enough sleep, regularly perform aerobic exercises, and eat a regularly scheduled and healthy diet that avoids food triggers. Gaining more control over your headache, stress, and emotions will make you feel better and let you embrace daily activities as much as possible. Non-pharmaceutical approaches to treatment and prevention A variety of headache education and drug and/or behavioral management techniques are aimed at improving headache treatment and prevention in adolescents. Scientists are testing the effectiveness of combined pain coping skills including age appropriate biofeedback, muscle relaxation techniques, imagery, activity pacing, and the use of calming techniques. Additional studies include the use of alternative approaches such as yoga to decrease headache in adolescents, and a modified diet to treat chronic daily headache in teenagers. Craniosacral therapy (CST) involves gentle massaging of the neck, head, and spine to release constraints in tissue in the head and around the spine. Limited preliminary data shows significant, sustained benefit of CST in a small group of individuals with migraine. Future research will gather data on the usefulness of CST in preventing migraines and examine the feasibility of a larger, randomized trial.

12 Electrical stimulation of the occipital nerve has effectively eased the symptoms of painful chronic headache conditions such as cluster headache as well as hard to treat migraine in small clinical studies. A tiny battery-powered rechargeable electrode, surgically implanted near the occipital nerve, sends continuous energy pulses to the nerve to ease pain. The use of this non-drug treatment in reducing migraine frequency, intensity, and effect on quality of life is being tested in larger clinical trials. Source: National Institute of Neurological Disorders and Stroke Headache Info Page Migraine Triggers This fact sheet outlines the main aspects of trigger factors in relation to people with migraine. What is a trigger? A trigger is any event, change, external stimulus or physical act which seems to result in migraine. It precedes the attack by a short interval which could be as much as up to 6 to 8 hours. Identifying a trigger is not always easy. Almost any factor can trigger an attack in a person predisposed to this condition and the list of possible suspects can be long and confusing. What triggers your migraine? People with migraine often avoid cheese, chocolate, citrus fruits and red wine. For most people, however, just avoiding certain foods will not prevent their migraines occurring as the situation is more complicated than that. Trigger factors seem to build up over a period of time and together result in a migraine attack. This helps to explain why, if you have a tendency to migraine, you might eat a certain food on one day and have no ill effects whereas on another day you will experience a migraine. Trigger factors are certainly present at the onset of migraine attacks, but it is not possible to state simply that chocolate or cheese, for example, causes migraines. These are factors which can have a part to play, if you are predisposed to migraine. Dr Anne MacGregor (Understanding Migraine and Other Headaches) gives an excellent explanation of this process: Imagine a migraine threshold that is determined by your genetic makeup. This threshold is also raised or lowered by external factors, as well as internal changes in your brain. Varying triggers occur over a period of time. If a sufficient number of different internal and environmental triggers build up to cross the current threshold a migraine attack is initiated. This explains why you do not always get a migraine attack in similar situations perhaps your threshold fluctuates or the number or importance of triggers varies. Consequently, missing a meal and less obvious triggers such as flickering sunlight or a lack of sleep do not always bring on an attack. However, if any or all of these are combined with a period of stress at work or hormone changes an attack may occur.

13 You may feel full of energy before an attack and rush around. When the attack begins you may think your migraine was therefore caused by this over activity. In fact such mood changes (which may equally be experienced as a low mood), cravings for sweet things, tiredness, incessant yawning, increased energy or feeling thirsty can all be a sign that the attack has already begun (called the premonitory phase). Changing triggers It is important to remember that your trigger factors are likely to change over time and new triggers may be discovered if your circumstances change. Stress and red wine may be implicated at times whereas neck and back problems at other times may be more significant. A migraine diary It has been suggested that rather than trying to decide what individual factor triggers a migraine, it is more useful to discover how many triggers are needed to start the migraine. This is where keeping a trigger diary can be so helpful. The diary can include information on as many aspects of daily life as possible to see what may be a trigger, including: what and when you eat missed or delayed meals your medication social and work activities your bowel movements vitamins or any health products taken the exercise you take how much sleep you have other aspects such as environmental factors women should record details of their menstrual cycle. Then the diary can record the physical aspects of the attack such as: when the head pains started if there are other symptoms (such as being sick or having vision problems) how long the attacks last and where the pain is It is vital that you record the number of attacks you have in a month. It is often useful noting if you did anything different prior to the attack such as missing a meal. The 6-8 hours before the migraine attack are particularly important to record. The diary may then highlight a particular trigger or series of triggers which could be avoided or minimized.

14 How to keep a trigger diary It may be helpful to look at your daily list of potential triggers before you go to bed each night even when you have not had a migraine. The trigger diary should then be reviewed after you have experienced at least three migraines. The information should be compared to see if there is a build up of factors which coincide with the attacks. So, for example, if you experience your migraines in the late mornings, it may be that low blood sugar due to lack of food is implicated. Eating a snack in the mid morning may be a simple remedy to help alleviate this. You should then divide your list of triggers into two columns: those which you can do something about (such as avoiding missing meals or sleeping late at weekends) those which are beyond your control (such as your menstrual cycle or starting a new job) You may then be able to cut out those triggers which you can influence one at a time and record any changes in the pattern of your migraine. Dietary advice Many people with migraines are advised to avoid particular foods, however, they may find that they can control their migraine by identifying other trigger factors with only limited changes to their diet. Some of the more common migraine triggers are listed below. If, however, you think a certain food item does trigger your migraine, first try to establish whether this is the case using a trigger diary. If you are concerned about avoiding any food related trigger factors you can see your GP, practice nurse or ask for a referral to a dietician for specialist advice. Common triggers Changes in routine Some people find that changes in their routine can contribute to a migraine. For example changing sleep patterns or changes caused by long journeys can precede an attack. Even pleasant changes such as a holiday can be implicated. Weekend headaches Many people complain that they suffer migraines at the weekend. At the weekend you may have a change in many of your daily routines such as eating times, reduced caffeine consumption which is particularly noticeable if you have a lie in after a busy week. See also stress, sleep, and caffeine below.

15 Stress Migraines and stress are strongly linked. Indeed, anxiety, excitement and any form of tension and shock may all lead to a migraine attack. However, some people report that their migraines start when the stress reduces. This is sometimes experienced as weekend headaches when, after a busy and stressful week at work, an individual might experience a migraine at the weekend when they are more relaxed. Sleep The complex nature of trigger factors is illustrated by sleep. Both too much and too little sleep can be implicated in a migraine starting. Some people find that sleepless nights, a number of late nights and being over tired can trigger a migraine. Other people find that sleeping in or dozing in the mornings has the same effect. Caffeine Excessive consumption of caffeine may contribute to the onset of a migraine attack. You could try not having more than 4 or 5 cups of tea, coffee or cola in a day. Some people find that suddenly stopping caffeine altogether can also be a trigger factor. If you suspect this, you may wish to cut down on caffeine more gradually. Some people find that consuming less caffeine at the weekend can have an impact on migraine attacks, but you should also note that caffeine can be found in many products including chocolate and over the counter painkillers. Hormonal changes in women Migraine is closely associated with female hormones. Some women find their migraines start at puberty, and are linked to their menstrual cycle. The additional hormonal trigger for women may explain why more women than men experience migraine during their reproductive years. The menopause is often the most difficult time for women with migraine. The environment There are certain trigger factors which can be related to environmental issues such as high altitude, weather changes, high humidity, loud noises, exposure to glare or flickering lights. Computer screens/vdus

16 Sitting in front of a computer at home or work for long periods of time can cause problems if you experience migraine. Following common sense precautions such as taking regular breaks, using anti glare screens and good lighting can help prevent this sort of difficulty. Sitting comfortably is very important when you use a computer to avoid muscle tension building up in the head, neck and shoulders. This muscle tension is implicated in the onset of migraine. Food Food related triggers occur in about 10% of people with migraine. Many people will crave sweet food such as chocolate before the pain of the migraine is experienced which leads them to conclude that eating sweet food is a cause. However, sometimes the craving for particular food is a symptom of the beginning of the migraine. Lack of food Missing meals or eating sugary snacks instead of a balanced meal can all contribute to a migraine attack. Insufficient food is probably one of the most important dietary triggers. You may find that eating small nutritious snacks at regular intervals can help to control your attacks. Additives Some food products contain chemicals or additives which may also be implicated in an attack. Ones which are frequently mentioned by people with migraine are monosodium glutamate, nitrates and aspartame. Alcohol and cheese There is some evidence that red wine may trigger a migraine because it contains tyramine which has been linked to migraines. Certainly many people with migraine avoid red wine. Tyramine is also found in other food products such as soft cheeses like camembert and brie. Mild dehydration Mild dehydration can have an impact on people who have migraine. It is recommended that you should drink at least 8 glasses of water per day. This is in addition to any other drinks you may have. Fizzy drinks can contain the sweetener aspartame which some people link to their migraines.

17 Drugs Taking cocaine and withdrawal from cocaine can trigger an attack. Exercise Like sleep, exercise can both help to prevent migraines and conversely can be a trigger factor. Regular exercise which is built up gently can help to prevent migraine. It also stimulates the body to release its own natural painkillers, as well as increasing the individual s sense of well-being and general health. Sudden vigorous exercise, particularly for people who do not usually take exercise, can be a trigger factor. Oral contraceptives The use of contraceptives which contain hormones such as the contraceptive pill can trigger migraine for some women. Medical advice should always be sought if this occurs. If you already experience migraine you should tell your GP this before you start taking hormonal contraceptives. Teeth grinding Some people grind their teeth during the night and find they wake with head pain. If this is the case it is worthwhile seeing a dentist as there are special mouth plates (called occlusal splints) which can reduce the teeth grinding. Physical conditions Head injury - Specific head injuries can result in headaches and migraine. Muscle tension - Tense muscles in the neck and shoulder areas can cause headaches and may be a premonitory symptom of the migraine starting. Coughing - Repeated coughing can lead to a migraine for some people. These are the most common triggers. If you are prone to getting migraines, it is wise to suspect everything until you have identified or eliminated a particular factor by using your trigger diary. References Dowson, AJ. Migraine and Other Headaches Your Questions Answered. Edinburgh: Churchill Livingstone 2003 Silberstein, SD Lipton, RB Goadsby, PJ Smith, RT. Headache in Primary Care. Oxford: Isis Medical Media,1999

18 MacGregor, A Understanding Migraine and Other Headaches. Dorset: Family Doctor Publications Ltd, 2005 MacGregor, A Migraine in Women, Revised Edition. London: Martin Dunitz, 2003 Hot Topics in Headache. London: The Migraine Trust 2002 Source: The Migraine Trust Migraine Triggers