Health

Migraines investigated: triggers, treatment and taking control

We look at why migraines are a feminist issue, the key triggers, as well as the latest intel on how to ease the pain...
Illustrations: Michelle Thompson

‘Most people rise with their alarm clock, but every few weeks I’m woken by an excruciating hammering in my head, which wraps its way from the front of my forehead to the base of my skull,’ says Poppy East, 51, a supply teacher. ‘Struggling desperately to quell nausea and avoid even the smallest sliver of light peeping through the curtains, I know I’ll be spending the next few days in pain in a dark room. And yet again, my work, relationships, family life – everything – must be put on hold.’

Make no mistake: a migraine isn’t just a ‘bad headache’. It’s a condition that can trigger intense pain on one or both sides of the head (and sometimes the face and neck, too), often accompanied by sickness, lethargy and sensitivity to light and sound, for anything from a few hours to a few days. About one in three sufferers will also experience temporary warning symptoms known as an ‘aura’, which can include seeing flashing lights, experiencing numbness, feeling dizzy or off balance and having difficulty speaking. (These symptoms can also signal a medical emergency – see ‘When to dial 999’, below.) And, yep, being a woman makes you more likely to have one – an estimated one in five women is affected, compared with just one in 15 men. Plus, in a study on the impact of Covid-19 by The Migraine Trust, more than half of people said their migraines were more frequent and a third said they were increasingly severe since the start of the pandemic.

As migraines are one of the biggest causes of work absenteeism in the UK and are ranked globally as the seventh most debilitating disease, this is a huge pain – literally and figuratively. So why are women getting more than their fair share, and what can be done?

Mind the (migraine) gap

The first thing you need to know? It’s thought that genetics may play a key role, and if you’re a frequent sufferer, it’s likely you were born with a predisposition. ‘The exact cause of migraines is unknown, but they’re thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain,’ says Una Farrell from The Migraine Trust. ‘Your genes make it more likely you’ll experience migraines, while hormonal changes and the menstrual cycle can trigger an attack.’

In fact, migraines can be heavily affected by hormonal events throughout a woman’s life. The first attack often occurs around puberty, with the time around your period being a danger zone. Migraines may improve during the later stages of pregnancy and worsen in peri-menopause. But – silver lining alert – everything may ease off after the menopause (although this isn’t always the case).

There could also be a migraine gap between men and women due to the gendered roles and extra things some of us take on. Take stress, which is one of the biggest migraine triggers. In a study from late last year, 73% of women reported feeling work-related stress, compared with 57% of men. Not to mention the fact that many women are doing more childcare, domestic chores or caring for elderly parents. No research has been done on this link, but it’s worth keeping in mind.

Trigger happy

What can flip the switch from zero to migraine? This varies, with common triggers including too little (or too much) sleep, bright lights, strong smells/perfume, dips in blood sugar, poor posture, caffeine or alcohol, dehydration, flickering screens, certain medicines and foods containing tyramine (such as cured meat, yeast extract and some cheeses). Even changes in the weather can be a culprit, with sizzling temperatures causing problems for some people and cold for others.

‘The migraine brain doesn’t like change,’ says Una. ‘When you get thrown off, your brain gets thrown off, and it’s then that a lot of migraines can happen.’ Anything out of routine – from staring at a work screen all day without a break to trying intermittent fasting and missing breakfast – could make your brain sense that something isn’t right.

Unfortunately, there are many triggers you can do diddly-squat about (like the weather). And what sets you off one day might not be a biggie the next. But if triggers happen while your hormone levels are fluctuating, then bingo. This is something that resonates with Poppy. ‘I get migraines around the start of my period, but I get them at other times, too, sometimes brought on by stress or alcohol, but other times not. Being aware of this and being mindful of things I can control helps, but it doesn’t give me a superpower to sidestep migraines altogether.’

New research also suggests that some so-called ‘triggers’ are actually giving us a different message. ‘Take chocolate – there’s a widespread belief it’s a cause, but this lacks scientific evidence,’ says Una. ‘Recent studies have actually found chocolate is likely to be a dietary symptom of a migraine, rather than a trigger – because you’re more likely to experience food cravings before the onset of a migraine.’

Migranes, Headache, Woman sleeping

Taking control

This is not a one-size-fits-all condition, so playing detective is key. ‘Keeping a diary over a few months, noting down things such as migraine frequency and whether they’re associated with common triggers can help you see patterns emerge,’ says Dr Louise Wiseman, a former GP and author of Your Best Life: A Doctor’s Secret Guide to Radiant Health Over 40. For instance, notice that you’re prone to migraines on weekends? This could be due to a change in your routine. Migraines coincide with your period? Discuss hormonal options with your GP. How you do your diary is up to you, but a template, such as the one at migrainetrust.org, can be useful, or an app such as Migraine Buddy or N1-Headache.

Then take your diary to your GP to get a migraine diagnosis (if you haven’t already), and deal with any obvious problem areas. Whether this means swapping coffee for herbal tea or ensuring you’re always hydrated, see what works for you. ‘There’s lots of interesting research being done right now on our internal clock – aka our circadian rhythm – and its impact,’ says Una. ‘Simple things such as keeping the same sleep/wake times on weekends can help.’ Dr Wiseman also suggests focusing on whole, healthy foods and reducing over-processed options that are laden with preservatives. Certain nutrients may be beneficial, too. ‘Magnesium is a well-researched factor in menstrual migraines, so ensure you eat enough leafy greens, nuts and cereals,’ she says. ‘Co-enzyme Q10, found in oily fish and whole grains, as well vitamin B2, found in lean meat, eggs and legumes, may also be helpful.’

Yay for science

The whoop-worthy news? ‘There’s been groundbreaking preventative migraine medication approved by the NHS in the last few years,’ says Una. Known as CGRP pathway monoclonal antibodies, they can be useful if you’re not responding to common treatments, but you’d need a referral to a migraine specialist.

Drugs aside, transcranial magnetic stimulation, which uses magnetic pulses, has been approved by NICE for the treatment and prevention of migraines. Even Botox – in your pain zones rather than your wrinkles, obviously – can be an option for chronic migraine sufferers, with research suggesting it can ‘turn off’ certain nerve cells involved in migraine pain. So keep talking to your GP about your options: remember, prescription medication can also relieve migraine symptoms or help prevent them. And ask about a referral to a specialist migraine clinic. Of course, over-the-counter medication can also be effective – but if you’ve been taking painkillers regularly, talk to a Boots pharmacist or your GP. Using the maximum dosage on a regular basis can make the headache worse.

For Poppy, her prescription medication and lifestyle tweaks, such as running, yoga and deep-breathing techniques, have been a lifeline.

So, speak to your GP, as drugs and treatments are changing all the time. Stay aware, deal with the things you can control and, all importantly, let go of what you can’t.

When to dial 999

Most headaches aren’t life-threatening. But call 999 immediately if you have: paralysis or weakness in one or both arms or on one side of your face; slurred or garbled speech; a sudden agonising headache unlike anything you’ve felt before; a high temperature and stiff neck with your headache. These symptoms can signal a serious condition, such as stroke or meningitis.

For more advice and support, go to migrainetrust.org.

 

Ease the ouch

Kool 'n' Soothe Cooling Gel Sheet

Kool ’n’ Soothe Migraine Cooling Gel Sheet EXCLUSIVE. When used at the first sign of a migraine, each gel sheet can provide instant, cooling relief by placing on the forehead.

Boots Migrane Relief Feverfew Capusles

Boots Migraine Relief Feverfew Capsules. A traditional herbal medicinal product used for the prevention of migraine headaches, exclusively based on long-standing use as a traditional remedy. Always read the label.

Boots Migrane Relief 50mg Sumpatripan

Boots Migraine Relief Tablets. They help ease pain in 30 minutes, and shut down sensitivity to light and feeling sick or being sick. Contains sumatriptan; always read the label; subject to suitability assessment.