Migraines are the most common type of headache that make us contact our doctor. They can be worse during the week before our period, and in the perimenopause. Thankfully 50-90% of women find they improve during pregnancy! Here are my top tips for managing migraines.
If you have recurrent headaches characterised by throbbing or pulsating pain on one side of the head, this is usually migraine. Many more of us are “migrainers” than we realise as it can often present with varying symptoms and the nature of the headache can change over our lives.
If headache limits our activities for 1 day or more, or is associated with light sensitivity or nausea, this increases the chance that it is a migraine.
Low oestrogen levels can trigger migraine. Menstrually related migraine happens at the end of the menstrual cycle. One treatment option for this can be to take the combined contraceptive pill 3 cycles back to back, or even continuously, however people who have “aura” with their migraines are not able to take the combined pill.
Aura is a visual, sensory or other central nervous system symptom associated with migraine.
Thankfully, having an aura with your migraines does not mean you can’t have HRT, which is a useful treatment for migraines in the perimenopause. During this time oestrogen levels can have large fluctuations and HRT can be used to regulate the levels.
At the onset of migraine, a combination of medications should be taken as soon as possible, otherwise they are less likely to work.
The standard treatment to relieve a migraine would be an antisickness medication, with a painkiller like aspirin or ibuprofen, together with a triptan. Providing there are no medical contraindications. These meds are all available over the counter from a pharmacist. (Check with the pharmacist and read the product leaflet before use.)
Codeine and co-codamol should be avoided. They increase the chance of medication overuse headache. Medication overuse headache is a bizarre but very real phenomenon which most people don’t know about. If you take medications for more than 10 days a month, they can actually cause headache! If in doubt, keep a diary to monitor your use. If you are taking a lot of aspirin or ibuprofen you also need to have a chat to your GP as there is a risk of stomach ulcers (and a few other risks) if used regularly. Take it with food, or with a prescribed antacid medication called a “proton pump inhibitor”.
Pregnancy is a special situation and you would need a discussion with your pharmacist or GP about what you can take.
Trying to determine migraine triggers is also really useful. This is another reason why a diary can help.
Migraine prevention medication is sadly too rarely sought out. This is medication that your doctor can prescribe to prevent migraine attacks. There are several options available and if one dosn’t work, another can be tried. In my experience they are usually effective.
Of course it is important to point out, that any really severe or excruciating headache, headache after head injury or with new unexpected neurological signs, needs urgent medical attention.
To find out more information about migraines, you can look at the Migraine Trust website.
Dr Joanna Clarke