Welcome back to The Health Bar fellow geeks, with your resident health coach Robert House.
Today we are talking Migraines. The history, the science, the myths, all those cool little things to help you understand it better and, hopefully, help avoid them.
What are migraines?
The word migraine comes from the Greek hemicrania (hemi being half and crania being skull).
Migraines are an intense head pain but shouldn’t be confused with headaches as they can bring with them a whole host of other negative effects, including nausea, vomiting, light sensitivity and dizziness – though some migraine sufferers can experience these symptoms without a headache.
Migraines are common, really common. 1 in 7 people globally are affected by them. It’s more common than all bar 2 diseases, with cavities and tension headaches taking the gold and silver. Sorry ladies but you are 3 times more likely than your male counterparts to suffer from a migraine; though the likelihood of migraines drops after menopause, suggesting a hormonal cause. Migraines can start in puberty but the peak ages for migraine sufferers is 35-45, which as a 33 year old chronic migraine sufferer, doesn’t fill me with confidence.
Each day nearly 200K people in the UK suffer a migraine, and with a large percentage of these missing work, or those that do still go to work their productivity is only about a third of normal, there is a great economic cost as well with an average of 5.7 days a year being missed per migraine sufferer. The EU describes migraines as the most costly neurological disorder, with a cost roughly of £24 billion!
There are 2 main types of migraine, an aura migraine and a common migraine. A common migraine is just that, the most common form with roughly 80% of migraine sufferers having this form. They will normally come on without warning, can last anything from a few hours to a few days and have any of the side effects with it. Like most migraines they are typically on just the one side of your head and pain can be made worse even with simple motor skills such as walking.
Aura migraines differ in the way they typically start. People will experience an aura sensation before the start of the migraine. The person will experience one or more of a whole host of symptoms. This will be things like:
- Stars, sparkles, zig zagging lines or flashing lights
- Blind spots
- Coloured spots
- Tunnel vision
- Temporary blindness
- Numbness, pins and needles or tingling around the body
- Spinning sensation and dizziness
A few, rarer types include a menstrual migraine (syncs with menstrual cycle), brainstem aura (rarer form of aura), silent/acephalgic (aura but no migraine following), hemiplegic (temporary weakness on one side of the body) and, controversially abdominal migraine in children, where the pain is in the abdomen, though this is highly debated.
History Of Migraines
Migraines have always been a thing; the earliest known writing about any form of headache comes from over 6000 years BCE on an ancient Babylonian cuneiform tablet, then further definition on migraines actually comes from the Egyptians. As far back as 1500-1200 BCE there was writings regarding migraines and management thanks to them. On the Ebers Papyrus, the oldest known medical papyrus; there are recommendations that a clay effigy of a crocodile, with herbs stuffed in its mouth, tightly wrapped around your head, will cure the migraine. I hope they didn’t try a real crocodile first.
Galen of Pergamon (modern day Bergama in western Turkey) was the first to use the term Hemicrania, and first suggested that the pain comes from the meninges (The 3 layers of protective tissue around the brain and spinal cord) and the blood vessels way back in the second century, in his book De locis affectis. It would be 1500 years before it was recorded in medical literature again!
Come the 18th and 19th centuries, many would investigate migraines and one of the stand out moments is when in 1887 French librarian, Louise Hyacinthe Thomas was the first to split the migraines into the 2 types we still use today, aura and common.
Another was a British man called Edward Living, who worked with John Hughling Jackson on Epilepsy (which you can read about in our Coaching for Geeks article on epilepsy), who was the first to suggest the thalamus being disturbed accounted for the aura and that vagal nerve disturbance accounted for the nausea and vomiting. This was in 1873, and seems to be standing the test of time.
English Physiologist Thomas Willis, who discovered the reflex action, was the founder of clinical neurology and wrote the first clinical neurology textbook, was the first to suggest that migraines are genetic. Something that also stands up to testing today. Along with this though, in 1672, he was also the first to suggest a vascular component and argued that the pain is from vasodilation (blood vessels expanding and becoming bigger) of some of the heads main vessels – the meningeal and cerebral arteries.
American MDs John Graham and Harold Wolff were the first to study migraines in the lab and, following the vascular ideas set out by Willis, they showed that the vessels initially constrict before they dilate. They then discovered the first drug treatment for migraines, Ergotamine, and the rest, as they say, is history.
Causes of Migraines
Migraine may have been known about for all human history in one way or another, but we still can’t pin down the underlying reasons for them. What we do have though, is our best guesses and a building body of evidence. It is generally thought that your genetics play a strong role, with several family and twin studies showing a hereditary component. Though the results are varied, suggestions range from roughly 30% to 50% chance of the genes being passed on. This also isn’t helped by the way we are struggling to pin down which genes are the ones responsible.
Brain chemicals being out of sync can be a cause too. So that’s things like hormonal changes, for example, women during menstruation are far more prone to a migraine. Some medications have also been known to cause migraines in some people, for example some sleeping pills or, for you poor ladies again, the combined contraceptive pill. Sorry but the female population really got the short straw in this one. Migraines are also considerably more common in people suffering from stress, anxiety and depression, suggesting a strong negative emotional state can be a cause.
Environment! Not the green kind. Your daily environment can cause migraines to occur too, commonly this includes things such as:-
- Some foods like chocolate and cheese (basically my diet)
- Hypoglycaemia (low blood sugar)
- Temperature fluctuations
- Bright lights
- Loud noises
- Strong smells
Most of these are individually based, with some being more common than others, which just means it’s variable from person to person. It’s down to the individual to recognise what are the likely causes for themselves. The food additives Tyramine and Monosodium Glutamate (MSG) were suggested to be a big cause of migraines and are often included in generic information on migraines, but there really is no evidence to suggest that these are a cause.
Treatment Of Migraines
Now this is where we need to put our science hats on.
Because migraines are very common and affect a lot of people, there is a lot, and I really mean A LOT of pseudoscience around. This is also compounded by the way there are a lot of biases in play, a lot of anecdotal information and belief systems/old wives’ tales. With that in mind, let’s take a look.
Let’s start with the supported evidence – preventative medication. Anti-epileptic drugs, anti-depressants and beta blockers used to lower blood pressure (Sodium valproate, propranolol, etc), have been shown to reduce the incidences of migraine by up to half.
Pain killers are used to treat them once they have hit. Naproxen, co-codamol, ibuprofen, aspirin etc can all be used. But, as with most pain, getting them in early is the best course of action because once it’s become painful, it’s often really difficult to get back on top of it.
In the UK we seem to have a thing against suppositories. Honestly – they work quicker and with a better drug delivery efficacy. We just need to change the culture for that one though.
Triptan medications are something your GP can prescribe and these are the best we have. They cause the blood vessels in the brain to constrict, with the intention of reversing the cause of the migraine.
Now we move on to treating other symptoms like nausea. Simple anti-emetics can do the job here. Then, if you are like me and the light is not your friend, go lie in a dark room and reminisce about the times you took being able to blink comfortably for granted.
That’s about it for medication, but we can look at our lifestyles and how to improve these to help reduce to frequency of migraines. Exercise, diet, reducing stress, time management, sleep patterns, etc. all the wonderful things you can find help and advice for right here at the Coaching for Geeks health bar.
Now on to the pseudoscience stuff. These are the things that are not supported by tried and tested scientific methodology. But persist because of belief, placebo, lobbyists and bias. I should also make the point that the NHS has to include these sorts of things in its treatments section because there is still a vocal section in these areas that deem it should be included, despite no real evidence.
Acupuncture. No it does not cure migraines, sorry. People have said ‘yes it worked for me’ and that’s lovely, but the reason they improved wouldn’t have been acupuncture, or chi, despite that being the reason they accredit their improvement too. Most likely its placebo, desperation for a cure because it’s bad or observer bias. This also extends to Daith ear piercings, as ear cartilage has nothing to do with migraines.
Chiropractors. Sorry again, but no. I used to think of chiropractors as most do, as normal practitioners of a science. I remember the penny drop moment and that horrible awkward feeling of being wrong for ages about something. But, like all things if the evidence tells me something different to my beliefs, it’s my beliefs that have to change. Sadly there is no evidence to support any form of chiropractic practice and definitely not for helping migraines. Placebo and observer bias again are the most likely reasons people attribute spinal manipulation to their improvements.
Transcranial magnetic stimulation (TMS). This one is highly debated, but the evidence doesn’t seem strong as of yet. It’s more common in America but there are a few places that practice this in the UK.
Migraines are horrible things, but they are also really interesting. They affect so many people and have a huge social and economic cost. But by looking after yourself and with early treatment it can be easier.
As always, take care of yourselves and happy geeking!
Robert House – Operating Department Practitioner and Coaching for Geeks health correspondent
Follow Robert on Twitter @Roberthouse1985