Whether it’s severely debilitating or just a minor inconvenience, a pain in the head cannot be ignored. Healthy Food Guide senior nutritionist Rose Carr looks at ways to soothe the ache.
It’s believed 18 per cent of women and 12 per cent of men suffer from migraines and there’s a strong genetic link. Around 75 per cent of people who get migraines have a first-degree relative who also does.
Why do we get migraines?
We don’t know the underlying causes, but there are some common factors that may bring on a migraine in susceptible people. Triggers include:
• Specific food or drink (commonly, chocolate, caffeinated or alcoholic drinks, artificial sweeteners, cheese)
• Hunger or skipping meals
• Strenuous exercise, particularly if associated with meal skipping
• Physical factors, such as a head blow or spinal disc pressure around the neck
• Glare or flashing light
• Strong smells
• Anxiety, stress or relaxation after stress
• Hormonal changes Women who get migraines often start getting them around puberty, may improve during the later teens and 20s, only to worsen after having children.There is often improvement again after menopause. For some women, migraines are predictable at certain times in their menstrual cycle.
Migraines are diagnosed based on the description of the headache along with other symptoms. For around 30 per cent of people, migraines are preceded by an aura, thatis, loss of vision and flashing lights. Migraines are often accompanied by nausea and vomiting and can also be associated with hypersensitivity, particularly to light and noise and, sometimes, to strong smells.
A migraine can last for hours or days and the severity and frequency is highly variable between people and over a person’s lifetime.
Ever wondered how bad a migraine can be?
Here’s neurologist Jon Simcock, writing in the Neurological Foundation of New Zealand’s booklet on migraine: “During a severe attack, some people feel they would rather be dead, in contrast to people who have had a heart attack and worry that they may die.”
There are a range of prescription medications available to relieve the pain and nausea of migraines as well as some to help prevent them. In addition to medication, most people find lying in a quiet, darkened room, using hot or cold packs and applying pressure around the temples helps relieve the pain, or at least make it tolerable.
What you can do
Learning to recognise your triggers for a migraine is likely to be the most important thing to help you cope and to limit the impact migraines have on your life. To help identify triggers, keep a diary noting food, drink, sleep, stress, activity, migraines and other headaches, as well as medications used.
There are some uncommon disorders that start with migraines, so if yours become more severe and frequent, make sure your GP is aware of that.
Tension headaches are by far the most common headache. It’s thought around 80 to 90 per cent of us will experience a tension headache at some stage in our lives.
Tension headaches can be mild or severe and can occur rarely or often. Stress seems to be the most common trigger for these headaches, although how that actually causes a headache is not completely understood.
Sometimes headaches are caused by muscle tension around the back of the neck and scalp, with the original tension being from such things as lack of sleep, poor posture or anxiety.
Less common, but very painful, are cluster headaches, which occur at regular times daily, often during the night and in clusters that can last four to 12 weeks. While the body clock is thought to play a role, the root cause is unknown. During the cluster period, alcohol can trigger a headache, so most people who suffer these avoid alcohol at that time. Heavy smokers are more susceptible to cluster headaches.
There are also a raft of headaches brought on by activities such as coughing, exercise and, for some unfortunate folk, sex. And that’s before we get to trauma, injury, infection or other health issues that may, in turn, cause a secondary headache.
If you regularly suffer headaches, it’s a good idea to discuss that with your GP before getting too carried away with over-the-counter medications (see Rebound headaches, right). And although it’s difficult to pin down a specific trigger for some headaches, others may have an underlying cause that can be addressed. It could be as simple as muscle tension or disc pressure, but it could also be a lot more serious. If you regularly get headaches but they change or become more frequent, that’s another good reason to see your GP.
Here’s a good reason not to pop those pills if you don’t really need to. If you overuse headache medication, you can get even more headaches. And, the only way to stop the cycle is to go cold turkey on the medication. That doesn’t mean you can never take headache medication again, but it does mean you may not be able to take any medication for up to six weeks.
Different types of drugs can stimulate medication overuse headaches (MOHs), from aspirin to opioids, and you don’t need to be medicating every day. There can be unpleasant side-effects when you initially stop using the medication, so see your GP if you think you might need help.
Minimise the malaise
1 Eat and drink well
The starting point is to aim for a well-balanced, plant-based diet that will provide all the nutrients you need.
Then you need to remember to eat regularly and get plenty of fluids, favouring water and limiting caffeine, sugar and alcohol. And if you’ve identified trigger foods, avoid or limit those too.
The American Migraine Foundation recommend relaxation training as headaches are often related to the body’s reaction to everyday stresses.
For headache-prone people, stress does not need to be excessive, so learning specific techniques such as progressive muscle relaxation and abdominal breathing can often help.
Everyday activities that can help manage stress include any type of exercise, whether strenuous or gentle, watching a YouTube relaxation video, having a laugh with friends, listening to music, going to a movie or just reading a book.
Regular exercise helps keep our mind and body in the best shape possible. For some people, too-vigorous exercise can trigger a headache, but gentler exercise will help.
We often feel muscle tension around the neck and shoulders when we’ve been desk-bound or stressed. Practise some simple exercises to release this tension when you feel it building.
Aim for seven to nine hours each night, depending on your needs. Shorter or longer are not recommended.
Beware the hot stuff
After eating the hottest chilli in the world, the Carolina reaper, a 34-year old man started dry heaving followed by neck pain and, over several days, experienced brief intense thunderclap headaches. While lasting just seconds the pain was so excruciating he sought emergency help.
The man’s symptoms cleared up by themselves and a CT scan five weeks later showed the arteries that had been temporarily constricting had returned to their normal width.
The authors note that eating cayenne pepper has been linked to sudden constriction of the coronary artery and heart attacks.
Source: BMJ Case Reports, April 2018.
Other non-drug treatments
The evidence for different therapies to treat migraines and other headaches is not strong, as the body of research is limited. However, for people who suffer frequent or severe headaches, trying different treatments, as long as they’ll do no harm, could reap huge rewards.
• Manual therapies, such as physiotherapy, can often help with headaches and migraines caused by physical factors.
• Acupuncture may help treat frequent tension-type headaches and could also help people who get migraines, according to two 2016 Cochrane Reviews.
• Feverfew (Tanacetum parthenium L.) is a herbal remedy often used for the prevention of migraines. While it appears safe to use, its effectiveness is uncertain.
Can’t focus or think clearly? We often use the term ‘brain fog’ to describe a very mild tension headache. While not bad enough to be called a headache, that feeling of mental fatigue is an indication that something’s out of kilter.
Article sources and references
- BPAC NZ. 2008. Medication Overuse Headache, bpac.org.nz Accessed April 2018https://bpac.org.nz/bpj/2008/september/overuse.aspx
- Chiabi A et al. 2011. Manual therapies for migraine: A systematic review. Journal of Headache Pain 12:127-33https://www.ncbi.nlm.nih.gov/pubmed/21298314
- Gunasekaran K. 2018. An unusual cause of thunderclap headache after eating the hottest pepper in the world – ‘The Carolina Reaper’. BMJ Case Reports doi:10.1136/bcr-2017-224085https://casereports.bmj.com/content/casereports/2018/bcr-2017-224085.full.pdf
- Headache Classification Committee of the International Headache Society. 2018. The International Classification of Headache Disorders, 3rd edition. Cephalalgia 38:1-211https://www.ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf
- Linde K et al. 2016. Acupuncture for the prevention of tension-type headache. Cochrane Database of Systematic Reviews CD007587https://www.ncbi.nlm.nih.gov/pubmed/27092807
- Luedtke K et al. 2016. Efficacy of interventions used by physiotherapists for patients with headache and migraine: Systematic review and meta-analysis. Cephalalgia 36:474-92https://www.ncbi.nlm.nih.gov/pubmed/26229071
- Martin VT & Brinder V. 2016. Diet and headache: Part 1. Headache 56:1543-52https://www.ncbi.nlm.nih.gov/pubmed/27699780
- Martin VT & Brinder V. 2016. Diet and headache: Part 2. Headache 56:1553-62https://www.ncbi.nlm.nih.gov/pubmed/27699772
- Mayo Clinic. 2016. Cluster headache, mayoclinic.org Accessed April 2018https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080
- Rist PM et al. 2015. Dietary patterns according to headache and migraine status: A cross-sectional study. Cephalalgia 35:767-75https://www.ncbi.nlm.nih.gov/pubmed/25424709
- Simcock J. 2010. Migraine. A Patient’s Guide. Neurological Foundation of New Zealand, neurological.org.nz Accessed April 2018https://neurological.org.nz/sites/default/files/Migraine%20Handbook%204%20June%202010.pdf
- The Migraine Trust, migrainetrust.org Accessed April 2018https://www.migrainetrust.org/
- Wider B et al. 2015. Feverfew for preventing migraine. Cochrane Database of Systematic Reviews CD002286https://www.ncbi.nlm.nih.gov/pubmed/25892430