Q + A with Neurological Nurse, Rachel Barnes.
Migraine is a common neurological condition that is reported to affect around 5 million Australians. Women are around three times more likely to experience migraines than men and over 80% of sufferers are of working age.
Classified by the World Health Organisation as a disability, migraine is often invisible, yet it can be a significant burden on an individual’s life, their family, their work and our wider society, with reports estimating the economic cost at around a staggering 35.7 billion annually.
As part of Migraine Awareness Month, we caught up with neurological nurse, Rachel Barnes, to shine a light on this “invisible”, neurological condition.
How would you define a Migraine?
A migraine is a complex, neurological disorder that affects multiple parts of the brain. They are typically associated with pain, usually on one side of the head, lasting anywhere from a few hours to days.
A migraine is much more than just a simple headache. While headaches are often associated with, or made worse by fatigue, lack of sleep, certain allergens, or stress, they’re generally successfully treated with rest or medications.
A migraine, on the other hand, can present with severe pain and may be accompanied by other debilitating symptoms such as nausea, vomiting, sensitivity to light, sound, and smells, tiredness, irritability and more. Migraines can also appear with no headache pain at all - every person’s experience is different, and symptoms may change with each migraine.
What are some of the other symptoms of Migraine?
Some sufferers can also experience a variety of more extensive visual and sensory symptoms known collectively as an aura.
This is typically in the form of; visual disturbance such as seeing spots, flashes, zig zags, stars, or even losing sight for short periods of time; sensory changes such as tingling or numbness in the face, body, hands, and fingers; or, even speech and language issues, for example, being unable to produce the right words, slurring, or mumbling words.
Some migraine sufferers may experience one or several of these symptoms at a time, and they tend to follow the headache. Others may simply experience aura symptoms without the onset of headache.
There can be 4 stages of migraine: 1. Prodrome phase which can last from 1 – 2 days, 2. Aura phase which might last for approximately 30 mins, 3. The attack itself, which could last from 4 – 72 hours, and 4. Post drome phase which can last from 1 – 2 days.
What causes migraines and what are some of the risk factors?
It is still unclear as to why some people get migraines and others don’t. What we do know, is that women are three times more likely to suffer from the condition than men, which may be because of hormonal fluctuations brought on by menstruation, menopause, childbirth or conditions such as endometriosis.
Some people can be susceptible to migraines if it is a condition that runs in their family, so their genes might be driving the condition. And, although obesity isn’t a direct trigger of migraine, it can potentially increase the risk for a regular headache progressing into a migraine.
Migraines can also be caused or triggered by certain things like stress, bright lights, lack of sleep, hormones, dust, certain foods or skipped meals, and even things like perfume or the weather – there are many things that can trigger an attack.
What sort of an effect can migraine have on a person’s life?
Severe migraines can have a huge impact on an individual’s quality of life and wellbeing. We’ve seen clients who have experienced a loss of confidence and an inability to carry out day-to-day activities, self-care, be productive, and maintain relationships due to their condition.
In addition, migraines can interfere with a person’s ability to work and maintain employment, causing frequent absences due to illness and often leading to a lack of engagement with colleagues.
Sufferers sometimes attempt to reduce their attacks by altering their diets or by avoiding certain environments, but this can also lead to feelings of isolation and may negatively impact relationships.
What treatments are available?
Before coming to us, many sufferers will have tried a range of pain relief and for some patient’s paracetamol or Ibuprofen in the early stages of a migraine attack can work well.
However, there are many other ways to treat the condition including:
Identifying triggers and managing them. Once the trigger is identified, patients can avoid them or minimise them, and migraine frequency can be significantly reduced for some people.
Lifestyle interventions are also very important, and many people find they can reduce the number of migraines by keeping fit, managing their stress and making sure they get the right amount of sleep.
Or, for more severe migraines, there are different types of migraine specific medications available that can play a role in successful treatment of the condition.
These can be acute treatments (i.e. medications to stop a migraine episode while it is happening or reduce severity or duration) or preventive treatments (i.e. medications designed to prevent migraine episodes from starting and reduce frequency and severity).
The medications available range from triptans to CGRP’s and are proving successful for many sufferers, although it is really down to trial and error with your doctor until you find what works for you.
How do you support clients to manage their migraines?
Every migraine is different and so are the circumstances of the sufferer, so one of the most important things we do when a client comes to us, is establish a patient history so we can begin to understand the best way forward for the individual.
For example, is there a pattern and frequency of attacks and how long do they generally last? Does anything seem to trigger the migraines? Is there a family history? At what age did the client begin experiencing migraines?
We determine the severity and type of pain, the location of the pain and whether it is worse when moving around. Do they experience any other symptoms before, during or after an attack, and are all the attacks the same or are there different types? How does the patient feel between attacks – are they generally well?
Clients are also encouraged to keep a migraine diary and a record with us so we can determine the frequency, severity and type of migraines they experience – this can be very important information when trialling new medications.
Home assessments can be carried out to determine if there are any triggers in the home such as air freshener plug ins, chemicals and the like, and we also do in-home health checks or assist with attending medical appointments where necessary.
The Neurological Council’s Neurocare model of care focuses on patient-centred condition management with wellness plans that are tailored to individual circumstances. With the appropriate advice, treatment and support, patients can transform their lives and manage their condition successfully.
While it may not always be possible to prevent chronic migraine, there are some steps that a person can take to help reduce the severity or duration.
Everyday things you can do now include making certain changes to your diet to include more healthy, unprocessed foods, ensuring you are having regular meals and an adequate intake of water, limiting caffeine and alcohol, practicing activities and exercises that encourage relaxation, such yoga or mediation, and ensuring that you are maintaining a consistent sleep routine.
There are many new treatments available now, so patients need no longer suffer in silence. Always talk to your doctor, ask about your options, and get second opinion if necessary.
Neurological Nurse, Rachel Barnes
and Migraine Sufferer, Joanne, who
has had success treating her migraines
with migraine specific medication.
Please note: This article should not be taken as a replacement for professional medical advice and is general information only. You should always consult your doctor if you believe you are suffering from migraines, or you notice that your symptoms are changing, becoming more severe, or increasing in frequency.