One of the frustrating aspects of having a headache disorder is that there is no test to diagnose the condition. While tests are often done to rule out secondary causes of headache, and this can be a very important step, in most cases imaging such as MRIs and blood tests are normal. This can be difficult to accept when symptoms are very severe and frequent.
Primary headache disorders such as migraine, cluster headache and tension type headache are diagnosed based on symptoms and exclusion of other causes. Sometimes the diagnosis is straightforward – symptoms may be very classic and easily identifiable, but sometimes it is less clear. This can be the case if the symptoms have changed over time, or if there are other associated symptoms that are less classically recognised as being migraine related such as vertigo or sensory changes.
How can you be sure it is migraine?
We often will ask about how the symptoms were when they first started, such as in childhood or adolescence. In migraine we know that over many years, some of the classic features of aura, nausea and vomiting, having to lie down in a dark room and severe light sensitivity can reduce. The headaches can become the predominant feature but can become more persistent.
If there is a family history of migraine, then knowing this can be helpful, as the condition is highly familial. A childhood history of car sickness or motion sickness, or recurrent abdominal pain can also be helpful in diagnosing migraine. If there is a pattern of a visual aura (flashing lights, tunnel vision, squiggly lines) then twenty minutes or so later then onset of a headache, then this is almost certainly migraine. On the other hand, some people never or rarely experience visual aura.
People can experience more than one type of headache disorder. It is certainly possible to have migraines and tension type headaches, or migraine and cervicogenic headaches, or almost any combination. Keeping a diary can be very helpful in trying to work this out.
I have been told I have vestibular migraine, but I don’t have bad headaches?
Migraine is not just a headache, although it is the symptom that most people associate with it. It is a complex brain disorder, with among other things, abnormal electrical changes in the brain and changes in blood vessels. Vestibular migraine is a type of migraine which involves parts of the brain involved in balance and connections to the inner ear.
Most patients with vestibular migraine will also have some typical migraines with headache at times, but not always. The symptoms of vestibular migraine can include vertigo, tinnitus (ringing in the ears), motion sensitivity, unsteadiness, a sensation of rocking, nausea and vomiting. Often people have undergone a lot of other testing before they are diagnosed with vestibular migraine.
Vestibular migraine can respond to standard treatments for migraine. Vestibular physiotherapy can be very helpful as well, particularly with sensitivity with head and eye movements.
I am not keen to take medications – what can I do?
There is actually a lot that can be done to help control migraine without medications. For some people with migraine that is very intermittent, it may not be worth taking medications all the time (for example, daily preventer medications).
If you are keen to avoid medications, then the first step is to try to work out what are your triggers for migraine. If you don’t already have a good idea of the triggers, then it is a good idea to start a headache diary. There are several digital options available such as Migraine Buddy, but a pen and paper is also very effective. Each day record if you had a headache or not, the severity (0-10 – 10 being the worst pain), and whether there were any hormonal triggers present (menstruation, ovulation), and how much sleep you had the night before/quality of sleep. You could try to notice or record if you had any alcohol, particular foods, or if you were particularly stressed. This can be a lot of work, but if you do it for a month or two, you will probably have a good idea of triggers. If you have a headache every day this can be more of a challenge.
The most effective ways of improving headaches without medications are by improving sleep, improving stress and improving other lifestyle factors. It can be hard to do all this at once.
Some people find over the counter supplements to be helpful. Magnesium, Coenzyme Q10, some B vitamins and Curcumin can be helpful.
Massage therapy, acupuncture, physiotherapy and other techniques can be helpful.
No two people respond it the same way, and it could be that a combined approach is needed. Understanding triggers and patterns of your migraines is an important first step in the process.
Would you like to know more about relief from headaches and migraines? Contact us now and make an appointment today.