Migraine prevalence
Migraine affects 4.9 million Australians1 and at least 12% of the global population2 with migraine incidence increasing by over two per cent between 1990 and 2019.3
Chronic pain conditions are complex, often requiring a multi- modality approach, and frequently impacting sleep, mood, and the individual's ability to socialise and work.4 More than one in two Australians with chronic pain will experience anxiety or depression because of their pain1 with many reporting that finding an effective management plan is often not easy.
Table 1. Migraine management approaches5,6
Difficulty in managing migraine
Migraine pathogenesis is complex making clinical treatment challenging.7 A therapeutic plan needs to be tailored to individual clinical characteristics, preferences, and needs with a range of approaches for each individual.5
Most pharmacological approaches for prevention were developed for other purposes6 and are ineffective for many people.8 Migraine is classified as refractory when all classes of migraine preventatives have failed treatment and at least eight debilitating headache days per month are suffered for at least six consecutive months.9
Migraine types
The varying subtypes of migraine complicate treatment.
Table 2. Migraine types
Migraine treatment options
Complementary medicines show great promise as adjuncts to standard care. There is good evidence supporting a range of nutrients such as zinc,12,13 magnesium,14 CoQ10,15,16 riboflavin,17 plus the herb, feverfew.18
Ketogenic or low-glycaemic diets offer significant promise.19 Acupuncture has been used effectively for both acute and preventative treatment and is as effective as some pharmaceutical interventions for the latter.20
Table 3. Migraine therapeutics
RESEARCH HIGHLIGHT
Vestibular migraines11
A recent (2023) study assessed the efficacy of two tablets a day for the treatment of vestibular migraine containing a combination of riboflavin 200 mg, vitamin B6 12.5 mg, folinic acid 250 mcg, vitamin B12 200 mcg, magnesium 150 mg, CoQ10 75 mg and Tanacetum parthenium (feverfew) leaf 280 mg equivalent to parthenolide 200 mcg over three months.
Vestibular migraine severity and frequency were assessed by the Dizziness Handicap Inventory (DHI), Vertigo Symptom Score short-form (VSS-sf), visual analogue for severity (VAS-s) and VAS for frequency (VAS-f).
There were improvements in all measures:
-
DHI decreased 44.1%
-
VSS-sf decreased 44.9%
-
VAS-s decreased 44.1% and
-
VAS-f decreased 38.9% More research needed
More research needed
More research is required to assess alternative treatment options to current pharmacological approaches to vestibular migraine management which may be associated with a range of side-effects including weight gain, sedation, weight loss, hypotension, and mood disturbances.11
Gender bias in healthcare
Two-thirds of Australian women report they have experienced healthcare-related gender bias or discrimination.27 Being dismissed and disbelieved is a common experience, particularly when symptoms relate to pain.27 It is unsurprising that many people with migraine do not seek medical care and, of those that do, many do not receive adequate diagnosis or treatment.2 A large US study found that more than half the cases of migraine go undiagnosed, rates of management with prescription medicines are poor, and migraine continues to cause significant disability.28
Finding a health professional who takes a woman’s concerns seriously can be a turning point for their health care, but women report that it can often take a long time to find such a person.27
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2. Burch R, Buse DC, Lipton RB. Migraine. Neurol Clin. 2019;37(4):631-649. doi:10.1016/j.ncl.2019.06.001
3. Safiri S, Pourfathi H, Eagan AW, et al. Global, Regional, and National Burden of Migraine in 204 Countries and Territories, 1990 to 2019. Pain. 2021;163(2):e293-e309. doi:10.1097/j.pain.0000000000002275
4. Healthdirect. Chronic Pain. Published online 2023. Accessed May 24, 2024. https://www.healthdirect.gov.au/chronicpain#:~:text=Chronic%20pain%20can....
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6. Jenkins B. Migraine Management. Aust Prescr. 2020;43(5):148-151. doi:doi.org/10.18773/austprescr.2020.047
7. Wang Y, Wang Y, Yue GX, Zhao Y. Energy Metabolism Disturbance in Migraine: From a Mitochondrial Point of View. Front Physiol.2023;14. doi:10.3389/fphys.2023.1133528
’8. Antona L, Matharu M. Identifying and Managing Refractory Migraine: Barriers and Opportunities? J Headache Pain. 2019;20(1). doi:10.1186/s10194-019-1040-x
9. Amiri P, Kazeminasab S, Nejadghaderi SA, et al. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Front Neurol. 2022;12(800605). doi:10.3389/fneur.2021.800605
10. Cheng T. Migraine. Published online 2021. Accessed May 22, 2024. https://headacheaustralia.org.au/migraine/
11. Hannigan IP, Rosengren SM, Di Tanna GL, Watson SRD, Welgampola MS. Effects of Nonprescription Therapies on Vestibular Migraine: A Questionnaire‐based Observational Study. Intern Med J. Published online 2024. doi:10.1111/imj.16314
12. Mazaheri M, Aghdam AM, Heidari M, Zarrin R. Assessing the Effect of Zinc Supplementation on the Frequency of Migraine Attack, Duration, Severity, Lipid Profile and hs-CRP in Adult Women. Clin Nutr Res. 2021;10(2):127-139.
13. Ahmadi H, Mazloumi-Kiapey SS, Sadeghi O, et al. Zinc supplementation affects favorably the frequency of migraine attacks: a double-blind randomized placebo-controlled clinical trial. Nutr J. 2020;19(1):101. doi:10.1186/s12937-020-00618-9
14. Schwalfenberg GK, Genuis SJ. The Importance of Magnesium in Clinical Healthcare. Kucuk O, ed. Scientifica. 2017;2017:4179326. doi:10.1155/2017/4179326
15. Hershey AD, Powers SW, Vockell ALB, et al. Coenzyme Q10 Deficiency and Response to Supplementation in Pediatric and Adolescent Migraine. Headache J Head Face Pain. 2007;47(1):73-80. doi:10.1111/j.1526-4610.2007.00652.x
16. Natural Medicines Comprehensive Database. Coenzyme Q10 Professional Monograph. Published online 2024. Accessed May 21, 2024. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-s...
17. Natural Medicines Comprehensive Database. Riboflavin Professional Monograph. Published online 2024. Accessed May 21, 2024. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-s...
18. Natural Medicines Comprehensive Database. Feverfew Professional Monograph. Published online 2024. Accessed May 21, 2024. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-s...
19. Jahromi SR, Ghorbani Z, Martelletti P, Lampl C, Togha M. Association of Diet and Headache. J Headache Pain. 2019;20(1). doi:10.1186/s10194-019-1057-1
20. Natural Medicines Comprehensive Database. Acupuncture Professional Monograph. Published online 2024. Accessed May 21,2024. https://naturalmedicines.therapeuticresearch.com/databases/health-wellne...
21. Natural Medicines Comprehensive Database. Melatonin Professional Monograph. Published online 2024. Accessed May 21, 2024. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-s...
22. Maghsoumi‐Norouzabad L, Mansoori A, Abed R, Shishehbor F. Effects of Omega-3 Fatty Acids on the Frequency, Severity, and Duration of Migraine Attacks: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutr Neurosci. 2017;21(9):614-623. doi:10.1080/1028415x.2017.1344371
23. Natural Medicines Comprehensive Database. Fish Oil Professional Monograph. Published online 2024. Accessed May 23, 2024.
24. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-s...
25. Liu H, Wang Q, Dong Z, Yu S. Dietary Zinc Intake and Migraine in Adults: A Cross‐sectional Analysis of the National Health and Nutrition Examination Survey 1999–2004. Headache J Head Face Pain. 2023;63(1):127-135. doi:10.1111/head.14431
26. Vetvik KG, MacGregor A. Sex Differences in the Epidemiology, Clinical Features, and Pathophysiology of Migraine. Lancet Neurol. 2017;16(1):76-87. doi:10.1016/s1474-4422(16)30293-9
27. Alexander L. Prevalence and cost of headache. Accessed May 20, 2024. https://headacheaustralia.org.au/what-is-headache/prevalence-and-cost-of...
28. Australian Government Department of Health and Aged Care. National Women’s Health Advisory Council. #EndGenderBias Survey Results - Summary Report.; 2024. Accessed May 20, 2024. https://www.health.gov.au/womens-health-advisory-council/resources/publi...
29. Lipton RB, Diamond S, Reed ML, Diamond ML, Stewart WF. Migraine Diagnosis and Treatment: Results From the American Migraine Study II. Headache J Head Face Pain. 2001;41(7):638-645. doi:10.1046/j.1526-4610.2001.041007638.x