As one of several GP specialists in Melbourne with a particular interest in treating migraines, I too often see the pain, inconvenience, and frustration patients endure.
While some people successfully treat their migraines, others remain underdiagnosed and under-treated.
Many just find a way to cope with this ‘invisible’ condition’. I empathise with you and am here to help.
ON THIS PAGE
- Headaches vs migraines
- Types of migraines
- Migraine triggers & phases
- Treatment options
- Who’s the best doctor to see for migraines?
- About Dr Michael Macpherson
I’ve consulted with patients for all types of migraines and firmly believe we must tailor migraine treatments to fit individual needs.
Helping you get back on track all starts with getting a proper diagnosis, figuring out what triggers your migraines, and then putting your personalised plan into action.
Managed by myself, your treatment may involve input from a care team, including a neurologist or migraine clinic.
How Headaches and Migraines Differ
Migraines are less understood and more complicated than headaches.
We know that migraines come in all shapes and sizes. They’re usually characterised by throbbing or pulsating pain, as opposed to the achy pressure of a headache.
Migraines can affect different parts of your brain and involve multiple symptoms, the most common being a headache.
Other symptoms include:
- nausea and vomiting
- sensitivity to light, sounds, and smells
- vertigo and dizziness
- blurred vision
- slurred speech or difficulty moving (if you unexpectedly experience any of these symptoms, please seek urgent medical attention).
Types of Migraines
Migraines come in many forms. I’ve summarised the most commonly diagnosed types below.
Migraine with aura
Around 30% of sufferers experience migraine with aura. People often sense an aura, visual distortion, or sensory event as a warning of a migraine attack.
Other symptoms include a headache (though not always), tingling arms and legs, muscle fatigue, and dizziness.
Common migraine (migraine without aura)
Experienced by up to 75% of sufferers, a common migraine usually attacks one side of the head with pulsating and throbbing head pain.
It can be severe enough to limit movement or physical activity. The best many can do is lie in a dark and quiet room.
Vomiting and light or sound sensitivity are also symptoms.
Vestibular migraines don’t always involve headaches, yet people regularly experience vertigo, unsteadiness, and dizziness.
Most patients have a childhood history of motion sensitivity, such as travel sickness.
As the name suggests, this migraine occurs before or during menstruation. Hormonal changes are often to blame, mainly a drop in oestrogen.
What Can Trigger a Migraine Attack?
Triggers that set off a migraine vary immensely between people.
Multiple triggers can be at play, making it tricky to recognise which stimuli are contributing to your migraines.
Common triggers reported by my patients include:
- Certain food and beverages, including those with additives like MSG
- A lack of sleep
- Hormonal changes and menstruation
- Certain medications
- Sensory stimuli, such as bright/flashing lights, sun glare, smells and noise
- Alcohol and drugs
During diagnosis, it’s an essential part of my job to help you identify your triggers.
I often recommend patients keep a migraine diary to track the timings of their migraines and specifics such as events and occurrences in days and hours before an attack.
There are many apps available to help track migraines and headaches.
Phases of a Migraine Attack
Unlike headaches, migraine attacks often occur in stages or phases:
Stage 1 – Premonitory or prodromal phase
Early warning signs of a migraine can occur up to 24 hours before it hits. These signs include:
- Mood swings
- Sudden appetite changes
- Neck and shoulder stiffness
- Frequent urination.
Stage 2 – Aura phase
Lasting 5-60 minutes, many people experience visual or sensory disturbances, or auras, in both eyes. Auras can come in the form of:
- Blind spots and visual disturbances
- Difficulty focusing or speaking
- Numbness and weakness
Stage 3 – Headache phase
Though not all sufferers experience headaches, this phase is when severe pain is most likely to occur, along with one or multiple of these symptoms:
- Light, sound, and smell sensitivity
- Nasal congestion
- Nausea and vomiting.
Stage 4 – Postdrome phase
Also known as the migraine hangover, this is when recovery begins. Some patients report feeling drained and wiped out for up to 24 hours. Others feel invigorated and energised.
Migraine treatments and management options are plentiful.
With a good dose of patience and a bit of trial-and-error, I’m confident we’ll find ways to help reduce the frequency of your migraines, minimise their intensity, help relieve your symptoms, or all of the above.
Undertaking a structured treatment plan always gets the best results.
Depending on your diagnosis and the type of migraines to which you’re prone, this plan may involve a combination of:
- Relief treatments
- Preventative medications, if necessary
- Complimentary therapies
- Lifestyle changes.
Also known as acute treatments, these medications help relieve symptoms within the first couple hours of a migraine attack, quickly putting the spring back in your step.
Over-the-counter aspirin, paracetamol, and ibuprofen can work a treat for people with mild symptoms. Others experiencing more severe attacks may benefit from triptans (migraine-specific medication) or prescription painkillers.
Some migraine treatments come in a nasal spray for those that suffer from vomiting with their migraines and may have difficulty swallowing tablets.
There are also a variety of medications for nausea and vomiting.
Aimed at preventing migraine attacks or at least reducing the severity of symptoms, this treatment approach centres around taking prophylactics at regular intervals, usually daily.
- Beta-blockers – otherwise used to treat high blood pressure
- Antidepressants, including anti-serotonergic medicines
- Anti-seizure treatments.
Neurologist-only medications are available for chronic migraine sufferers. These include:
- Emgality, an injectable drug that’s now on the Pharmaceutical Benefits Scheme (PBS)
If you’d prefer to go medication-free or combine natural treatments with your prescribed medication, there are plenty of options. The trick is to find what works best for you and your budget.
Here are a handful of therapies patients have used:
- Physiotherapy – works for some people depending on your migraine type.
- Massage and derivatives such as myofascial trigger point therapy.
- Cognitive behavioural therapy.
- Supplements such as magnesium and vitamin B2.
I can help you improve lifestyle factors and adjust daily routines that may contribute to your migraine attacks.
Making minor lifestyle changes can limit migraine triggers and prevent migraines while enhancing general health and well-being. Together, we can look at:
- Getting enough sleep.
- Adjusting your exercise approach and frequency.
- Improving diet and nutrition.
- Addressing any mental health issues and practising stress reduction techniques, including meditation.
- Reducing alcohol intake and stopping smoking.
Who’s the Best Doctor to See for Migraines?
Most people self-diagnose and self-medicate when they first start getting migraines, often with good results.
However, if symptoms persist, it’s a great idea to seek advice from a GP, especially one experienced in treating migraines.
We’ll occasionally refer patients requiring certain medications to specialists, though migraine sufferers don’t always need to see a neurologist.
Please make an appointment with your GP if you notice any of the following:
- Migraines are affecting your sleep, work, and social life.
- Over-the-counter medications aren’t relieving your headache symptoms.
- Your migraines are happening more often, and are feeling more intense than usual.
- You’re having trouble identifying triggers.
- Instinct tells you that you need help managing your migraines.
You’ll benefit from our years of practise caring for people in similar situations to yours and a personalised treatment plan for lasting relief.
Dr Michael Macpherson is a local GP at Doctors of South Melbourne.