We recently had National Headache and Migraine Awareness week in Australia.
Unlike other years there seemed to be more happening around it, and congratulations must go to Headache Australia for putting on a number of events, which were accessible online.
Two talks in particular gave me pause, the first from Dr David Williams of Monash Medical Centre, and the second from Dr Gerald Edmunds from Headache Australia.
The first talk from Dr David Williams I wrote about during the week, and expressed my frustration at people being labelled as ‘wired for life’ for migraines and that the best we can do is to try and increase the time between events, and try our best to minimise the severity when it does happen - primarily by using medications, botox or electrical stimulation.
All sound advice, however botox is only used once the condition has already become chronic, and medications and electrical stimulation are not preventive measures.
A broader view must be taken to recognise the extent to which we can minimise the number of events and decrease the frequency. There was certainly a sense of resignation to ‘learn to live with and minimise’ them.
At the end of the 'Awareness week' Gerald Edmunds, Secretary General for Headache Australia was interviewed on 3AW’s health show “House of Wellness”.
Gerald referred to one of the differences between a ‘headache’ and a ‘migraine’ is that migraine has a genetic basis.
"other than genes what causes migraines and whether environmental factors could be significant?
Gerald responded that that was more likely to be ‘headache’ as once you’ve got the migraine gene, you will be subject to them regardless. You just have to accept that they are going to happen and deal with them when they do.
Gerald Quigley, a pharmacist who co-hosts the show then commented that he is puzzled as to why amongst patients, particularly female, there seemed to be a ‘resignation’ that migraines are ‘just part of my lot in life’
I think it is hardly surprising that people (not only women) that they are ‘resigned to this being their lot in life’ when the key message being purveyed by ‘experts’ in awareness week is - "Learn to live with it, its genetic".
The disappointing aspect for me was not that the message of managing your triggers, relaxation and good healthy habits was being pushed. I couldn’t agree more with these sentiments.
My concern is that an opportunity has been missed to educate, and to de-mystify headache in all its forms, and that many sufferers will hear the 'its genetic so learn to live with it' line as a reason to not pursue treatments, and misrepresents what 'genetics' means and what we can do about it.
David Williams started to talk to the ‘migraine circuit’ but instead of going on to explain what this circuit is, and what types of things switch it on, he moved on to accepting that it’s a ‘bad circuit’ and lets try not to upset it.
At the end of the session Sally Obermeder suggests that maybe our modern lifestyle of looking down at our phones a lot is playing a role here. Unfortunately there was no support for the comment other than Gerald Quigley talking briefly to the effect of blue light. With the three nerves from the top of the neck feeding directly into the 'migraine circuit' in the brainstem our posture can be critical.
While I will talk quite heavily to the role of the neck in 'irritating' the migraine circuit, and the research that sows its fundamental to a well rounded approach, I will also touch on other topics over the coming weeks and months:
- such as the role of diet (not only as a trigger avoidance measure, but what foods may assist the body to minimise attacks)
- Importance of good sleep patterns
- Medication overuse headache: what is it and what drugs might pose the greatest risk
- Genetics and migraine: what does it mean?
Whilst I am not a specialist in any of these areas I think it is important to broaden the discussion across all areas, and bring you the opinions of those who are experts in the area for your own information, in the hope it may prompt you to discuss this first hand with someone who within their chosen profession (i.e. nutritionist) also has a good handle on the role their field plays in headache and migraine.
Roger O'Toole is the Director and Senior Clinician of the Melbourne Headache Clinic and has over 10 years experience as a physiotherapist.