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Epidemiologist Dr Fiona Imlach has lived with migraines for many years.

Now, as co-founder of Migraine Foundation Aotearoa New Zealand, she has also spent many years researching them.

Imlach told RNZ’s Jim Mora that a TikTok video suggesting a “McMigraine Meal” (a bottle of Coke and a side of salty fries) as a treatment might not be all that far-fetched.

“TikTok is not really the font of all wisdom but there is some element in this in terms of the cola, which has caffeine in it, and we know that caffeine can be quite an effective migraine treatment.”

However, she said medication with caffeine in it could be a problem if over-used.

Does it really work?

An alternative was to limit caffeine intake to one or two cups of coffee per day and take it at the same time each day because the migraine brain “likes routine”.

A sugar hit could also help, Imlach said, because there is a theory that a migraine attack was triggered by nerves in the brain being depleted of glucose.

On the salty fries, Imlach said food cravings were much stronger during the prodrome phase, causing people to think the food they ate triggered the attack when actually it was already under way.

Salt was not known to help treat an attack, she said.

Imlach told Mora there is a lot of mystery surrounding migraines.

In the past, migraines had been treated as a vascular disease and thought of as an allergic disease with certain triggers, but Imlach said it is very much recognised as a neurological disease.

She said migraine was a genetically determined condition and some people inherited a pre-disposition through one of their parents.

A person who suffered migraines was thought to have a “sensitive” brain, or a hyperactivity toward sensory input, and it did not react the way it normally would, she said.

“That triggers all these other things you get with a migraine attack. Often people think about headache pain but also things like being sensitive to light and sound.”

Those symptoms, along with nausea, fatigue and mood disturbances, were a brain disturbance caused by the sensitivities and could be painful and unpleasant, she said.

Migraine is a disease of the brain which is present all the time but symptoms are only triggered during an attack.

When the attack is over, the migraine tendency does not go away.

Imlach said a classic migraine started with sufferers “feeling a bit rotten” in the “premonitory” stage, which preceded the attack.

This is a stage which people hadn’t recognised very well in the past.

Imlach said she herself suffers cognitive difficulties during this phase - being unable to speak properly.

The premonitory or prodrome phase could last up to two days according to brain scans of some patients.

“So you’re going about your life, you haven’t got a headache, you think you’re fine but actually your migraine attack has started.”

These early symptoms include difficulty concentrating, fatigue and mild head pain, and that could be a warning sign.

A full-blown attack involves other symptoms including a visual aura.

“I used to get spots in my vision, which I couldn’t see, or I’d get flashing lights.

“And then you move on to the headache phase and that can last for a few hours to a few days.

“Quite a severe pain. Usually on one side of the head – for me it was on one side of the head – sometimes it would move to the other side of the head for a while.”

Neck pain, nausea and vomiting are also common for Imlach, who said while light sensitivity is common for many, she is highly sensitive to sound during an attack.

“Even someone speaking to me can feel really painful and echo in my head and also I get sensitive to smells so smells can be really unpleasant.

“Even someone’s deodorant can make me want to vomit.”

Migraine prevalence is two to three times higher in women than men.

“The hormone is probably the most common trigger. So women who have migraines will have a hormonal triggering element to that.”

This becomes obvious around puberty, while after menopause migraines could improve.

Differing medication and resistance

There are two types of treatment for migraine – acute and prevention.

The best available treatments for an attack is migraine-specific medication called triptans, as well as over-the-counter medicines.

For frequent and severe attacks, Imlach said a preventative treatment should be considered to “calm the brain down”.

“Traditionally all we’ve had is treatments that have been repurposed from other conditions.

“So we’ve had anti-depressants which people have taken and sometimes found it helps their migraine attacks.”

Others found to help are beta blockers and anti-hypertension medicines as well as botox, none of which are specifically developed to prevent migraines.

In the past nine years, new micro-medications have been developed specifically to treat one of the neurotransmitters in the brain involved in the pain part of the migraine attack, Imlach said.

“Those have been a revolution in treatment and they don’t have the same side-effects – they’re much more tolerated – because they’ve been developed with migraine in mind.”

Unfortunately, they are not funded, she said.

“We have three available in New Zealand at the moment but they are quite expensive and they’re on Pharmac’s waiting list so they’ve been approved for funding but they’re just waiting to see whether Pharmac can actually get the budget to fund them.”

Imlach said frequent migraine sufferers have to be careful about taking too many migraine-specific triptans and over-the-counter medicines such as non-steroidal drugs.

“If you start taking too many of those you can actually make the headache worse and you can actually develop a headache.”

That spoke to the migraine brain’s sensitivity, she said.

-RNZ