Migraine
Neurologist Perth
What is a migraine?
Migraine is a distinct neurological disease where you have recurring headaches. What we call a migraine would typically last for hours, anywhere between four and 72 hours. On top of the headache, you may experience nausea or vomiting. You may be extremely sensitive to light or sound.
If you often experience a throbbing headache, and it gets worse as you go about your daily routine, then your GP might refer you to me for further diagnosis.
A migraine can include 4 phases:
- Prodrome: This phase may precede an actual migraine attack by 24-72 hours. What you would experience can be a combination of tiredness and fatigue, yawning, food cravings, a stiff neck and sensitivity to light.
- Aura: This is a phase that usually occurs within an hour before the actual headache begins, and it generally lasts less than 60 minutes. About one in three migraine patients experience ‘auras’, so you may not necessarily have them before a migraine attack. But if you do have auras, you may experience temporary visual symptoms such as blind spots or zigzag lines floating across your field of vision. Other patients describe the symptoms as shimmering spots or stars, and flashes of light. Migraine auras sometimes cause numbness, which you would typically feel as tingling in one hand or on one side of your face. Other patients experience speech or language difficulties, or a weakness in their limbs.
- Attack: The migraine attack itself is the most intense phase. You would have a one-sided pulsating or throbbing headache. It can be moderate, or it can have a severe intensity. Sometimes a migraine attack causes nausea or vomiting, and sensitivity to light and noise. The headache (the migraine attack) can last between four and 72 hours.
- Postdrome: We call these symptoms the ‘postdrome’ phase, that arises or lingers after the actual migraine pain has resolved. Postdrome migraine symptoms can be fatigue and sensory disturbances, persisting for up to 24 hours.
As a neurologist, patients often ask me what distinguishes a migraine from a regular headache. Professor Peter Goadsby, one of the leading authorities at The Migraine Trust, defines it as follows: ‘Migraine is an inherited tendency to have headaches with sensory disturbance. It is an instability in the way the brain deals with incoming sensory information, and that instability can become influenced by physiological changes like sleep, exercise and hunger.’
Unlike a regular headache, migraine is a complex condition with a wide variety of symptoms, as you can see in the overview above.
As a Perth neurologist, I have developed a particular interest in the diagnosis and treatment of migraine. I believe that nobody should suffer from these debilitating symptoms, simply because they can heavily impact your quality of life, your family life and your work situation.
Migraine Specialist Perth
When to see a migraine specialist or neurologist?
If you suffer from non-severe headaches, it’s a good idea to start with a visit to your GP. However, I recommend you visit a neurologist, or a migraine specialist, if:
- You are over 50 and have chronic persistent headaches or a new type of headache
- Your headache is sudden and severe and accompanied by a stiff neck or fever
- Your headache started after you hurt your head
- Your headache is accompanied by nausea, vomiting, dizziness, confusion, loss of consciousness or blurry vision, limb weakness, speech disturbance
- You have two or more headaches per week
- Your headaches are getting worse over time and treatment has not helped
- Your headache is making it hard for you to carry out your daily life
- Your headaches are not responding to over the counter and / or prescription drugs
Your GP will help you define if you need a diagnosis from a specialist neurologist.
Perth Neurologist
What causes migraines?
As you start exploring and reading up on your migraine symptoms, you may wonder what causes the condition. There is actually no known cause for migraine, although there is a genetic predisposition. It means that when we look at the data, migraines seem to be more common in people with a documented history of migraine. Another thing we learn from research data, is that migraines are generally more common in women than in men.
In fact, any change in your environment could become a trigger, and that includes hormonal changes in women. So even if you are not totally clear about what exactly triggers your If you are susceptible to migraine, it can be triggered by a wide variety of external situations. Sometimes a migraine attack is intensified or triggered by stress situations. When I speak to my Perth patients, they would often tell me that bright lights, changes in the weather or some foods can set off an attack.
Other patients can clearly confirm that the use of alcohol, a lack of food, or a change in their sleep pattern, are responsible for a migraine attack.
If you have migraine symptoms, it may be wise to start the process and to see a neurologist.
Perth Migraine Specialist
How is migraine diagnosed?
Migraine is diagnosed based on your personal combination of clinical symptoms. As a migraine specialist, my role is to pay attention to every detail of your medical history. And because of the hereditary factors, that also includes your family history.
A physical examination may provide additional information to get a clear overview. If there are any red flags, further assessments may include:
- Eye examination - done by an ophthalmologist to rule out eye problems such as a retinal tear.
- CT brain scan - to rule out acute bleeding in the brain.
- MRI of the brain - to rule out raised intracranial pressure, strokes and structural lesions in the brain such as tumours.
- MRA and MRV - to rule out vascular abnormalities and thrombosis of veins.
- Lumbar puncture - may be performed if infection or bleeding is suspected.
Perth Neurologist
Migraine treatment in Perth
The diagnosis is an important step to have clear information, but your focus might be on reducing the symptoms and getting treatment for your migraines.
Your neurologist (or migraine specialist) may prescribe various types of medication to treat the attacks or to prevent them:
- Relief medication for migraine - these include:
- Pain relievers such as aspirin or ibuprofen,
- Triptans such as sumatriptan, rizatriptan,
- Opioid medications (should be avoided) and
- Anti-nausea drugs such as chlorpromazine and metoclopramide
- Preventive medications for migraine include:
- Beta-blockers such as propranolol
- Anti-depressants such as amitryptyline
- Anti-seizure drugs such as valproate and topiramate
- Botox for migraine
- Injections of onabotulinumtoxinA (commonly known as botox) about every 12 weeks help prevent migraines in some adults
- Injections of onabotulinumtoxinA (commonly known as botox) about every 12 weeks help prevent migraines in some adults
- Calcitonin gene-related peptide (CGRP), monoclonal antibodies - such as
- Erenumab (Aimovig),
- fremanezumab (Ajovy)
These are newer drugs recently approved by TGA but they have not yet received PBS subsidy. Therefore, these drugs can be very costly.
Why Dr Susan Ho?
As a neurologist with special interest in migraine, I understand how debilitating migraine symptoms can be. My patients at my practice in West Leederville Perth, have often told me what a negative impact the symptoms can have on their quality of life, their role in the family or at work. So I am very aware that migraine is often underestimated or even dismissed. And that may even include doctors.
Another problem with migraine is self-medication. When there is no specialised help available, migraine sufferers often decide to ‘get on with it’, using readily available treatments they picked up at the local pharmacy. And that can then lead to ‘medication overuse headaches’, or in other words, make the problems worse.
As a Perth-based neurologist with many years of experience in migraine management, I can help you with proper diagnosis of your migraine. The diagnosis is always the first step. Based on clear information, I then discuss appropriate treatment options with you. If you have chronic migraines that have not responded to oral preventive medications, I can administer botox injections.
I have recently completed a research study in the area of cognitive changes in chronic migraine. My findings are now published in the British Medical Journal Neurology Open.
(Click here to access the research on BMJ Neurology Open)
This was a prospective real world study of 60 patients with chronic migraine treated with onabotulinumtoxin A. At 6 weeks post-treatment, 88% of all patients reported a good response with greater than 50% reduction in headache frequency. Improvement in mood and cognitive measures were also noted.
My work here in Perth utilises knowledge gained from cutting-edge international research in the field of migraine neuroscience in recent years and I am committed to letting every single patient benefit from the long standing experience I have in this area.
Contact Dr Susan Ho
