Pain is bad. But when it keeps pounding in your head ceaselessly for a week, sometimes occurring two to four times a month, that’s just inexplicably horrible. What makes it worse is that for most people, migraines don’t come with an early warning indicator.

They affect just one in twenty of us (don’t confuse a plain headache with migraine) and they are three times more common in women than in men.

‘A migraine is a headache in which blood vessels in the brain constrict and dilate, releasing inflammatory substances that cause painful pulsations,’ explains Dr Yie Teck Leong, senior resident medical officer at Sunway Medical Centre (03 7491 9191/www.sunway.com.my/sunmed). The causes of migraines are rather complex and somewhat controversial. ‘One theory is that the symptoms are due to temporary changes in blood vessels. Attacks may also be associated with allergic reactions, bright lights, loud noises, physical or mental stress, changes in sleep patterns, missed meals or even hormonal fluctuations.’

However, Dr Yie assures that true migraine headaches are not a result of underlying brain tumours or other serious medical problems. Nevertheless, only an experienced physician can determine whether headache symptoms represent migraines or another underlying condition that requires further testing.

Dietary
A migraine is personal. The trigger differs between individuals. Still, not many of us bother to find out what sets off the throbbing pain in our heads. ‘(A) migraine is something we often overlook. Migraine comes, pop a Panadol and that’s it. That’s the common practice here,’ says Dr. Ng Yee Voon, a dietitian also from Sunway Medical Centre.

But that’s not the right way to go. To find out if your migraine is diet-related, Dr Ng suggests that you keep a food diary for at least three days, which preferably includes two weekdays plus one weekend. ‘We try to find out the item that triggers the migraine and avoid it. Then we reintroduce it to see if the migraine comes back. Only then we can pinpoint if food is the trigger.’

According to Dr Yie, foods that are commonly associated with migraines include chocolates, nuts, onions, dairy products, baked goods, meat containing nitrates (bacon and hotdogs), food containing the amino acid tyramine (red wine, aged cheese, smoked fish and some beans), and even fruits such as avocado and banana.

Having regular meals might also help reduce the chances of developing migraine attacks. Dr Ng explains that a structured lifestyle may lessen stress and in turn, there is a lesser chance of getting migraines.

Yoga
Seeing how stress is a common trigger among city dwellers, ‘mYoga’ instructor Adrian Chua recommends restorative yoga as a relief option. ‘Restorative yoga is based on Hatha yoga. It can really relax the mind and the body. The postures are geared towards getting you to unwind, settle and rest. And since movement might aggravate migraines, these postures minimise the need to move,’ explains Adrian.

These four postures (see figure) pretty much focus on the back. ‘Such as the forward bend — this helps block out the glaring light from the eyes. It also serves to parallel the heart against the floor so that it calms you down a little,’ says Adrian. Props such as blankets, bolster, wooden blocks and even straps, which are regular household objects, are used to provide additional comfort to the body. And this is particularly important because for people affected by migraines, having support to the spine does wonders.

When you have familiarised yourself with yoga, Adrian recommends that you look into the breathing part. ‘Most of the time, because of our hectic lifestyle, we tend to take really rapid or shallow breaths that limit our oxygen intake. Yoga can help us deepen the breath, so you inhale and exhale more. And in a way that encourages the body to accept more oxygen and go into a more relaxed state,’ Adrian explains.

However, Adrian suggests that you learn restorative yoga (mYoga 03 2289 8588/www.mYogaOnline.com) first before practicing it at home. The instructor will be able to make any alterations to the postures or props to better suit your body size.

Fitness
Exercise can work both ways. Too much, too strenuous and it could trigger migraines. When you start exercising without prior planning or warm up, your body develops a sudden demand for oxygen. Or if you have not eaten properly prior to exercising, your blood sugar level drops and this too can trigger migraine attacks. Similarly with dehydration. Also, you should refrain from jumping straight into a vigorous keep fit programme at the same time as a healthy new diet. Your head might not agree with the sudden change of lifestyle stressing out your body.

Having said that, Rammish Mariam, master trainer from California Fitness (03 2295 0088/www.californiafitness.com), says that research has shown that moderate aerobic exercise can have a therapeutic effect on migraines and may even prevent an attack. These could be jogging, swimming, cycling, brisk walking and even dancing, but it’s important that you choose an activity that you enjoy. ‘Exercise stimulates your body to release natural pain-controlling chemicals called endorphins, and natural anti-depressants known as enkephalin,’ says Rammish.

Once your body is accustomed to the aerobic routine, up the game a notch and start on weight training but continue to supplement your workout with either jogging or swimming. For starters, three times a week with 30 minutes of moderate intensity per session would be good. ‘Begin your exercise programme gradually and build up the momentum over several weeks. It is best to do short, frequent sessions,’ says Rammish.

Give yourself six weeks to see if there are any beneficial effects. Rammish also suggests keeping a migraine/exercise diary to record the pain and your workout to give you an idea of the effect aerobic exercise has had on your migraine, and if they are related at all.

Alternative Therapies
‘When you take the pulse of a person with a migraine, often enough you’ll feel that the artery is very constricted; it feels tight. The treatment with acupuncture would be to soften the pulse and make the blood flow better,’ says Oran Kivity (012 934 8040 /www.japaneseacupuncture.net), who is a practitioner of Japanese acupuncture.

Chinese or even Japanese medicines talk about the contrasting and complimenting elements of yin and yang, hot and cold. ‘Very often you find people who have migraines, or tendency to headaches, have very tight shoulders. Sometimes red face and very often have cold feet. In acupuncture, we call that condition “deficiency below, access above,”’ says Oran.

In this case, migraine is internal in origin. It comes from an imbalance in the body and as Oran puts it, ‘it’s like a big electrical storm in the body’. So migraine needs to be treated internally and acupuncture works exactly that way.

However, Oran thinks that oil-based massages might not be effective because they only soften the back muscles and the neck, which only relieve some of the minor headaches. ‘The more energetic types of massage such as zen shiatsu, acupressure or Thai massage work on the meridian lines. And because they are working more internally, they can balance the body’s energy better, which would be more likely to have an effect [on migraines],’ Oran explains.

Unlike Chinese acupuncture, the Japanese variety is very subtle. The silver needles are not inserted into the skin but merely touch the acupuncture points. It’s light and non-invasive. Most of the time, you won’t feel that it’s there. ‘People don’t realise that it’s profoundly relaxing. They often fall asleep during treatment. In return, their digestion improves, sleep improves and the shoulder pain is gone,’ says Oran about the misconception with Japanese acupuncture.

Oran also states that our lifestyle today tends more towards deficiency diseases because we tend to be exhausted. It’s true. ‘We work very hard. We are always on the go. We don’t nourish ourselves properly. We don’t sleep enough. Our lives are always full of movement, not enough stillness,’ says Oran. ‘So meditation is very useful in balancing ourselves because it’s enforced stillness,’ he adds.

But just how much sleep is enough? ‘You should always be asleep between midnight and 4am because that’s the most restful time,’ says Oran. But do we listen?