New migraine treatments in Australia

Written by Rachel Smith for Australian Seniors

I was 41, desperately deprived of sleep and five months post-partum when I had my first migraine. It hit on one side of the head, I could barely keep my eyes open and it didn’t respond to any ‘normal’ painkillers. Eleven years on, I manage between five to seven migraine attacks a month with rescue meds, and, like the one in three who suffer from this often ‘invisible’ condition, hope to one day be migraine-free.

Luckily, there’s more hope than ever for those living with the debilitating condition.

“In the last decade we’ve seen a generation of new medications,” Dr Jason Ray – neurologist and headache specialist at The Alfred Hospital – says. “We’re also getting better at conducting research, there’s more interest in migraine, and while we’re not where we should be yet, things are improving.”

What exactly is migraine?

Headache Australia describes migraine as a neurological condition that causes recurring attacks of moderate to severe headache, often accompanied by symptoms such as nausea, and sensitivity to light and sound.

Migraine is commonly described as occurring with or without aura. Aura refers to a group of temporary neurological symptoms that can happen before or during a migraine, often affecting vision, speech or sensation.

Migraine can also be classified based on how often it occurs. Episodic migraine refers to fewer than 15 headache days per month, while chronic migraine is defined as 15 or more headache days per month, with migraine features on at least some of those days.

“About one third of people have migraine with aura, which can occur generally before the headache,” Dr Ray says. “You might experience kaleidoscope-type vision or temporary blind spots.”

Other types of migraine include vestibular (causing dizziness and vertigo), hemiplegic (causing weakness on one side) or menstrual (linked to hormonal fluctuations). Thankfully, there are a number of treatments available to help you knock that headache on the, well, head.

Always consult your doctor or a qualified healthcare professional to discuss treatment options appropriate for your individual health circumstances.

Related: Migraine attacks: causes, symptoms, and treatments

Who can take what medication?

Internationally, CGRPs are recommended as first-line preventative therapies and are available to anyone who has more than four migraine attacks per month. In Australia, access to newer migraine treatments like CGRP medications is guided by strict clinical criteria and usually requires specialist assessment. Given migraine is estimated to cost the Australian economy around $35.7 billion each year in health system costs and lost productivity, the condition represents a significant burden for both individuals and the broader community. Dr Ray hopes this will change in time. “It would cost the government a lot of money to allow CGRPs to be prescribed in a less restrictive manner, but migraine is a common and disabling disease, and it impacts people in their most productive years. I think there’s a conversation to be had about the economic benefit of treating migraine [with these drugs].”

In five to 10 years, we’ll hopefully have more treatments in the toolkit, he adds. “There’s interest in personalised and precision medicine for treating migraine. Another neuropeptide, PACAP, is being investigated as a potential treatment.”

For any neurologist, nothing beats seeing people come out of chronic migraine. “I’ll often see people who have progressed through multiple neurologists and have quite resistant migraine,” Dr Ray says.

“So when you see improvement, and people being able to return to work, to caring roles and get their life back, sometimes after decades, that’s very rewarding.”

Visit Headache Australia to find neurologists who specialise in headache and migraine, apps and downloadable diaries to monitor your attacks and triggers, and a drug directory. For more on migraine, you can also read the Brain Foundation's fact sheet.

Related: The most frequently asked health questions

6 things to know about migraine as shared by Dr Jason Ray

1. The blame game doesn’t help: There are certainly things working for you or against you but migraine is a complex disease affecting the whole brain. It’s not controllable.
2. Migraine can’t cause dementia: But the cognitive fog you can experience during a migraine attack is a common complaint and can be disabling.
3. Migraine can be genetic: If you have a first-degree relative who has migraine, you’re more likely to experience it, but it may impact you totally differently.
4. Complementary therapies may help: Anecdotally, you may find benefit from acupuncture – and physiotherapy, particularly if you have a lot of neck symptoms.
5. A ‘migraine-friendly’ lifestyle is possible: Exercise, good sleep, eating well without fasting, limiting caffeine and reducing stress will play a role.
6. Weekend migraine IS a thing: You’re more likely to experience migraine after a period of stress – for the office worker that might be Friday night or Saturday, when your body finally relaxes, because your brain was running at one level and then it shifts.