Migraines — NZ Condition Guide | KiwiMeds

What are Migraines?

Migraines are recurrent, severe headaches that are often throbbing or pulsating and usually affect one side of the head. They are much more than just a bad headache — migraines are a neurological condition associated with nausea, vomiting, and extreme sensitivity to light, sound, and smell. Migraines affect around 15% of New Zealanders and are 3 times more common in women. They are a leading cause of disability worldwide. Many people can manage their migraines well with the right treatment strategy.

Symptoms

A migraine attack typically progresses through phases. The prodrome phase (hours to days before) may involve mood changes, food cravings, neck stiffness, or fatigue. About 25–30% of people experience an aura — neurological symptoms (visual disturbances such as flashing lights or blind spots, tingling, or speech difficulties) that develop over 5–20 minutes and last up to an hour before or during the headache. The headache phase typically lasts 4–72 hours — severe, throbbing, one-sided pain, often with nausea, vomiting, and light/sound sensitivity. The postdrome phase brings fatigue and “hangover” symptoms as the attack resolves.

Causes and Risk Factors

The exact cause of migraines is not fully understood but involves abnormal brain activity affecting nerve signals, blood vessels, and chemicals. Risk factors include family history (if a parent has migraines, there is a 50% chance of having them), being female (hormonal influences — migraines often worsen around menstruation), stress, poor sleep, skipping meals, dehydration, bright lights, strong smells, weather changes, and certain foods (alcohol — especially red wine, caffeine, chocolate, aged cheeses, processed meats).

Diagnosis

Migraines are diagnosed based on symptoms and history — there is no specific test. A GP or neurologist uses the ICHD-3 diagnostic criteria. Important features are the recurrent nature, the character of the headache, and associated symptoms. Brain imaging (MRI) is not routinely needed for typical migraine but may be done to rule out other causes if there are atypical features or “red flag” symptoms (sudden onset, worst headache of your life, neurological symptoms, fever).

Treatment in New Zealand

Migraine treatment has two components: acute treatment (stopping attacks) and preventive treatment (reducing frequency). Acute treatment: simple analgesics (paracetamol, ibuprofen, aspirin) work for mild attacks — take them early. Triptans (sumatriptan, zolmitriptan) are the most effective acute treatment and are funded by Pharmac for people with diagnosed migraines. Anti-nausea medicines (metoclopramide) can also help. Preventive treatment (taken daily): for people with frequent migraines (4+ per month), options include beta-blockers (propranolol), amitriptyline, topiramate (all Pharmac-funded), and newer CGRP antagonists. A migraine diary helps identify triggers and monitor treatment response.

NZ-Specific Information

Sumatriptan is funded by Pharmac for diagnosed migraines — ask your GP for a prescription if over-the-counter options are not working. The Migraine Foundation of NZ provides support. Migraines affect workplace productivity significantly — many employers have employee assistance programmes that can support migraine management.

Frequently Asked Questions

Can migraines cause permanent brain damage? Standard migraines do not cause permanent brain damage. However, people with migraines with aura have a slightly increased stroke risk — particularly women who smoke or use oestrogen-containing contraception. Are triptans addictive? No, but using acute migraine treatments (including triptans) more than 10 days per month can cause medication overuse headache. Can migraines be prevented? Yes — with the right combination of trigger management, lifestyle measures, and preventive medications, many people reduce their migraine frequency significantly.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Magnesium (Glycinate or Citrate) — Prophylactic magnesium (400–600 mg/day) has demonstrated a 41% reduction in migraine attack frequency in randomised trials. Deficiency is strongly associated with migraine susceptibility, particularly menstrual migraine. It is considered first-line evidence-based supplement prevention.
• Riboflavin (Vitamin B2) — Riboflavin at 400 mg/day has demonstrated 50% reduction in migraine frequency in randomised controlled trials, equivalent to some prophylactic medications. It is included in European headache society guidelines for migraine prevention.
• Coenzyme Q10 — CoQ10 at 300 mg/day has demonstrated significant reductions in migraine frequency and duration. Onset of benefit may take 3 months of consistent use.
• Butterbur (PA-free extract) — Standardised PA-free butterbur extract at 50–75 mg twice daily has the strongest evidence of any herbal supplement for migraine prevention, with randomised trial data supporting reductions in attack frequency up to 48%. Use only PA-free certified products.
• Melatonin — Melatonin 3 mg/night has shown equivalence to amitriptyline in a migraine prevention trial. It also improves sleep quality, a key migraine trigger.

Relevant Vaccinations

Individuals living with migraines may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Influenza illness is a known migraine trigger. Annual vaccination reduces trigger exposure.
• COVID-19 — Post-COVID headache and migraine exacerbation is a recognised complication. Maintaining vaccination may reduce this risk.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of migraines. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Magnesium-rich foods (dark chocolate, spinach, pumpkin seeds, avocado) — Dietary magnesium supports neurological stability and may reduce migraine susceptibility.
• Identify and avoid personal dietary triggers — Common dietary triggers include tyramine (aged cheese, red wine, preserved meats), caffeine excess or withdrawal, alcohol, MSG, and nitrates in processed meats. A migraine diary helps identify individual patterns.
• Regular meal timing (avoid skipping meals) — Hypoglycaemia is a major migraine trigger. Eating at regular intervals with protein at each meal maintains stable blood glucose.
• Adequate hydration (2–3 litres daily) — Dehydration is among the most common and modifiable migraine triggers.
• Omega-3 enriched diet — A diet enriched with omega-3 fatty acids (oily fish, walnuts, flaxseed) and reduced omega-6 has demonstrated reductions in migraine frequency through modulation of lipid pain mediators.

Related Conditions & Medications

Related medications: Sumatriptan, Ibuprofen, Paracetamol. Related conditions: Anxiety, Depression.