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In partnership with the University of Melbourne, Dr Wijeratne has also designed an online education course to help GPs correctly diagnose migraine. Titled ‘Mastering Migraine Management’, this interactive masterclass in whole headache medicine contains about eight hours of educational material, from videos to reinforcement questions. In addition, the International Headache Society has published a reasonably complex headache disorders classification resource that’s available online in most languages. The intention is for doctors to use it as a reference when required, rather than trying to remember every diagnosis. About migraine Migraine has multiple phases. The first is known as prodrome, which can last anywhere from a few hours to a few days. During this phase the brain starts to become chemically sick and electrically transient. It is believed these changes happen in the back of the brain in a centre called the hypothalamus. This area tells us when we’ve had enough food, and when to go and have a particular drink or eat something specific. It’s a key component of food preference. “There is a common belief that many people get migraine when they eat cheese or chocolate or drink red wine. To my mind this is almost a total myth. Because the hypothalamus has become sick, your sick brain basically commands you to consume the cheese, chocolate or red wine. So nine out of ten times, it is a symptom of the prodrome phase rather than the trigger. “Other possible symptoms of prodrome include excessive yawning, binge eating, binge drinking, suddenly feeling miserable when everything else is going hunky dory or feeling hunky dory when everything is pretty miserable. Inappropriate moods can also occur, as well as fatigue or tiredness that hits you like a bulldozer after you woke up feeling well.” After the prodrome phase, about 15 to 20% of patients experience what is known as aura. Aura is basically Neurological symptoms moving from one area to another. “While many people understand aura to be vision effects, like flashing lights, aura can also be sensory or motor effects. In other words you can experience a spreading tingling or numbness moving from one area to another, or some sort of motor abnormality.” After the aura, migraine sufferers’ experience the acute attack phase and finally the postdrome phase. “I have patients who have a postdrome phase that lasts one to three weeks, during which they feel exhausted. So if your prodrome lasts a couple of days and postdrome lasts a week, you can be out of action for half a month.” Dr Wijeratne’s colleagues at the Mayo Clinic have presented some research on doctors who suffer from migraine. In the research, the doctors performed activities on a tablet; when they were going through a migraine, they showed a seven to eight second delay compared to when they weren’t. “Imagine if this is a neurosurgeon, a vascular surgeon or a cardiologist putting a stent into a coronary artery. A seven second delay could cause the patient’s death and it would not be recognised as migraine related. So, migraine is a huge burden that we need to fix as a matter of urgency.” Headlines 13