Commonly Asked Questions	Possible Answers
What causes migraine? Why does my head hurt so much?	Migraine is a 'brainstorm' leading to many changes in the body. A 'generator' in the brain becomes activated and causes the storm. At certain times, the generator may be more easily activated (i.e. the migraine threshold is lowered), and at these times even small triggers (e.g. lack of sleep or missing a meal) can cause migraine attacks. Several factors may work together to cause this increased sensitivity
Is this headache serious? Is there a brain tumour?	Although migraine is not a serious disease, an attack can be very disabling. The possibility of more serious illness, such as a brain tumour, is excluded by considering your medical history and conducting a complete physical examination
What can help or prevent the symptoms?	Migraine cannot be cured, but the attacks can be controlled and symptoms relieved by adequate treatment, including:    getting enough sleep and eating regular meals    avoiding other triggers (e.g. certain foods)    taking medications for the symptoms [e.g. ibuprofen, paracetamol (acetaminophen)] Preventative medication may be considered if attacks are frequent, severe and/or there is not adequate response to symptomatic treatment
Is it inherited?	Migraine, especially migraine with aura, runs in families. However, exactly how it is passed on is not known
What is the prognosis?	Migraine symptoms may disappear in adolescence, especially in boys. However, most patients will experience migraine as adults, although attacks may occur less frequently

Drug	Class	Dosage (oral)	Possible Adverse Events	Efficacya
Flunarizine†	Calcium antagonist	0.1-0.3 mg/kg/dayb	Bodyweight gain, drowsiness, GI effects, EPS, menstrual disturbances, depression	Reduced frequency and duration of migraine in 2 trials.[11,12] As effective as aspirin[13] or propranolol[14] in reducing frequency of migraine
Pizotifen	Serotonin receptor antagonist	1-1.5 mg/day	Bodyweight gain, drowsiness, nausea, muscle pain	Effective in 1 trial,[15] and prevented abdominal (but not classical) migrainec in a small study,[16] but was not effective in a further trial[17]
Propranolol	Beta-Blocker	1-2 mg/kg/dayd	Fatigue, bradycardia, hypotension, bronchospasm, sleep disturbance/nightmares, GI effects	Effective in 1 study,[18] but not in 2 others.[19,20] Similar efficacy to flunarizine in another double-blind trial.[14]

^†Flunarizine is not available in Australia and is available only in special circumstances in Sweden.
^aStudies were double-blind and placebo-controlled unless otherwise stated.
^bIt has been suggested that the therapeutic dosage is >/=5 mg/day.^[3]
cAbdominal migraine is a controversial condition that is defined as recurrent attacks of dull periumbilical abdominal pain associated with anorexia, nausea, vomiting and pallor in otherwise healthy children.
^dStarting dose. It has been suggested that the therapeutic dosage is >/=60 mg/day.^[3]
Abbreviations: EPS = extrapyramidal symptoms; GI = gastrointestinal.