Migraines - more than a pain in the head
Headaches are a pain. We all get them now and again but for non-migraine sufferers, they may just be that - a pain we can work through.
Migraine is different - and more common than you might think, as this week's Migraine Awareness Week hopes to help us all understand. It's estimated that one in four women and one in 12 men get migraine at some point. That's about 8 million people in the UK, meaning it affects more people than diabetes, epilepsy and asthma combined. The World Health Organisation ranks it as one of the top 20 most disabling adult conditions worldwide in terms of years of healthy life lost due to disability. (1)
The pain of migraine is often, but by no means always, felt on one side of the head. Importantly, only about one in four people get the pre-headache 'aura' (features include flashing lights, loss of part of your vision, numbness in one or more limbs etc). Lots of sufferers in my surgery don't realise that they may benefit from migraine treatments because they don't get an aura. The pain tends to be pulsating, moderate or severe in intensity and enough to stop you functioning. But for quite a lot of my patients, the biggest issue is not so much the headache but how ill they feel. Migraine sufferers can be exquisitely sensitive to light or noise, and feeling or being sick is not unusual. In addition, migraine sufferers may feel anxious, irritable, tired, confused and light-headed.
All this would be bad enough if you were trying to get a job done. But migraine often reaches its peak in your 30s or 40s, when women in particular are trying to juggle home and work commitments and stopping, or even slowing down, is not a feasible option. Migraine is also surprisingly common in children, and it's estimated that a total of 25 million days are lost from school or work each year in the UK because of this condition. (2)
While 'simple' painkillers such as paracetamol or ibuprofen may not help once the attack is well under way, they can be surprisingly effective if they're taken at the start of the migraine headache. Hardly surprising, then, that many migraine sufferers take tablets at the first hint of pain. But this can lead to the vicious cycle of medication-overuse headaches - the third most common cause of headache after migraine and tension-type headache. NICE (National Institute for Health and Clinical Excellence) recommends that doctors should consider a diagnosis of medication-overuse headaches in anyone taking simple painkillers such as paracetamol or ibuprofen on more than 15 days, or anyone taking combination painkillers or triptan tablets on more than 10 days, in each month for three months or more. (3)
Most people know that cheese, chocolate and red wine can bring on migraine. But so can hormone changes, smoky rooms, irregular meals and disrupted sleep. Keeping a migraine diary can help identify triggers and avoid them as far as possible. Or if you prefer to record your diary in app form, try downloading patient.info's free Migraine Diary app for iPhone.
If you get an aura, it's best to avoid painkillers during the aura but to take them as soon as the throbbing headache develops. Painkillers combined with anti-nausea medication are available from your doctor if it's hard to keep anything down. Triptans can be very effective (although they should be avoided on more than 10 days a month). If you're caught away from home without your triptan, you can now buy Imigran Recovery from your pharmacist.
If you're a migraine sufferer, do be aware of the risks of medication-overuse headache - they are the most common kind of headache seen in hospital neurology clinics, because they can be so debilitating and hard to treat. (4) If you're needing painkillers more and more often, do see your GP before you reach this stage. And if someone you know suffers from migraine but you never have, don't ever imagine you know what it feels like. And don't ever believe it's just a headache - sadly, in terms of leading a normal life, it's often so much more.
1) The World Health Report 2001, WHO
2) Steiner et al, Cephalalgia, 2003
3) National Institute of Health and Care excellence. Headaches - Diagnosis and management of headaches in young people and adults NICE clinical guideline 150, NICE, September 2012
4) Dodick D. N Engl J Med. 2006;354:158-165