Mi­graine at­tacks – so much more than just a headache

Know­ing the trig­gers and liv­ing a healthy life­style are im­por­tant tech­niques to man­ag­ing mi­graine

The Irish Times - Tuesday - Health - - Migraine - Sylvia Thomp­son

The founder of the Mi­graine As­so­ci­a­tion of Ire­land, Au­drey Craven, de­scribes a mi­graine at­tack as “a power cut”. It’s a per­fect de­scrip­tion for the sud­den un­pre­dictable ar­rival of a se­vere headache, some­times ac­com­pa­nied by nau­sea, dizzi­ness, sweat­ing, weak­ness and hy­per-sen­si­tiv­ity to light, sound and smell. Es­pe­cially when you re­alise this melée of symp­toms means that suf­fer­ers usu­ally need to take a com­plete break so they can man­age their mi­graine in the way that suits them best.

Craven is one of the con­trib­u­tors to a new book, Mi­graine – Not Just An­other

Headache (Cur­rach Press), which of­fers a “one-stop shop” to un­der­stand­ing mi­graine. The book has chap­ters by a GP, a neu­rol­o­gist, a phys­io­ther­a­pist, a psy­chol­o­gist and ex­perts in mi­graine in chil­dren and sports peo­ple. It is edited by psy­chol­o­gist Dr Marie Mur­ray.

Craven, who founded the Mi­graine As­so­ci­a­tion of Ire­land in 1994 af­ter gain­ing sup­port ini­tially from the UK equiv­a­lent, writes in the book about her per­sonal ex­pe­ri­ence of mi­graine. “As a child, I suf­fered from what I now know to be ab­dom­i­nal mi­graine [ex­perts now agree the main symp­tom of mi­graine in chil­dren is of­ten tummy pains]. This grad­u­ally pro­gressed to se­vere one-sided headaches, vom­it­ing and di­ar­rhoea from my 20s on­wards,” she writes.

In the be­gin­ning, Craven’s mi­graine at­tacks lasted two to three days and oc­curred five or six times a year, but in her 30s, she ex­pe­ri­enced at­tacks three or four times a month. How­ever, it wasn’t un­til 1990 that she re­ceived the di­ag­no­sis of basi­lar mi­graine, a rare form which can in­clude loss of bal­ance, dou­ble vi­sion and faint­ing.

Di­ag­no­sis

Dr Paddy Daly, who writes the chap­ter on

Headaches in Gen­eral Prac­tice and Women and Mi­graine, says di­ag­no­sis is hugely im­por­tant. “Peo­ple with mi­graine aren’t eas­ily heard and are of­ten be­lit­tled. They of­ten suf­fer for years be­fore get­ting a proper treat­ment plan,” he says. “I spend 40-45 min­utes with some­one on their first visit. You have to lis­ten to what they are say­ing and what they aren’t say­ing.” There is no test for mi­graine and di­ag­no­sis re­lies on good case his­tory tak­ing.

Now re­tired, Daly worked in gen­eral prac­tice and at the headache clinic at St Vin­cent’s Univer­sity Hos­pi­tal in Dublin. He says mi­graine is of­ten un­der-di­ag­nosed by doc­tors, partly due to the time pres­sures of gen­eral prac­tice but also due to lack of on­go­ing train­ing of GPs on mi­graine.

“There has been a lack of progress on clin­i­cal pro­grammes on neu­rol­ogy. And, if more GPs were trained in mi­graine, there would be fewer re­fer­rals to spe­cial­ist ser­vices,” he says. Chronic or se­vere cases are re­ferred to one of the five mi­graine clin­ics in neu­rol­ogy de­part­ments in five hos­pi­tals across Ire­land.

Ad­dress­ing wider is­sues is also im­por­tant, ac­cord­ing to Daly. “It’s im­por­tant for peo­ple to re­alise that smok­ing, drink­ing, tak­ing drugs, be­ing over­weight or the hor­monal pill for women can also in­crease the risk of mi­graine.”

Know­ing your trig­gers, keep­ing a mi­graine diary, man­ag­ing stress and liv­ing a healthy life­style are im­por­tant self-man­age­ment tech­niques for those who suf­fer from mi­graine. Red wine, chocolate, cof­fee, changes in the weather are all very com­mon mi­graine trig­gers. Over-ex­er­cise can also be a trig­ger, es­pe­cially if you’ve skipped a meal, are dehydrated or lack sleep be­fore ex­er­cise.

Dr Ed­die O’Sullivan, clin­i­cal di­rec­tor of the Cork Univer­sity mi­graine clinic, pro­vides ad­vice to those par­tic­i­pat­ing in mod­er­ate or ex­treme ex­er­cise in the chap­ter on Mi­graine in Sport.

“Recog­nis­ing your trig­gers is cru­cial,” Craven says, “but also I be­lieve that peo­ple with mi­graine need to be con­scious of hav­ing down time, stay­ing hy­drated, keep­ing blood sug­ars up and hav­ing reg­u­lar sleep and meal times.”

Get­ting the right med­i­ca­tion is also cru­cial, ac­cord­ing to Daly. “Peo­ple who suf­fer from mi­graine are vul­ner­a­ble to over-us­ing medicines. Pain medicines [anal­gesics] aren’t al­ways a suit­able treat­ment for mi­graine. Some peo­ple will need anti-nau­sea drugs and anti-in­flam­ma­to­ries, but pain tablets should not be used on more than four days a month.”

Daly is also keen to point out that pain tablets used for more than 10 days a month is re­ferred to a medicines over-use and may lead to more headache days. “Some­one who over-uses med­i­ca­tion will get a re­bound headache af­ter­wards and will have to stop tak­ing tablets al­to­gether be­fore they can make progress.”

In his chap­ter on Go­ing to the Phar­macy, Martin Hen­man, an as­so­ciate pro­fes­sor in phar­macy at Trin­ity Col­lege Dublin, pro­vides use­ful guid­ance to the pre­scrip­tion and over-the-counter med­i­ca­tions au­tho­rised for use in the treat­ment of mi­graine.

Mi­graine in chil­dren

Mi­graine in chil­dren is of­ten missed, es­pe­cially be­cause chil­dren of­ten de­scribe it as a tummy ache. Pae­di­atric neu­rol­o­gist Dr Deirdre Peake, who wrote the chap­ter on Mi­graine in Chil­dren, says chil­dren can of­ten sleep off the pain if symp­toms are no­ticed early enough. The same ad­vice on self-man­age­ment (see panel) ap­plies to chil­dren and adults alike.

About 60 per cent of mi­graine is hered­i­tary, which means that chil­dren should of­ten be able to draw on cop­ing strate­gies of other fam­ily mem­bers with mi­graine. It is also three times more com­mon in women than men, partly due to hor­monal trig­gers, but sim­i­lar num­bers of boys and girls ex­pe­ri­ence mi­graine be­fore hor­monal fac­tors have an im­pact in the teenage years.

Just as out­door weather con­di­tions can be a trig­ger, of­fices that are over-warm or too cold with poor light­ing can also be a trig­ger for some peo­ple. Claire Bradley, who suf­fers from reg­u­lar mi­graine at­tacks, has adapted her work sta­tion to help her man­age at work. “I have the light turned off over my desk and I wear a peak cap and dark glasses when I have an at­tack. My work col­leagues know when they see the hat and glasses that I’m hav­ing a bad time.”

Bradley says the ma­jor­ity of work­ers are re­luc­tant to say they suf­fer from mi­graine. “I’ve gained sup­port in the work­place by draw­ing out the hid­den mi­graine suf­fer­ers to talk about their trig­gers. If you re­main in­vis­i­ble, you can’t get the sup­port you need.”

Peo­ple with mi­graine need to be con­scious of hav­ing down time, stay­ing hy­drated, keep­ing blood sug­ars up and hav­ing reg­u­lar sleep and meal times

Left, Au­drey Craven, founder of the Mi­graine As­so­ci­a­tion of Ire­land, writes in the book about her per­sonal ex­pe­ri­ence of mi­graine.

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