Women who crippling have headaches EVERY day
It’s agonising — and linked to hormones. But doctors are still baffled by the curse that strikes millions
MOst of us know what it’s like to experience a headache. If we’re lucky, they’re an occasional problem caused by lack of sleep, stress or one too many glasses of wine.
But imagine waking up most mornings with a pounding head. For up to three million people in Britain who have a little-known condition called chronic daily headache ( CDH), it’s an excruciating reality. And women are twice as likely to suffer as men.
sophie kearney, 43, a part-time pilates instructor from Bray, in Berkshire, says she’s always been a ‘headachey’ person. But after her twin boys were born in 2008, a vice-like pressure across her forehead became an almost daily fixture.
‘they were tension headaches,’ she says. ‘not a sharp pain, more a constant, dull thud. At first, I put them down to what was going on in my life — I had two newborn sons, Jesse and Ethan, now seven, and I wasn’t getting any sleep. My daughter, lola, 13, is severely disabled and needs everything to be done for her.
‘I looked after them while my husband, paul, was at work. I thought the headaches would ease when I established a routine and felt less stressed.’
But months later there was no relief. ‘I’d wake up and notice the pain in my head before I’d even opened my eyes.’
Consultant neurologist Dr Fayyaz Ahmed says: ‘ CDH means suffering a headache on at least 15 days a month, lasting for four hours or more each time, for at least three months.
‘ In reality, most sufferers have a headache for 25 to 30 days a month — almost constantly. It’s a severely debilitating condition.’
In about 70 to 80 per cent of CDH cases there’s a genetic link. ‘ the cause is thought to be a pain-processing error in the brain,’ says Dr nazeli Manukyan, a headache specialist at the national Migraine Centre. ‘ But what triggers headaches is different for everyone.’
the fact that most cases occur in women aged 20 to 50 — the reproductive years — suggests a strong hormonal link.
‘Many women experience changes in headache symptoms around puberty, pregnancy, menopause, or on a monthly basis,’ says Dr Manukyan.
It’s a link sophie has made, too. ‘I started to notice that they would get significantly worse in the week leading up to my period. I’d always had heavy periods and symptoms of premenstrual syndrome (pMs), such as tearfulness and irritability, had been getting worse.’
sOpHIE went to her gp, who suggested fitting the Mirena coil, which releases an artificial form of the hormone progesterone. ‘this helped by making my periods much lighter, but it had no impact on my moods or headaches.’
sophie had blood tests to look for nutritional deficiencies or hormonal imbalances and even a brain scan to rule out a tumour. they came back fine.
‘I was able to muddle through the day, but I felt exhausted and irritable. I wanted to be enjoying time with my family.’
Eventually, sophie found relief with a food supplement. ‘ A friend said taking krill oil had helped her pMs, so I bought a supplement called Cleanmarine For Women ( cleanmarinekrill.co.uk).
‘As well as Omega-3 oils it’s got vitamins B and D and isoflavones, and it’s supposed to help balance hormones.
‘After two or three months I started to feel less tired and moody. Best of all, the headaches eased up significantly and became less frequent. now I feel the best I have in years.’
Chronic migraine is the most common type of CDH, accounting for 80 to 90 per cent of cases. sufferers already have migraines, but the headaches associated with them become more frequent, often accompanied by light and noise sensitivity and nausea.
Other types include new daily persistent headache — where a headache comes on suddenly and from that point is almost continuous — and hemicrania continua, where pain is experienced on one side of the head (sometimes alternating), often with watering of that eye.
Identifying the type of CDH is key to effective treatment. the World Health
Organisation has classified headache as a major health disorder and migraine in the top 20 most disabling lifetime conditions.
Nadine O’Connor, 44, a company director from Hampshire, has spent a significant amount of time in doctors’ surgeries and A& e departments since her first migraine in 1997, aged 26. Her worst time was between 2002 and 2012, when she was regularly hospitalised during migraine attacks.
‘If I could have drilled a hole in my head to release the pressure and end the pain, I would happily have done so,’ Nadine says.
‘One day, in 2002, I managed to get to the GP surgery when I was experiencing a migraine. I was in desperate need of pain relief.
‘There were no appointments, but I was told the doctor would ring, so I dragged myself home.
‘Later, the doctor called, but I didn’t answer, so he popped by on his way home. He found my door open and me collapsed on the bathroom floor. I was sent to hospital where I had to be put on a drip I was so dehydrated. That was the first time, but it was to happen many times over the next decade.
‘I had such nausea I couldn’t stop being sick. But the involuntary motion of throwing my head forward to vomit felt like being hit in the head with a mallet.
‘By 2005, my migraine attacks were so bad I’d have to call out the doctor in the night for pain relief. Or my dad would have to bundle me into his car and carry me into A&e.
‘There I would sit being violently sick and crying from the pain, before being put on a drip and having steroids injected into my bottom.
‘My extreme attacks lasted five or six days and happened fortnightly, with dull headaches in between.
‘At the worst end of the scale I’d be sick, unable to walk, have partial paralysis in my face, lose the use of my left arm and hand and be unable to speak properly.’ Over the years, Nadine kept diaries and tried in vain to spot patterns or triggers for her migraines.
‘I did everything from faddy diets to acupuncture and reiki. I tried not sleeping too much, not sleeping too little. Prescription and over-the-counter remedies were hit and miss.’
Unlike Sophie, her menstrual cycle didn’t seem to have an effect — though hormones did play a role when she became a mother. ‘The only time I have ever been completely migraine and headache-free for any length of time was when I was pregnant with my daughter, Phillippa, now 15, and son, Archie, nine,’ she says.
‘But being constantly pregnant was too extreme a “cure” for me. As a single mother of two young children, living on my own until I met and married my husband, Matthew, in 2009, I had no choice but to work through the pain.
‘Running my own business was the only option for me as no employer would have tolerated the amount of time I needed off.’
The turning point for Nadine was a new GP who herself suffered migraines and understood.
‘She said I needed a type of pain-killing drug called a triptan.
‘Migraines are caused by the expansion of blood vessels around the brain and triptans reduce this swelling. They have been the only medication with a real impact. Since 2010, I have used Imigran (sumatriptan) to help minimise attacks. It doesn’t erase symptoms completely, but it lets me function.’
Dr Manukyan says that while painkillers have a role to play, they need to be used sparingly: ‘ They become less effective with time and can even activate headaches.
‘A good migraine management plan involves preventative medications, such as beta blockers, antidepres-sants and anti-convulsants. These raise the threshold for suffering headaches, so you don’t get to the stage where you get a headache and reach for painkillers.
‘Botox injections in the head, neck and shoulders can also help — we think that they work by over-riding the brain centres that are over-sensitised during a migraine.
‘People should follow Nadine’s lead and develop a good relation-ship with their doctor in order to find the right treatment for them.’
Studies have shown 80 per cent of CDH sufferers over-use medication — understandable when you’re desperate to be pain-free, but not a good idea if the result is even more headaches.
CDH can worsen if standard analgesics ( such as aspirin or ibuprofen) are taken for 15 days or more a month or stronger medica-tions (triptans, opioids, combined analgesics) for ten days or more.
These medication over-use headaches are also referred to as analgesic, drug-induced or rebound headaches. Reducing dependence can be the fastest route to relief — as CDH sufferer Mildred Talabi, 32, found out by chance.
‘My headaches started in my late teens,’ says Mildred, who lives in Dartford, Kent, with her husband, Malachi, 32, and their one-year-old daughter, Tatiana.
Mildred worked out that if she took paracetamol within 15 minutes of a headache starting she could normally get rid of it.
‘I’d be left with a low-level ache,’ she says. ‘ But it allowed me to function for the day. If I missed that window, the pain would take hold and I’d need rest, silence and darkness until it eased.’ Mildred came to rely on the paracetamol so she didn’t have to take time off work.
‘I had packets at home, at work and they were always in my handbag. One doctor told me I should think myself lucky that paracetamol worked for me. But I became concerned about how many tablets I was taking.’
So last year, she decided to go cold turkey. ‘ The first headache was three days of agony. But I persevered and finally it went away. When it came back a few days later, I continued to resist painkillers and had another few days of misery.
‘I followed this pattern for about a month until I started to notice it was taking longer for the headaches to come back. The less often I took the drugs, the less I needed them.
‘By spring of this year, I had my first clean month without a headache for 15 years.
‘It marked such an exciting time in my life. For several months, I enjoyed a peaceful head and didn’t once think about popping a pill. Unfortunately, two months ago, I woke up with that tell-tale throb-bing and ended up medicating.
‘Now I’m pregnant again, but as soon as my baby is a few months old I’ll be heading back to my GP for a referral for tests and scans. I can’t live with this hell.’
Some women find CDH ends with the menopause. For the rest of us, Dr Ahmed offers this advice: ‘Go to see your GP, get enough sleep, stay hydrated and take exercise. Keeping a diary is useful to look for triggers.
‘Avoid painkillers containing codeine and caffeine as they’re the most addictive and likely to cause rebound headaches. If you feel your GP isn’t understanding, seek a referral to a neurologist with a specialist interest in headaches.’
And most importantly, remember: ‘ If you have a headache that requires you to take painkillers on more than two days a week, this should concern you. Likewise if headaches are causing you to miss work or cancel arrangements.’