HEADACHE THAT’S REALLY A MIGRAINE
SYMPTOMS: Throbbing pain at the front or side of the head, often focused on an eye, possibly also vomiting, sensitivity to light and noise, and nausea are signs of a classic migraine (as distinct from tension-type milder migraine, see above).
POSSIBLE CAUSE: During an attack, generally from four to 72 hours, blood vessels on the brain’s surface dilate, releasing inflammatory chemical messengers that trigger pain.
Doctors are moving away from identifying triggers, as people often do not pick out the true cause. Many identify chocolate as a trigger, when the start of the migraine may be making you crave chocolate, says Brendan Davies, a consultant neurologist at University Hospitals of East Midlands NHS Trust.
TREATMENT: Over-the-counter painkillers, such as aspirin in 900mg doses or a nonsteroidal anti-inflammatory drug such as 600mg of ibuprofen, or prescription-only 50mg diclofenac or 375mg naproxen, can all help deal with the pain. The soluble forms are particularly effective, as they are absorbed more quickly, says Dr Davies. ‘People often don’t medicate early enough,’ he warns.
Dr Davies says 400mg ibuprofen may not be sufficient — ‘the reason people don’t necessarily respond is that they don’t take enough. It’s fine to take ibuprofen in 600mg or 800mg doses, as long as you don’t take it more than three or four times a week.’ If these don’t help, prescription migraine medication including sumitriptan, in oral, nasal spray and injectable forms, may be given. This is thought to narrow blood vessels, preventing the release of pain-causing chemicals. It can be bought at a pharmacy, as Imigran Recovery, at a lower dose than the prescription form.
A recent Cochrane review as well as NICE guidelines suggest a combination of sumatriptan and naproxen is particularly effective for migraine, especially when taken early. Other preventative prescription drugs include high blood pressure medication beta blockers, the anti-epileptic drug topiramate and anti-depressant amitriptyline.
People tend to get migraines when they relax, often after a busy week, possibly because of a change in routine.
Dr Davies says: ‘Try to eat, drink and sleep regularly.’