Migraine attacks – so much more than just a headache

The founder of the Migraine Association of Ireland, Audrey Craven, describes a migraine attack as "a power cut". It's 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.

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, Dr Daly worked in general practice and at the headache clinic at St Vincent’s University Hospital. He says that 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 Dr 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 your blood sugars up and have regular sleep and meal times.”

Getting the right medication is also crucial, according to Dr 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.”

Dr 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 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 below) 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.”

TIPS FOR LIVING WITH MIGRAINE

1) Learn about your condition and talk to your GP about management and treatment;

2) Keep a migraine diary and identify your triggers or patterns of attacks;

3) Learn to recognise your symptoms so that you know when an attack is about to happen;

4) Keep your medications with you at all times;

5) Stick to regular eating and sleeping patterns;

6) Make time for relaxation and regular light exercise;

7) Reduce stress as much as possible;

8) Drink plenty of water and keep a bottle of water with you at all times;

9) Don't be afraid to ask for help if you need it;

10) Educate your boss and colleagues in work or tell your teachers in school or college.

The Migraine Association of Ireland helpline is 1850-200 378, migraine.ie