Giving migraine a headache

Beaumont Hospital's specialist migraine clinic celebrates its 10th birthday

WHAT A difference a decade makes. In the 1990s, migraine was just starting to shake off its stigma of being a widely misunderstood "neurotic female thing", and wasn't taken too seriously by those who didn't suffer from it.

Today, migraine is a recognised neurological condition which can be treated with proven therapies, and this week the State's largest specialist migraine and headache clinic at Dublin's Beaumont Hospital celebrates its 10th birthday.

It's a far cry from former times, when Audrey Craven suffered from severe recurrent migraine, losing two to three days each week to the condition, which can present as headaches, nausea, sensitivity to light, visual disturbance and, in some cases, even temporary paralysis.

There was so little support back then, Craven vowed to address the situation as soon as she started to manage the debilitating symptoms, which affect about 400,000 people in Ireland.

"I made a promise to myself that if I ever got a handle on it I would do something to address the dearth of information about it here," she says, recalling how she had to travel to London for diagnosis and treatment before her condition improved. "So I did what everybody did back in those days - I wrote to Gay Byrne."

A stint on Byrne's radio programme rallied Craven to set up the Migraine Association of Ireland (MAOI) and push for a specialist clinic for migraineurs. "I knew we needed to do something in Ireland so I approached [consultant neurologist at Beaumont] Orla Hardiman and asked her would she consider opening a headache/migraine clinic for people with severe headache and migraine," says Craven, who is now president of the MAOI and of the European Headache Alliance.

"And to her eternal credit she said yes at a time when people pooh-poohed the idea of migraine at all, it was even seen as a neurotic female thing because three times more women than men suffer migraine."

Hardiman recalls how she jumped at the notion of setting up Ireland's first specialist clinic for migraine. "I was a young, rookie neurologist at the time and I felt in general that setting up clinics where you could build up an expertise in the discipline was a good idea," she says.

"One of the problems with migraine was that it was never really taken terribly seriously as a condition and that was reflected in the attitude that people had, even among neurologists, many of whom saw it as something 'soft'. But while it's not life-threatening - people don't die of migraine - it is enormously incapacitating."

In addition, migraines weren't really separated out from other headache syndromes, which made getting a diagnosis and proper treatment more difficult, adds Hardiman, who is also professor of clinical neurology at Trinity College Dublin.

She believes that in its decade so far, the Beaumont clinic has been important for putting migraine on the map in Ireland as a recognisable neurological condition and providing services and treatments for migraine and a range of other headache disorders.

"What has revolutionised migraine treatment is the availability of drugs called triptans," explains Hardiman, who runs the clinic with colleague Dr Ronan Walsh. "They are targeted, designer drugs that work very well if you get migraine with aura and they can get rid of the headache straight away. They have a big effect for people who have bad migraine."

And as junior doctors have rotated through the clinic over the years, they have learned about the proper diagnosis and treatment of migraine and headache.

"I would hope that we have sent out a lot of these people who are now specialists or GPs around the country and they have a better sense of how to manage people with migraine or other headache disorders," says Hardiman.

The Beaumont clinic now sees about 2,000 patients each year, according to its clinical nurse specialist Esther Tomkins, who tries to meet all new attendees on their first visit.

Getting the initial diagnosis right is critical, then usually patients need to attend the clinic every few months for about a year, along with telephone support, to help them identify triggers and optimise drug treatments, says Tomkins. When you live with a chronic illness like migraine, you have to be well educated to better manage the condition," she adds.

But not all migraineurs will need the specialist service. "We categorise migraine into thirds," explains Tomkins. "A third of migraineurs will be able to treat themselves with over-the-counter analgesics and remedies and treatments. Then you have a third who need to go to the GP for a prescription medication. The last third need to come to the specialist clinic for specialist advice and care."

The heavy workloads and waiting lists of existing migraine clinics in Dublin and Cork signal that further specialist services are needed, says Craven, and more centres are in the pipeline for the west and north of the country.

And it's particularly important to keep promoting education, research and awareness, she argues. "If you go to your GP and they don't know about migraine, it's a waste of your time and your money," she says, also stressing the need for continued public recognition of the debilitating effects of migraine: "No one sees you when you are lying in the darkened room."

• To find out more about migraine log on to www.migraine.ie

• A confidential Migraine Helpline service can be contacted at lo-call 1850 200 378; 10.00am- 4.00pm, Monday to Friday. From NI call 0844 826 9323