Migraine Awareness Week runs from the first Sunday in September for a week. Each September the Migraine Trust runs an awareness campaign to raise this serious public health issue and to reduce stigma across the workplace. Migraine affects 1 in 7 people globally and is the third most common disorder, however, awareness and understanding is still very low.
What is migraine?
Migraine is a complex condition with a wide variety of symptoms. In very simple terms, it is often an inherited tendency to have headaches with sensory disturbance, due to an instability of the way the brain deals with incoming information. This instability can be influenced by physical changes like sleep, exercise and hunger. For many people, the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and may result in you having to lie still for several hours. And whilst not a dangerous condition, without the correct treatment, migraines can have the potential in some people to have an enormous impact on your work, family and social lives.
What is an aura and a prodrome?
It is often difficult to predict when a migraine attack is going to happen. However, in some cases you can predict the pattern of each attack as there are well-defined stages. It is these stages and their symptoms which can help distinguish a migraine from a headache.
In adults, we can divide a migraine attack into four or five stages that lead on from each other:
- Prodrome or warning phase – physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and yawning. These feelings can last from 1 to 24 hours.
- Aura – this includes a wide range of neurological symptoms and occurs in approximately one-third of migraine sufferers. It most commonly causes visual symptoms like flashing lights. This stage can last from 5 to 60 minutes and usually happens before the headache.
- The headache – This varies in severity and some can feel unbearable. The headache is typically throbbing, made worse by movement and is usually on one side of the head. Nausea and vomiting can happen at this stage, and the sufferer may feel sensitive to light or sound, or both.
- Resolution – Most attacks slowly fade away. Sleep seems to help many sufferers, who find that even an hour or two can be enough to end an attack.
- Recovery or postdrome stage – This is the final stage of an attack, and it can take hours or days for this ‘hangover’ type feeling to disappear.
How is migraine diagnosed?
Your doctor will take a thorough history and examine you. In the majority of cases this will lead to a diagnosis. In some cases, your doctor may wish to arrange some investigations such as blood tests or imaging if another diagnosis is suspected. In the vast majority of cases though this is not necessary or useful. Your doctor may also ask you to keep a headache diary in order to identify triggers and to help identify the most suitable treatment.
What causes migraine?
There is no known cause for migraine, although it often seems to run in families. If you are susceptible to migraine, it is well worth being aware of some of the common triggers. These include stress, irregular meals, alcohol, inadequate fluid intake, hormonal changes in women and lack of sleep. It may therefore, be possible to identify small changes which may improve your symptoms.
There are two groups of drugs for treating migraine; acute medicines taken during an attack and preventative medicines to help prevent an attack.
There are a variety of medications available, so your doctor will advise you on the best combination for you. The combination and method by which drugs are taken can make a difference to the time it takes for them to be absorbed into your system and to produce an effect. For example, painkillers taken in soluble form are absorbed more quickly. This can be a crucial factor in migraine, because when an attack takes hold the digestive system slows down. This could mean that drugs taken at the wrong time may not be properly absorbed and so will not be as effective. There is now substantial evidence that you need to take your medicine at the first sign of an attack, as soon as you start having symptoms.
Don’t forget ‘Medication-overuse headache’. This is an important condition to be aware of in people with frequent migraines or headaches who understandably are taking regular painkillers in an attempt to treat their headache. An unexpected consequence of this can actually be a worsening of their headache with the potential for a vicious cycle in terms of further use of painkillers.
For further information please visit The Migraine Trust here.
The doctors at Pinches Medical and Wellbeing are all experienced GPs who will be able to give you the time to discuss any difficulties you may have in reaching a diagnosis or tailoring your treatment to your individual needs.