What is a migraine? Doctor Sue explains triggers and treatments for the condition

Dr Sue has explained to NewsNewsBlog.blogspot.com what a migraine is and how they're triggered

THEY can be scary and painful, but we have the answers to all your questions.

Eight million people in the UK suffer from migraines but little is truly understood by the public about the condition. Often confused for 'just a bad headache', migraines are actually so much worse and an attack can come in three stages. 

NewsNewsBlog.blogspot.com spoke to Dr Sue Lipscombe, a Headache Specialist at the Royal Sussex County Hospital in Brighton, about the condition and asked all the questions you need to know the answers to. 

 

Millions of people suffer from migraines every year but aren't quite sure what they are

It is very distressing, not just for the sufferer but for all the family and friends that see an attack

Dr Sue Lipscombe, a Headache Specialist

 

What is a migraine? It is generally believed that migraine is a bad headache. Those who have the condition know differently. Migraine is usually an episodic series of painful, disabling events. A full attack of migraine may consist of a warning phase (typically yawning, restlessness or just feeling odd) - the prodrome.

A migraine is an episodic series of painful, disabling events

This may be followed by an aura phase, where sufferers see changes in their vision, such as everything appearing larger, or flashing lights or even loss of vision. There may be tingling in one arm, the side of the face and in the tongue. 

Difficulties in finding the right words or speech impediments may follow and also changes in mood. 

 

The next part (the headache phase) is sometimes a pain arising from the back of the neck, one side of the face, behind the eye, or both eyes or, all over the head. The pain can be very severe and frightening and many people feel their head will explode or their eye pop out. 

Accompanying this, there may be very severe vomiting, dislike of sounds, light and odours. Often people flee to a darkened room to try and lie down but sickness, and sometimes diarrhoea can make this difficult. This headache phase can last between 4-72 hours. 

Afterwards people don't feel completely well, often a hangover or washed out feeling may last for as long as two days — the post-drome. It is very distressing, not just for the sufferer but for all the family and friends that see an attack.

How do they first start? Attacks can start at any age. Frequently the migraine gene — which is believed to be the major culprit - is inherited, i.e passed from mum or dad. But sometimes it may happen spontaneously, without any family history.

Often it is only when someone younger gets the symptoms, the family connection is found , grandma’s bad headaches with sickness, were probably migraine. They can start in young children, when they may be short attacks of tummy ache or sickness with a very short headache. At puberty, many migraineurs  (people who suffer with migraine), begin their attacks. Other times, typically, are during or after child-birth.

Are there any triggers?It is believed that the migraine brain is hypersensitive to change. Therefore changes in hydration (not drinking enough fluid), missing meals, hormonal changes, stress, weather changes, alcohol, certain smells (perfumes and after-shaves), foods (sometimes cheese and chocolate but other foods such as citrus flavours, garlic, onions etc) alcohol or medication can precipitate an attack.

Top five tips for keeping healthy and avoiding migraines:

• Make sure that you recognise any triggers that bring an attack of migraine on and avoid them
• Use a calendar to mark your attacks . There is a pattern that you might not have previously recognised
• Look at, and ideally join, Migraine Action or the Migraine Trust, where help and support will be available. Information gained from them can inform friends and relatives about migraine, as well as getting further knowledge yourself. If you are worried, see your doctor
• Try to get over an attack as quickly as you can without worrying when the next one will come — easier said than done-but a positive outlook can make a world of difference.
• Fresh air, reducing stresses, sharing your worries, finding the right medicine that works for you and taking it early are all essential parts of living with migraine. 

Are there any medicines you can take? Some people try and are helped by over the counter medications. Many will find paracetamol, ibuprofen and combination products such as “Syndol Headache Relief” can be extremely useful.

For the more difficult attacks, especially where tablets are immediately vomited back, the very migraine specific medicines, such as sumatriptan in many formulations,  rizatriptan and five other triptan medicines can be extremely useful.

All these medications should be taken early. That is when they work most effectively. 

Can you explain menstrual migraines? Menstrual migraine is quite common. Often around the time of bleeding during the month, women have a bad attack.

If it is the only attack they have each month, and it occurs between 2 days before bleeding to three days after the period has started, it is called true menstrual migraine. If migraine occurs at other times, then the attack around periods are called menstrual associated migraine. They are thought to occur because the oestrogen level falls rapidly ( causing a change in the  brain’s environment).

Do women tend to get migraines more than men? It is probably this hormonal factor that makes women of child-bearing age three and a half times more likely to have migraine attacks than men. However, it must be acknowledge that men can have equally bad attacks as women. 18% of women and 6% of men have migraine. It is common.

Are frequent migraines a sign of something worse?People with migraine, typically go through good and bad spells. Bad spells may be at times of stress (e.g young people with examination stress) or at the perimenopause, when hormone changes lead to more frequent attacks leading up to the menopause.

If migraine attacks suddenly start increasing in frequency and severity, specialist help is sensible, as occasionally there may be an aneurysm lurking or something else sinister. One of the major causes I see in increasingly frequent attacks is medication overuse headache, where people are taking more and more "headache tablets" making the brain dependent on the tablets. Stopping all headache tablets will often bring relief albeit after initial worsening and then return to usual migraine frequency.

Do they get worse or better with age? Ageing can bring help to many migraineurs. Women often experience a reduction in frequency or even stopping of their attacks after the menopause. Sadly, a minority of people do not get better as they age and very occasionally, migraine can start in later life. If this is the case and somebody starts for the very first time with migraine over 50, they should get medical advice.

Are there foods and drink to avoid? Alcohol and certain foods such as cheese and chocolate but other foods such as citrus flavours, garlic, onions etc as they can precipitate an attack.

How can you tell the difference between a migraine and a headache? Anybody who has suffered a migraine would say that a headache is not a migraine. The migraine headache is only part of the attack, the sickness, the dislike of noise, sound and smell and sometimes the aura make most migraines easily distinguishable.

In a migraine attack, sufferers are usually unable to do anything and just have to stop all activities. The duration of 4-72 hours is often a distinguishing factor.

Are migraines hereditary? About 60 per cent of people will have a first degree relative with migraine. Mum, Dad or brothers and sisters may suffer and have the "Migraine gene". There is lats of research being done throughout the world, looking at genes, in the hope that we may, one day, be able to cure, rather than manage migraine attacks.

This really is useful if a parent has migraine and the child has episodes of sickness or tummy ache as it enables the doctor and parent to make the diagnosis and prevent great anxiety and endless unnecessary investigations.

Can the weather bring on a migraine? Weather, can be a big trigger for an attack. Storms can be predicted a day or more before the weather breaks by some sufferers. Some people find that the bright light of summer can induce attacks, as can bright television and computer screens.

What's the quickest way to get rid of a migraine?The quickest way to get rid of a migraine attack is to take whichever medication works  for you (be it over the counter paracetamol, ibuprofen or Syndol, or one of the migraine specific triptans) as early as possible in an attack and take it with lots of water.

Dehydration is more common than generally acknowledged and coffee drinkers should ideally limit their caffeine intake. Avoiding trigger factors, if possible, will help to prevent attacks.

‘For tips and advice on managing headaches and migraines visit www.headforabetterplace.co.uk’