A migraine is common. It affects about 15% of the population.
The attacks can be extremely intense and disabling. Although the migraine sufferers are symptom free in between attacks the psychological and social affects can severely affect school, home and work life.
Your GP will need to get detailed history of the attacks to be able to make a diagnosis and offer you the best management.
There are 4 main types of common headache:
- Tension headache
- Cluster headache
- Medication overuse headache
It is important that you obtain the correct diagnosis as the treatment is different for all of the above.
Migraine is not just a bad headache
There can be changes in vision, sensitivity to bright lights, loud noises and even strong smells. There can be associated nausea and vomiting. When a migraine occurs, people may have to go into a dark room and lie down or sleep for a few hours to get through the worst of the migraine.
There are 2 different approaches to treatment:
- To stop a migraine as quickly and effectively as possible
- To reduce or prevent further migraines
1) Many migraine sufferers get the most benefit if treatment to stop a migraine is started as soon as possible in the course of the migraine. There are various treatments used: Paracetamol, Ibuprofen or other anti-inflammatories.
If nausea and vomiting are common with your migraine, speak to your GP about using a suppository, a tablet placed into the bottom. Though this is not commonly used in the UK, Europeans commonly use this type of medication and because it does not directly affect the stomach, it often causes fewer side effects.
2) Combining rest or sleep in the early part of the migraine with medication is more effective than medication alone. For some people, this is impractical so it may be worth trying to drink clear fluids, eat a carbohydrate-rich snack and adding a tablet for nausea and vomiting can also help prevent the migraine worsening.
3) Keeping a headache diary may help identify triggers for your migraine. A headache diary should be kept for at least 8 weeks. It should include:
- How often headaches occur
- How severe they are on a scale of 0-10 (10 being the most severe)
- Symptoms recalled before the headache (even the day before)
- Symptoms occurring at the start of the attack: Changes to vision and sensation
- Any possible triggers: what has been eaten in the last 24 hours
- Any activity carried out
- Any alcohol or drug use
- Any medication taken, even over the counter medication
- If female, any relationship to menstrual cycle
4) There are some lifestyle changes that may reduce the frequency of migraines:
- Having regular meals, especially breakfast
- Avoiding foods very high in sugar
- Ensuring that you are properly hydrated
- Reducing caffeine
- Reducing alcohol
- Doing regular exercise
- Having a regular routine for sleep
5) There are some symptoms that are more concerning. If these occur see your GP that day. If the GP is not available, see a private GP or attend accident and emergency THAT DAY. Any sudden, extremely severe (worst headache ever) needs to be reviewed in hospital immediately. Sometime people feel they have been hit on the head at the onset of this headache. Any headache where there is also fever, stiffness of the neck, pains in the joints or weakness of the joints, changes to vision, slurring of speech or difficulty making words, rashes or any fits or seizures needs to be reviewed in hospital immediately.
Any headache that wakes you from sleep or is made worse by lying down, physical activity, coughing, laughing, eating or straining needs to be reviewed by the GP that day.
6) If you are getting 2 or more migraines a month or if the treatment to stop a migraine is not effective, you should discuss with your GP about medication to prevent migraines. There a various medications available for this role. Whilst most are extremely safe and have been used for many years some of these medications must never be used if there is a chance you may get pregnant or you have pre-existing medical conditions such as asthma or heart problems.
It is also important to give these medications a proper chance to work. They should be tried for 6-12 weeks before a different preventative medication is considered
7) There are some alternative therapies that may be effective but they seem to only work for some people and the benefit is variable. These include:
- Coenzyme Q10
It is important to note that the above treatments should NOT necessarily replace standard medication. If you are keen to consider these, please speak to your GP or neurologist first as they might not be suitable and can cause side effects in some patients.
8) 75% of migraine sufferers are women – in women, the migraines seem to be associated with the menstrual cycle and start with the beginning of periods, get better during pregnancy and though they may get better towards menopause they ease off some time after menopause. However, migraines in women do not always follow this pattern. Many women find that the beginning of the period can trigger a migraine or if they are aware of a potential trigger for migraines, that they are more susceptible during their period. For example they may be able to eat chocolate or drink wine during their cycles except during the days of their period.
If you are unsure if your migraines and periods are related, keep a headache diary. This will show any association. It is important to discuss this with your GP, as there are treatments that can help treat or prevent period related migraines. Some of these treatments only have to be taken just before and during the period.
9) Migraines usually get better during pregnancy but if they are not improving there are still some medications that can be used in certain circumstances for acute headaches, the associated nausea and for migraine prevention. It is very important that you discuss your migraines with your GP or neurologist to ensure that you are prescribed the best and safest medication for you
10) Migraines can worsen towards the menopause but often get better afterwards. HRT does not worsen migraine in most women but the non-tablet forms of HRT may be more effective at preventing migraine than tablets.
Migraines are a very serious condition. The World Health Organisation has acknowledged the impact of migraine and ranks it at number 7 on the list of worldwide illnesses causing disability.
In the UK 25 million working days are lost each year to migraine, yet people often feel unsupported at school, college or work.
If you feel that your migraine is not being treated effectively or that you are unsure whether or not your headaches are migraine then please see your NHS GP or make an appointment to see a private GP who will have the time to help understand and manage your migraine.
To book an appointment with one of our GPs, please call 0161 428 4464.