Fifteen top tips to deal with the misery of migraines
Thousands of people in Northern Ireland battle the misery of migraines but, as Ailin Quinlan discovered, some simple strategies can help sufferers cope.
1. Get a correct diagnosis
A diagnosis of migraine is not made through a test; it is based on what the patient tells the doctor, explains Esther Tomkins, a clinical nurse migraine specialist. "You must be able to recognise and explain the symptoms you are experiencing to the doctor, because the diagnosis is based on the history you present."
Migraine comes in two forms - with and without aura. About 20% of migraine patients have migraine with aura. These may experience numbness or pins and needles in the arms, hands and face (paraesthesia). Other forms of the condition include a visual aura which involves a C-shaped or crescent-shaped shimmer around an object, or flashing lights. Migraine with aura can also feature temporary problems with word-finding or word-articulation which last for a few minutes. The aura is often seen as a warning that a migraine attack is occurring.
It's usually followed by the throbbing one-sided or uni-lateral headache which is a hallmark of migraine. It is accompanied by a heightened sensitivity to light sound or smell, along with nausea or vomiting and symptoms such as neck pain, watery eyes or feeling slightly physically off balance, all of which are also the symptoms of migraine without aura. A headache can last anything from four hours to three days.
2. Educate yourself
Understanding migraine and learning how to manage the condition is crucial because there is no cure for it, says Tomkins. Patients should also talk to their pharmacist or GP.
3. When should you consult your GP?
Many patients can manage migraine attacks with simple, over-the-counter analgesics or painkillers, such as aspirin, paracetamol or ibuprofen, says Dr Edward O'Sullivan, a GP specialising in the management of headache disorders.
However, when these don't work, it's time to see the GP. "There are specific migraine medications such as Triptans which are specific, prescription-only migraine medications," he says.
"These are very effective, and provide relief within two hours to between 60% and 80% of patients."
4. Know your triggers
Everyone has different triggers - they can be lifestyle-related, environmental, hormonal or dietary for example.
(A) Women and migraine: for many women, menstruation can bring on a migraine attack. Around 50% to 60% of women who experience migraine will report a worsening of migraine attacks around the hormonal cycle.
(B) Environmental factors can also have an effect. Bright lights, harsh sunlight, stuffy or smoky atmospheres and even very humid days can trigger an attack. Fluorescent lighting or artificial lighting, for example the kind used in shopping centres, can also be a trigger. Loud noise such as loud music, the noise of heavy construction work or simply unpleasant sounds can also cause problems.
(C) Weekend migraine: a long, busy week followed by some weekend relaxation can bring about a migraine attack.
(D) Diet: common food triggers include food containing monosodium glutamate, (MSG), which can be found in processed foods such as pizzas or curries. Alcohol, particularly red wine, is a common trigger.
5. Keep a headache diary
This is a crucial part of managing migraine."Keeping a headache diary helps you track your triggers and recognise the frequency and severity of attacks, record the treatments you use, how effective they are, and provide information about aggravating factors," says Tomkins. "It's a hugely valuable tool because when you go to see your doctor, you have a detailed record of the frequency, severity of the attack and possible triggers."
6. Live a structured lifestyle
The migraine brain tends to like routine, balance and structure so eat regularly, get regular sleep, stay well hydrated and know and avoid potential triggers where possible.
Different treatment plans apply to episodic migraine and chronic migraine. When migraine is chronic, a structured lifestyle is very important.
Exercise helps you relax and has a therapeutic value through the release of endorphins which can act as a defence against migraine and help reduce the number of migraine attacks, explains Dr O'Sullivan.
"We would recommend that patients with frequent migraine attacks take mild to moderate exercise - for example a brisk 30-minute walk - four or five days a week." Don't overdo it, he warns - excessive exercise can trigger an attack.
8. Be organised
If you're anticipating a migraine attack, ensure you have ready access to medication which you have previously found to be effective, says Dr O'Sullivan.
Education about migraine, knowledge about how it affects you and experience of what works for you is crucial, he explains.
"The more you understand about it, the better able you are to build up an individual treatment plan which works for you."
9. The 'don'ts' of migraine
- be careless about triggers following a migraine-free period.
- forget to have appropriate medication with you at all times.
- take too many acute medications. Avoid overuse of pain-killers, particularly codeine-based products. Acute painkillers, either by prescription or over the counter should be limited to two days a week. For the 3% to 4% of people who have chronic daily headache there are preventative drugs which can bring about a reduction in the frequency of attacks.
- get careless about taking your medication. Always adhere to the recommended use of preventative drugs prescribed by your GP.
10. Migraine in children
About 10% of children are affected by migraine. Some patients report experiencing their first migraine attack at the age of eight or nine, says Tomkins, adding however that it is very common in younger girls who present during puberty and adolescence.
"Children will experience abdominal cramping and upset stomach and there may be a mild headache. The complaint is quite cyclical and can be triggered by excitement over a school tour, skipping breakfast or playing a lot of sport," says Tomkins. However, she says, children tend to sleep it off and will generally be back to normal after a number of hours. As they get older children will present with more adult-type features of migraine.
11. Botox - not just for beauty
Botox is a medication given by injection to patients who have chronic migraine. However, Dr O'Sullivan emphasises, it does not relieve the symptoms of migraine. "Botox is used to try to reduce the number of headache days a patient experiences. It is licensed for use with patients who have chronic migraine - such patients experience more than 15 headache days in the month, of which half are migraine-like."
12. Migraine is a pain in the neck
Neck pain affects about three-quarters of people with migraine, says physiotherapist Julie Sugrue.
In some people it's a trigger, in others it's a symptom, but a physiotherapy session can help whichever one it is, she says.
Muscles and joints in the upper part of the neck can send pain to the head due to a combination of several factors including poor posture and/or neck injury.
Treatment includes hands-on techniques which can be carried out by a chartered physiotherapist or taught to the patient, as well as posture correction and specific neck exercises. Neck exercises strengthen postural muscles and relieve muscle and joint stiffness.
13. Acupuncture and stress reduction
Acupuncture is believed to be helpful to migraine sufferers - a study published in the Canadian Medical Association Journal in 2012 showed that acupuncture was effective in reducing the number of headache days suffered by patients.
In 2012, Sugrue points out, the National Institute for Health and Care Excellence in the UK suggested that a total of 10 sessions of acupuncture over a period of five to eight weeks could be beneficial for some patients. "Stress is a common trigger for migraine so learning skills to cope with the day-to-day stresses is important," Sugrue says.
One such technique is mindfulness, which is about being able to stay in the present without worrying about the future or the past.
14. Take natural supplements - vitamins and herbal preparations
These have been found to be therapeutic for some people, says Sugrue, who says the National Institute for Health and Care Excellence in the UK recommends 400mg of riboflavin daily. "This is a B2 vitamin which can be found in eggs, nuts, legumes, green, leafy vegetables and dairy foods." Other options can include magnesium, butterbur, feverfew and Co Enzyme Q10.
15. migraine in the workplace
If screen flicker is a trigger, make sure to take regular breaks. Use screens of 100Hz or above or plasma screens which have no flicker at all.
Reduce work-related stress by good time-management, taking proper breaks and eliminating unrealistic targets. Take care with your posture to avoid tension in the neck and shoulders. Ensure that your working environment is as ergonomically designed as possible to avoid unnecessary twisting, stretching and bending.
How broadcaster Yvette reduced number of attacks
Yvette Shapiro (49) is a freelance journalist. She lives in Bangor with her husband Michael and daughter Cara (11). She says:
I had my first migraine when I was about 22. I had the classic symptoms. I was nauseous, I had a gripping pain that took over my whole head before I was sick and I wasn't able to stand any kind of light.
I thought I had the flu at first but I started getting the attacks quite frequently. I went to the doctor who diagnosed migraines and advised me to stay away from caffeine as I had been filling my cup all day from the coffee urn in the office I was working in.
My migraines have certainly progressed over the years. There have been a couple of times I've had to take off long periods of work because I was having five or six of them a week and they were taking over my whole life.
I was really very ill with them and had to be seen by neurologists and prescribed quite strong anti-epilepsy medication, which has the side effect of preventing migraines.
I have also had beta blockers in the past, but they just make you dopey which is no use when you're working to deadlines.
There have been very serious migraines when I've been violently sick. I've hallucinated and then passed out, coming to on the bathroom floor. Those can be frightening and you start to wonder if you're having a brain haemorrhage instead of a migraine.
It's extremely debilitating and it comes often with no warning, which is very frustrating when you've been good, sleeping well and eating well and staying away from all the things that effect you. It can make you very angry as you will lose a portion or all of that day.
It's particularly bad when it happens on a Saturday or when you're on holiday.
There's not a remedy, natural or medical, that I haven't tried. For the last year or so I've been having regular acupuncture and Tui Na massage, which has really been effective. When I'm stressed it goes straight into my shoulders and neck, and that can kick off a migraine. I've found that with the regular massages and acupuncture that my migraines have become much less frequent, in fact I haven't had one in about a year.
I have plenty of triggers. I haven't drunk caffeinated coffee since I was diagnosed and I certainly can't drink alcohol. I haven't had any in more than 10 years since I realised that even a small glass of wine with dinner would set me off.
My migraines are linked with my blood sugar, so if I feel one coming on then a big injection of carbohydrates can fend it off - porridge, chips or brown toast. I keep chamomile tea and ginger biscuits close by as they can help with the nausea. You need to be quite clever about it and keep good snacks and fruit handy.
My mum did have migraines, so I might have inherited them from her. Cara hasn't had any yet and isn't prone to headaches but I do worry that she might develop migraines."
- Interview by Kerry McKittrick