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More than just a headache

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More than just a headache

With its multiple symptoms and disabling effect on sufferers, migraine is much more than just a headache

It is easy to dismiss migraine as “just a headache”. But ask anyone who has suffered from the condition – and with the World Health Organization (WHO) putting the global prevalence of migraine at almost twice that of diabetes, the search for a suitable interviewee shouldn’t take long – and they will say it is much more than that. The condition has been shown to put sufferers at increased risk of other problems – depression, for example, is three times more common in people with migraine or severe headache – and severe migraine attacks have been classified by the WHO as among the most disabling illnesses.

The Migraine Trust’s Susan Haydon agrees, saying: “Migraine attacks can have a significant impact on a person’s quality of life.” As well as the headache of migraine being on one side of the head, severe and lasting anything up to 72 hours, Susan points out that the other symptoms of the condition – such as aura (neurological symptoms such as visual disturbances, temporary numbness on one side of the body, and pins and needles), nausea, vomiting and sensitivity to normal levels of light, sound and smell – mark it out from other causes of headache.

The number of people in the UK who experience migraine is high: around 20 per cent of women and 10 per cent of men, according to Dr Andrew Dowson, chairman of Migraine Action’s medical advisory board. He says that pharmacy staff have a significant role to play in helping those seeking medication for the condition: “Migraine tends to respond better to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen than paracetamol, but timing the dosage to take it as early as possible during an attack is very important.”

Sumatriptan is more effective if taken alongside an NSAID than on its own, continues Dr Dowson, adding a caveat that the protocol for the OTC product should be followed and adhered to for every consultation. “Anything beyond this, such as co-codamol, is better done by the GP,” he says, a view shared by Susan, who adds: “Especially if someone is frequently buying painkillers for migraine, it is worth suggesting they keep a headache diary and take this along to their appointment.” Template diaries can be downloaded and printed from most migraine charity websites.

Diagnosing and managing migraine

Some pharmacists and pharmacy staff can be reluctant to diagnose migraine, fearing they may confuse it with other conditions, which have similar symptoms. Dr Dowson attempts to address this hesitancy by pointing out: “If the symptoms form a pattern over time, it is unlikely the cause is sinister.” He says that there are also differences between migraine and more common, less serious headache types: “Migraine has other symptoms and causes more disruption to someone’s life, compared to, say, tension-type headache, which is more common, but doesn’t have other features and is of much lower impact.”

Suggesting migraine as a cause of someone’s headache, or as a reason for someone’s medication not relieving symptoms as it has done in the past is another important role for pharmacy staff. Susan, who runs The Migraine Trust’s information and enquiry line, says: “Research suggests that around 50 per cent of people with migraine never see a doctor about their symptoms and so do not have a diagnosis and access to some of the most effective migraine medications.”

A sensitive approach is a must, urges Susan: “People with migraine are often aware of the stigma surrounding the condition and may be reluctant to admit to having migraine or to seek help for their symptoms.” It is all too easy for non-sufferers to label those who do get migraines as “malingerers“ or “weak”, she says, adding: “Non-sufferers may even use the term as an excuse to take a day off work.”

None of this is helpful in raising and spreading awareness of the condition, she says, pointing out that despite its high prevalence “people with migraine often say they feel alone with their condition”. Supplements have a role in prevention, says Dr Dowson, highlighting vitamin B2, magnesium, low dose aspirin and co-enzyme Q10 as potentially helpful. However, trigger identification – aided by a migraine diary – and subsequent avoidance is probably the most effective preventative action. Some of the more common triggers include:

  • Not eating regularly or adequately
  • Dehydration
  • Stress or relaxing after a stressful time
  • Hormonal changes, such as the menstrual cycle
  • Bright or flickering lights
  • Changes in routine or travel

Clearly, it is not always possible or practicable to avoid certain triggers: women who experience migraine related to their menstrual cycle, for example, are not able to switch off their monthly hormonal ups and downs at will. 

But Susan explains: “If a particular trigger factor cannot be avoided, then addressing some of the person’s other trigger factors may help to reduce the number of attacks. It is widely recognised that the ‘migrainous brain’ doesn’t like change, so aiming for regularity in daily activities is important. Regular sleep patterns, meals, exercise and avoidance of excess stress and other recognised triggers will be useful.”

Not a migraine?

As common as migraine is, Dr Dowson highlights: “It is a small number compared to the 70 per cent of people who suffer from tension-type headaches.” The pain of this condition usually feels like a constant ache on both sides of the head, often with tense muscles in the neck and a sensation of pressure behind the eyes. Much like migraine, tension-type headaches often have triggers, such as stress, anxiety, tiredness, dehydration, hunger, poor posture and certain noises or smells.

While OTC painkillers have a role in treating tension-type headache, lifestyle measures can prevent further bouts. Maintaining good posture, and healthy eating and drinking at regular intervals can make a big difference, as can exercise, particularly relaxation techniques such as yoga. There is also evidence that acupuncture can be beneficial.

Another reason to seek alternative pain management strategies is to avoid the onset of medication overuse headache (MOH), which can develop from frequent use of painkillers (usually at least 10 to 15 days a month for more than three months). Patients with this type of headache may ask for advice because their usual OTC medication seems to be making their headache worse rather than better, and they will say that they suffer headaches more than 50 per cent of the time.

MOH is remarkably common. In fact, it is the third most frequent headache type, sometimes referred to as rebound or painkiller headache. Patients can struggle with the treatment, which involves abruptly stopping the medication that is causing the problem.

Time off work could be required as the patient copes with withdrawal symptoms such as sleep disturbances, nausea, agitation and – counter intuitively – worsening headaches for up to three weeks. If you suspect MOH, involve the pharmacist. Another type of headache that may be confused with migraine is cluster headache, with the individual reporting sudden pain behind one eye. The reason they are called cluster headaches is because sufferers will experience one or more attacks a day for several weeks or months at a time. The pain is severe and often difficult to deal with.

Triggers are thought to have a role in cluster headaches, with drinking alcohol, extremely hot weather, and taking angina medication called nitrates all increasing the risk of an attack. People with cluster headaches need referring to their GP, and probably on to a specialist. Fortunately, the condition is thankfully rare, affecting just one in every 1,000 people.

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