MIGRAINE
Migraine is a condition that causes episodes ('attacks') of
headaches. Other symptoms such as feeling sick (nausea) or vomiting
are also common. Between migraine attacks, the symptoms go completely.
There are two main types of migraine:
- Migraine without aura - sometimes called common migraine
- Migraine with aura - sometimes called classic migraine
Who gets migraine?
Migraine is common. About 1 in 4 women, and about 1 in 12 men, develop
migraine at some point in their life. It most commonly first starts
in childhood or as a young adult. Some people have frequent attacks
- sometimes several a week. Others have attacks only now and then.
Some people may go for years between attacks. In some cases, the
migraine attacks stop in later adult life. However, in some cases
the attacks persist throughout life
What are the symptoms of a migraine attack?
Migraine without aura
This is the most common type of migraine. Symptoms include the following:
- The headache is usually on one side of the head, typically at the front or side. Sometimes it is on both sides of the head. Sometimes it starts on one side, and then spreads all over the head
- The pain is moderate or severe and is often described as 'throbbing' or 'pulsating'. Movements of the head may make it worse
- It often begins in the morning, but may begin at any time of day or night. Typically, it gradually gets worse and peaks after 2-12 hours, then gradually eases off. However, it can last from 4 to 72 hours
- Other symptoms that are common include: feeling sick (nausea), vomiting, you may not like bright lights or loud noises, and you may just want to lie in a dark room
- Other symptoms that sometimes occur include: being off food, blurred
vision, poor concentration, stuffy nose, hunger, diarrhoea, abdominal
pain, passing lots of urine, going pale, sweating, scalp tenderness,
and sensations of heat or cold
Migraine with aura
About 1 in 4 people with migraine have migraine with aura. The symptoms
are the same as those described above (migraine without aura), but
also include an aura (warning sign) before the headache begins:
- Visual aura is the most common type of aura. Examples of visual
aura are: a temporary loss of part of vision, flashes of light, objects
may seem to rotate, shake, or 'boil'
- Numbness and 'pins and needles' are the second most common type
of aura. Numbness usually starts in the hand, travels up the arm,
then involves the face, lips, and tongue. The leg is sometimes involved
- Problems with speech are the third most common type of aura
- Other types of aura include: an odd smell, food cravings, a feeling
of well-being, other odd sensations
- One of the above auras may develop, or several may occur one after each other. Each aura usually lasts just a few minutes before going, but can last up to 60 minutes. The headache usually develops within 60 minutes of the end of the aura, but it may develop whilst the aura is still present. Sometimes, just the aura occurs and no headache follows. Most people who have migraine with aura also have episodes of migraine without aura
Phases of a migraine attack
A migraine attack can be divided into four phases:
- A 'premonitory' phase occurs in up to half of people with migraine.
You may feel irritable, depressed, tired, have food cravings, or
'just know' that a migraine is going to occur. You may have these
feelings for hours or even days before the onset of the headache
- The aura phase (if it occurs)
- The headache phase
- The resolution phase when the headache gradually fades. During
this time you may feel tired, irritable, depressed, and may have
difficulty concentrating
Do I need any tests?
Usually not. There is no test to confirm migraine. A doctor can be
confident that you have migraine if you have the typical symptoms.
However, some people with migraine have non-typical headaches. Sometimes
tests are done to rule out other causes of headaches. Remember, if
you have migraine, you do not have symptoms between attacks. A headache
that does not go, or other symptoms that do not go, are not due to
migraine. Tension headaches are sometimes confused with migraine.
These are the common headaches that most people have from time too
time. Note: if you have migraine, you can also have tension headaches
at different times to migraine attacks.
What causes migraine?
The cause is not clear. One theory is that blood vessels in parts of
the brain go into spasm (become narrower) which may account for the
aura. The blood vessels may then dilate (open wide) soon after, which
may account for the headache. The blood vessels then gradually return
to normal. This is not the whole story, and it is now thought that
some chemicals in the brain increase in activity in addition to any
blood vessel changes. It is not clear why people with migraine should
develop these changes. However, something may 'trigger' a change
in your brain to set off a migraine attack. Migraine is not a strictly
inherited condition. However, it often occurs in several members
of the same family. So, there may be some genetic factor involved
which makes you more prone to developing migraine
What are triggers?
Most migraine attacks occur for no apparent reason. However, something
may trigger migraine attacks in some people. Triggers can be all
sorts of things. For example:
- Diet. Dieting too fast, irregular meals, cheese, chocolate, red
wines, citrus fruits, and foods containing tyramine (a food additive)
- Environmental. Smoking and smoky rooms, glaring light, VDU screens
or flickering TV sets, loud noises, strong smells
- Psychological. Depression, anxiety, anger, tiredness, etc
- Medicines. For example, hormone replacement therapy (HRT), some
sleeping tablets, and the contraceptive pill
- Other. Periods (menstruation), shift work, different sleep patterns,
the menopause
It may help to keep a migraine diary. Note down when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that may trigger your migraine attacks
What are the treatment options for migraine?
Painkillers
Paracetamol or aspirin work well for many migraine attacks. (Children
under 16 should not take aspirin.) Take a dose as early as possible
after symptoms begin. If you take painkillers early enough, they
often reduce the severity of the headache, or stop it completely.
A lot of people do not take a painkiller until a headache becomes
really bad. This is often too late for the painkiller to work well.
The only solution may then be to find a a quiet, dark room to 'sleep
it off'. Take the full dose of painkiller. For an adult this means
900 mg aspirin (usually three tablets) or 1000 mg of paracetamol
(usually two 500 mg tablets). Repeat the dose in four hours if necessary.
Soluble tablets are probably best as they are absorbed more quickly
than solid tablets
Anti-inflammatory painkillers
Anti-inflammatory painkillers probably work better than paracetamol
or aspirin to ease a migraine. (Although, strictly speaking aspirin
is an anti-inflammatory painkiller.) They include ibuprofen which
you can buy at pharmacies or get on prescription. Other types such
as diclofenac, naproxen, or tolfenamic acid need a prescription
Dealing with nausea and sickness
Migraine attacks may cause nausea (feeling sick) or vomiting. The nausea
causes poor absorption of tablets into your body. If you take painkillers,
they may remain in your stomach and not work well if you feel sick.
You may even vomit the tablets back. Tips that may help include:
- Use soluble (dissolvable) painkillers. These are absorbed more
quickly from your stomach and are likely to work better.
- You can take an anti-sickness medicine with painkillers. A doctor
may prescribe one. Like painkillers, they work best if you take them
as soon as possible after symptoms begin.
- An anti-sickness medicine is available as a suppository if you
feel very sick or vomit during migraine attacks. A painkiller suppository
is also available.
- Combinations of medicines - some tablets contain both a painkiller and an anti-sickness medicine. For example, Migraleve, Paramax, Migramax, and Domperamol. They may be convenient. However, the dose of each constituent may not suit everyone, or be strong enough. You may prefer to take painkillers and anti-sickness medicines separately so that you can control the dose of each
Triptan medicines
A triptan is an alternative if painkillers do not help. These include:
almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan,
sumatriptan, and zolmitriptan. They are not painkillers. They work
by interfering with a brain chemical called 5HT. An alteration in
this chemical is thought to be involved in migraine. Some triptans
work in some people and not in others. Therefore, if one triptan
does not work, a different one may well do so. Most people who have
migraine can usually find a triptan that works well for most migraines,
and where side-effects are not too troublesome. Do not take a triptan
too early in an attack of migraine (this is unlike painkillers described
above which should be taken as early as possible). You should take
the first dose when the headache (pain) is just beginning to develop,
but not before this stage (for example, do not take it during the
premonitory or aura phase until the headache begins)
Preventing migraine attacks
A medicine to prevent migraine attacks is an option if you have frequent
or severe attacks. It may not stop all attacks, but the number and
severity are often reduced. Medicines to prevent migraine are not
painkillers, and are different to those used to treat each migraine
attack. A doctor can advise on the various medicines available
Further sources of help and information
Migraine Action, Unit 6 Oakley Hay Lodge Business Park, Great Folds
Road, Great Oakley, Northants, NN18 9AS. Telephone: 01536 461333 www.migraine.org.uk
Migraine Trust, 2nd Floor, 55-56 Russell Square, London,
WC1B 4HP. Tel: 020 7436 1336 www.migrainetrust.org
Source: Adapted with permission from a © document supplied by EMIS and PIP
NHS
Direct 0845 46 47 www.nhsdirect.nhs.uk
