Migraine

I'm Dr Dawn Harper. I'm a GP with a particular interest in women's health. Migraine is an incredibly common problem that affects around 6 million people in the UK. Two-thirds of those are women. 'I do see a lot of people who describe their headaches as migraine.' I think we have to be careful that, as miserable as headaches are, they are not all migraines. Migraines classically are one-sided headaches, often associated with nausea, quite often actually make you sick. Usually people feel they have to just lie down in a darkened room. They don't like the light. They really are severe headaches which last for several hours. In some poor folk, will last for two or three days. Migraine can be very frightening. In its most severe form, I have seen people who think they've had a stroke, because actually they lose the use of one side of their body during the attack. That is thankfully not common. But it's very common for people to lose part of their visual field, so they can't see anything on one side or everything in one part of their vision has zig-zag lines through it. That's very common. One in six migraine sufferers will suffer with that. It can be frightening, particularly the first time. My cut-off really is if you are suffering with migraines more than once or twice a fortnight. Really, you should be having a chat to me about what else we can do to try and prevent them. There's been lots of debate about what really causes migraine. I think the jury is still out. One theory is that, for some reason, particular triggers in susceptible people, and it does seem to run in families, will cause a spasm of the blood vessels supplying the brain. So that temporarily the blood supply is impaired, which is what gives the problems with vision and so on. Then as the blood vessels dilate after the spasm, you then get the pounding headache. The thing about migraine is recognising what triggers it for you. Really, the first thing I do with any of my patients who we think may have a migraine is to get them to keep a symptom diary and a food and drink diary. What we usually find, relatively quickly, you can identify your own triggers. So, really it's a case of trying to identify what will cause it for you and then avoiding those. For many people, actually, that's all they need to do. If, despite all that, you're still struggling with symptoms, then many will cope with their symptoms with simple over-the-counter remedies. But for some, we need to give prescription drugs which will actually stop an attack when it starts. It rather depends on whether you get any warning about your migraine attacks. Some people will get a warning up to 24 hours before. They may feel a bit stiff in the neck. They may not like lights very much. Feel a little bit lethargic and off-colour. But nothing like the full-blown attack. That will go on for up to 24 hours. Only one in six people will get the classic flashing lights or the slight loss of vision that people associate with migraine, which means that five out of six won't. Some will just suddenly develop the one-sided headache which is classic of migraine and can last for several hours. If you have a warning and you are unable to control your attacks with simple analgesics from the chemist, there are lots of prescription drugs. Some now are available over the counter that your chemist can advise you on. There are, however, still sadly a few people whose attacks are so frequent that they need regular medication to prevent the attacks occurring. That means medication on a daily basis. We know that migraine can be linked to hormones. In a very small number of women, when they start the oral contraceptive pill, they suddenly start getting migraines. In that group of women, they really should be thinking about an alternative contraceptive. There is a very, very small, but it's a risk, of going on to have a stroke if they continue on the Pill. My own daughter suffered with something called abdominal migraine. That again is quite common. It tends to occur in children who are at high risk of migraine, so have a strong family history of migraine. But instead of the headache, they get episodes of tummy pain and vomiting. Usually when they've got overtired. It's the classic eating junk food on a sleepover and not going to bed. The following day, they pay the price where they feel a lot of tummy pain, sickness, pretty miserable. Sleep it off for a few hours and they're as right as rain. But actually that may well, if that's happening on a regular basis when your son or daughter is very tired, it may well be that that's an abdominal migraine. I do think, with migraine, prevention really is better than cure. And so it is really worth taking some time to keep a diary, quite accurately, work out what triggers your own migraine and trying to avoid it. For more information visit www.nhs.uk.