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Tackling the misery of migraine
Think a migraine is ‘just another headache’? The debilitating condition affects millions but remains largely misunderstood – which Migraine Awareness Week aims to change. Jaine Blackman reports on the conditions and diecovers what help is at hand in Oxford With more than eight million people in the UK affected, migraine is more common than diabetes, epilepsy and asthma combined. Yet it’s often badly misunderstood and public awareness is low.
As the Migraine Trust, a charity which supports people affected by migraine and funds research, points out, the World Health Organisation (WHO) recognises migraine as one of the most debilitating lifetime conditions. But a lot of people still think it’s just a fancy word for a headache.
The trust hopes Migraine Awareness Week, which this year runs from September 1 to 7, will dispel some of the myths surrounding the condition.
Anybody can suffer from migraines, though they’re more common among women, and while children can be affected, attacks usually start during teens.
Currently there’s no cure, but treatments are available which can help and, most crucially, understanding migraine can make a huge difference to managing it.
When is a headache a migraine?
“Everybody gets headaches from time to time, but the difference with migraine is partly the severity – it’s a much more acute, pounding painful headache, and there are other symptoms associated with it like vomiting and sensitivity to light,” says Dr Tim Woodman, medical director of policy and evidence for Bupa Health Funding.
“You generally do feel very ill with migraine, whereas most other headaches are more of a nagging discomfort.”
Woodman, a former GP, suffers with migraine himself. He points out that while headaches are a main characteristic of the condition, the symptoms go far wider.
“It’s actually perfectly possible to have a migraine and not even have a headache,” he adds. “Migraine is a whole complex of symptoms, things like visual discomfort, and pins and needles in your hands and feet.”
Some symptoms are known as ‘aura’ symptoms, relating to neurological disturbances like seeing flashing lights and blind spots before the eyes, temporary blindness or tunnel vision and, sometimes, numbness, dizziness and vertigo.
Speech and hearing can be affected too, and some people feel confused, struggle with memory and may experience fainting and vomiting.
A serious condition
The severity of symptoms varies greatly from person to person. A very mild migraine may not be too unbearable and might not prevent somebody from carrying out most daily tasks as usual, while severe migraines can be extremely debilitating and make work and socialising impossible.
In fact, according to WHO figures, migraine is one of the 20 top causes of disability and, worldwide, 25 million days are lost from work or school every year.
“It can be a lot more debilitating than people realise,” says Woodman.
The common link
One-off attacks are extremely unusual, though Woodman adds that cluster headaches, a variant of migraine, can occur with very long gaps in between.
But for most people, migraine is a long-term condition with attacks coming and going, and more than half of those affected experience one or more episodes a month.
“You typically have a run-up period to the acute migraine, and then the run-down period afterwards, so the whole episode can take several days,” says Woodman.
However, while the pattern of symptoms and severity may vary from person to person, it’s important to be aware that there is a pattern, as this could be key to managing your migraine.
Get a diagnosis
The first step is to see a doctor and get a concrete diagnosis. It’s believed that around 50 per cent of cases remain undiagnosed and untreated.
Making a note of any pattern – Woodman suggests keeping a diary, noting when symptoms start, what you were doing at the time and anything you had eaten – can help.
“There are a number of reasons why it’s important to get a diagnosis,” says Woodman. “As a former GP, the most important thing is that if you’re experiencing symptoms that could be migraine, or frequent and severe headaches, you need to go and get these things checked out.
“It’s no good assuming it’s a migraine and taking something over the counter, you need to be absolutely certain what’s going on.
“Headaches can have a range of causes and if there’s another cause, you’ll need to sort that out,” he adds. “And having an official diagnosis is an important step towards managing the condition.”
Crack the Code
This is where keeping a diary comes in especially handy, as familiarising yourself with the pattern of your migraines will help you identify triggers and avoid them.
“Because we don’t really understand what causes migraine, we don’t have an obvious cure,” says Woodman. “However, an awful lot of the management of migraine is about avoiding triggers. If you’re able to clearly identify these, you can effectively go for very long periods without a migraine.
“For example, one of the classic triggers for migraine is red wine. I get migraine with Rioja but I don’t get it with Merlot.”
Triggers also vary, but examples include certain foods, hormones (in some women, attacks are linked with their menstrual cycle) and stress. Self-help is an important part of migraine management. Avoiding triggers can reduce attacks and also reduce dependence on medication.
“It’s unlikely you’ll be able to eliminate migraine by avoiding triggers, but you can significantly reduce the number of attacks,” says Woodman. “And you can reduce your use of medication, which is important, as one of the possible causes of migraine can be overuse of medication, so you only want to be taking painkillers when you need them.”
Taking positive steps to help manage migraine can have wider benefits too. Living with a painful and debilitating condition can be a stress in itself and it’s not uncommon for sufferers to experience low moods.
Depression is three times more common in people with migraine or severe headaches, according to WHO research.
A few steps to improve your lifestyle like incorporating regular exercise, reducing stress through avoidance and making time for relaxation can make a big difference.
“If you’re suffering from something quite debilitating and feel your mood’s low, taking back control of the migraines may help you feel that you’re starting to take control of your life generally,” says Woodman.
“That sort of empowerment will lift you, and that could help reduce symptoms.”
Migraine Awareness Week 2013 is September 1-7. For more information about the campaign and the Migraine Trust, visit www.migrainetrust.org For more information about migraine and other common conditions visit www.bupa.co.uk/health-information
A sufferer's story
Anna Laerke, 49, who lives in Headington, has suffered from migraine since she was about seven years old, but it wasn’t diagnosed until she was 28 and a new GP sent her for a brain scan after she had a blackout.
It has had a huge impact on her life.
“I have had no social life for many years,” said single mum-of-two Anna, a co-ordinator for the charity Home Start Oxford and associate lecturer at The Open University.
“You lose friends because people do not really understand what migraine is. Many think it’s ‘just a headache’, and headaches are the proverbial excuse for when you skive from work, don’t want to have sex with your spouse, or want to cover up a hangover.
“Sometimes, I am sure friends have thought I was making it up, or exaggerating. And the fact that I have to cancel so often means that people have stopped inviting me.”
Anna has an attack four to eight times a month, each one lasting 12 to 36 hours.
“I get classic migraines with aura; severe headache; upset stomach; neurological symptoms such as pins and needles in my arms and hands, and coldness in the face; and cognitive symptoms like difficulty finding words and concentrating,” she said.
“My employers have to be understanding of the unpredictable and debilitating nature of the attacks when they occur.
“Migraines can be triggered by stress, so any stress in my life will make my condition worse.
“I have often had to withdraw from or cancel activities with my children [aged 14 and 16]. I feel extremely bad about that, but the kids are very understanding and they are my greatest support.”
Anna has taught herself mindfulness meditation as a way of managing her pain.
“Individual attacks are treatable, if treated at the onset of aura, the first sign of migraine,” she said. “But the condition is chronic, and as such untreatable.
“I have been through all kinds of examinations and treatments - neurology, pain management, psychology, specialist physio-therapy, hormonal treatment.
“I have a fantastic GP. If I did not have a GP who is always willing to try something else, I would not know what to do.”
Help at hand
Although there are no support groups in Oxford, Oxford is a good area for migraineurs, having a migraine clinic at the John Radcliffe and a new clinic opening,” said Rachel Markham of charity Migraine Action.
“Often people welcome the opportunity to share experiences with fellow sufferers. Migraine Action facilitates groups around the UK. If anyone is interested in setting up/attending a support group they can contact us. We don’t have funds to staff or pay for groups but we offer people advice on setting up and can help promote them. Often it is a case of collecting contact details and putting people in touch.
“People often want to join a group but by the nature of the condition do not feel able to be involved in running one. It would be great to get one going in Oxford.
“For people who don’t know where to go next, Migraine Action is here to offer support and information.
“Migraine can be such a distressing condition that people can feel extremely lost, but although there are no magic answers, there are now many treatment options.”
Migraine Action is the national advisory and support charity. It has free factsheets, diaries and a helpline – 0116 275 8317. Visit www.migraine.org.uk A new clinic, the Oxford Headache Centre, will open from 9am on Thursday, September 12, to provide the best standards of care to patients with headache disorders.
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