Dr Michelle O'Driscoll: How to deal with migraine

CONTRARY to the beliefs of many, migraine is not “just a headache,” as those who suffer from them can attest to. Headache is just one of the multiple symptoms, albeit the best-known.

Migraine is a neurological condition that can be long-lasting and recurring. It affects 15% of the population, (that’s about half a million people) and is three times more common in women than men. It can cause significant pain, discomfort and distress, leading to inability to work, study or socialise.

Migraine occurs when nerves get activated in the brain which signal to the blood vessels to dilate or widen, resulting in pain and further nerve stimulation.

According to the International Classification of Headache Disorders, migraines are recurrent headaches that typically last between four to 72 hours, are moderate or severe in nature, throbbing and often one-sided, and worsened by movement. They may be accompanied by aversion to light or loud sounds, and/or nausea and vomiting. Around 20-30% of sufferers also experience what is known as an aura — blind spots, flashing lights or zig-zag patterns interrupting the field of vision. Aura may even present as pins and needles on one side, muscle weakness, or slurring of speech.

What are the triggers?

For 40% of sufferers, migraines can be directly attributed to a specific trigger or combination of triggers. These triggers are very individual to each person. Some of the most commonly implicated are food (eg. cheese, chocolate and alcohol), hormone levels (e.g. menstrual migraines), emotional stress, or environmental factors (eg strong smells).

Dietary and lifestyle choices can increase the severity and frequency of migraines (eg, inadequate hydration, irregular meals).

It’s always wise to consult with a doctor if you experience what you believe to be migraine for the first time, or any new additional migraine symptoms that you haven’t noticed before. Otherwise, any migraines lasting longer than three days, any exceptionally severe symptoms, or migraines that are not being successfully treated by over-the-counter medications should be investigated further.

The key to effectively treating a migraine is to catch it early. Sufferers (unfortunately!) become very familiar with their symptoms through repeat occurrence, and can usually anticipate early on that a migraine is brewing. It’s at this point that treatment medication should be taken, because symptoms of migraine slow down the gut’s motility. Absorption of the medication won’t happen on time if it’s taken too late. Get in there fast!

How to get relief

The first step in migraine treatment is over-the-counter pain relief; paracetamol, ibuprofen or aspirin, which all come with their own suitability criteria, based on age, other medications taken, and other medical conditions. It’s important to take note of how often you need to use these, however, as excessive use over long periods of time can actually lead to the added complication of medication-overuse headaches.

Failing the above, attempted individually and in combination products with caffeine or codeine, there is the option to try something stronger; since 2018 a select cohort of migraine sufferers can be given access to sumatriptan by their pharmacist. This medication is specifically indicated for migraines. It works by causing the blood vessels to constrict or shrink, and reduces the levels of inflammatory markers in the brain. It can be supplied after a consultation with the pharmacist if you meet all of the eligibility criteria; if you’re between the ages of 18 and 65, have had five or more migraines in the past year, and your migraines have been officially previously diagnosed by your doctor. The pharmacist will also need to check your smoking status, ask if you’re on the combined oral contraceptive pill, and take a full medical history.

If you’re not eligible to try sumatriptan, or it doesn’t work for you, don’t worry. There are a variety of prescription medications to try at the onset of a migraine under your doctor’s supervision. You may also be considered suitable for prophylactic treatment. This means starting a daily treatment in order to prevent migraines from happening at all.

This can be a huge relief for people who experience multiple migraines per week, and are struggling to function as a result.

Keep a diary

In the meantime, do whatever you can at a practical level. Keep a migraine diary to identify triggers or specific patterns. Eat regular meals, exercise, maintain adequate hydration, and in the event of a migraine occurring, do what you need to do to get through it — for most, this means pain relief, a dark room and sleep.

You can also visit Migraine Ireland’s website, www.migraine.ie for further information and .

Find what works for you

Finally, don’t give up on the search for treatment. Finding effective strategies for your migraines is life-changing.

Sufferers become disillusioned when the first few treatment options aren’t successful, and reside to fact that this is their “normal.”

Don’t settle for recurring debilitating migraines — persevere with the help of healthcare professionals to find what works for you.

Don’t settle for recurring, debilitating migraines, persevere with the help of healthcare professionals to find what works.

Dr Michelle O'Driscoll writes a weekly column in Women on Wednesday (WoW!).

ABOUT MICHELLE

Dr Michelle O’Driscoll is a Lecturer of Clinical Pharmacy in UCC, while continuing to work in the community pharmacy setting.

Her research lies in the area of mental health education, and through her company InTuition she delivers health promotion workshops to corporate and academic organisations nationally.