Courtesy of The Migraine Trust.
Migraine: isn’t that just a bad headache?
Migraine is a condition which affects people of any age, gender and ethnic group. Far more than ‘just a headache’, migraine affects the whole body and can result in many symptoms. Often people experience an intense throbbing headache which may affect one side of the head. Other symptoms can include nausea and/or vomiting, confusion, visual disturbances (such as flashing lights in front of the eyes, or blind spots), pins and needles, numbness, and an increased sensitivity to light, sound or smell. If a headache is accompanied by two or more of these associated symptoms, occurs episodically and affects the person’s ability to continue with normal daily activities, it is probably migraine. Few people realise that 10% of schoolchildren also have migraine; however, as migraine in children often presents very differently, with many not experiencing a headache or this being mild and the main symptom instead being a bad stomach ache, this can mean that the condition goes unrecognised.
Migraine attacks can last for between 4 and 72 hours. On average people experience around 13 attacks a year, although some people have two attacks a week and others can go for many months without an attack. People with migraine will usually be free of symptoms between attacks.
It is believed that everyone has the capacity to suffer from migraine but, in 10-15% of the population, there is an increased susceptibility, a lower threshold at which an attack is triggered. There is a genetic element to migraine so it can run in families. This is not always the case and there are many internal and external factors which can ‘trigger’ a migraine. Triggers are individual to each person, but can include dehydration, stress, particular foods and drink (common ones include chocolate, cheese, and red wine, but they can be very individual, including citrus fruit, marmite, processed meats, bananas), low blood sugar levels (not eating regularly), hormones, bright sunlight or flashing lights, changes of weather, irregular sleep patterns or spending too long on a computer. For many people there is not just one trigger but a combination of factors which individually can be tolerated but, when several occur together or accumulate over a short period of time, a threshold is passed, triggering an attack.
There is no test to diagnose migraine. If you suspect you may be affected it is always advisable to seek a professional diagnosis from your GP. Keeping a migraine diary to record your pattern of attacks will be very useful to both you and your GP and may help to identify any likely triggers, although this is not always possible.
Your GP will also be able to provide information about the many treatment and management options available to relieve the symptoms and reduce the severity and frequency of attacks. These include over-the-counter and prescribed medications (both to help during an attack and to help prevent attacks) and complementary therapies. Many simple lifestyle tips can also make a huge difference, including keeping hydrated, eating healthily and regularly (not skipping meals), maintaining regular sleep patterns, taking regular breaks from the computer / making sure your place of work is comfortable and if you work at a desk this is set up correctly, making time for relaxation and exercise, getting some fresh air every day and wearing sunglasses in bright sunlight.
Migraine Facts & Figures
- One in seven people in the UK suffers from migraine
- Migraine is more prevalent than diabetes, epilepsy and asthma combined
- Migraine affects twice as many women as men
- Migraine affects people of all ages (even young children) and all social classes
- Migraine is more than just a headache. Other symptoms can include visual disturbances, nausea and vomiting, sensitivity to light, noise or smell
- A migraine attack can last for between 4 and 72 hours
- Migraineurs experience an average of 13 attacks each year
- An estimated 190,000 people have a migraine attack every day in the UK
- Every day more than 100,000 people are absent from work or school in the UK as a result of migraine
- Migraine costs the UK around £2.25 billion per annum
- The World Health Organisation has rated migraine amongst the top 20 most disabling lifetime conditions
- Although there is no cure for migraine there are many ways to help manage the condition
Migraine & M.E.
Migraine is primarily a disorder of the brain but is not just about headache. Migraine can have many non-headache symptoms, including chronic fatigue. Some doctors believe that patients with M.E. have migraine as the main underlying cause or have a centralized sensitization syndrome causing migraine and fatigue symptoms. This area can go ‘below the radar’ given that misdiagnosis for migraine headache can be extremely high and that migraine may present with symptoms other than headache.
Episodic migraine may occur in four phases, but not everyone has all four phases (or has them during each attack). They are the prodromal phase, an aura phase, a headache phase and a postdromal phase. The prodromal phase may occur on a number of days before the other phases, and fatigue can be a key symptom. This, along with other prodromal symptoms, can continue into the headache phase of the attack. Fatigue can also be a factor in the postdromal phase.
As patients escalate from episodic to chronic migraine, their attacks generally become more frequent and the background fills in with a milder, less impactful headache, with some complaining of little or no headache but having other prominent symptoms. It is generally believed that as a patient escalates from episodic to chronic migraine they will develop many other non-headache symptoms and feel generally unwell. Medication overuse (and possibly caffeine overuse) is a key reason that people will become chronic migraineurs (whereby medication once used to elevate symptoms in fact causes an increase in headaches and other symptoms). If non-headache symptoms attributed to other disorders, such as Chronic Fatigue Syndrome, fully disappear on headache-free days, this may be an indicator that this is actually an aspect of chronic migraine.
Many patients who present to specialist headache clinics for treatment have already been separately diagnosed as suffering from Chronic Fatigue Syndrome. However, chronic migraine in its own right is recognised as a significant cause of fatigue and many patients will meet recognised criteria for diagnosis of Chronic Fatigue Syndrome. Some doctors suggest that as the diagnosis of Chronic Fatigue Syndrome or M.E. relies on the initial exclusion of any other known underlying cause, M.E. or Chronic Fatigue Syndrome should not be diagnosed without first excluding the presence of chronic migraine.
As with all things migraine, much more research needs to be conducted in this area. If you have concerns about your migraine and M.E., speak to your healthcare provider and you may wish to request a referral to a specialist headache clinic.
The Migraine Trust
The Migraine Trust seeks to empower, inform, and support those affected by migraine while educating health professionals and actively funding and disseminating research. To find out more visit www.migraine.org.uk or call 0203 9510 150.