| Migraine
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What is
Migraine?
For most people migraine is a great deal more than just a headache. It
can be a debilitating condition which has a huge impact on the quality of
life of sufferers and their families.
If you have two or more of the following
symptoms during an attack it is probable that you are suffering from
migraine.
*Visual disturbances including blind spots,
distorted vision, flashing lights or zig zag patterns. These symptoms,
often called an aura are most often identified with migraine but in fact
only about 10% of sufferers experience them. Migraine with aura is often
called classical migraine.
- *Intense throbbing headache, often on
one side of the head only.
- *Nausea and/or vomiting and/or
diarrhoea.
- *Increased sensitivity to light
(photophobia)
- *Increased sensitivity to sounds
(phonophobia)
- *Increased sensitivity to smells
(osmophobia)
You may also experience stiffness of the
neck and shoulders, tingling or stiffness in the limbs, an inability to
concentrate, difficulty in speaking, or in very rare cases paralysis or
loss of consciousness.
A general rule of thumb is that if a
headache and/or other associated symptoms prevent you from continuing with
normal daily activities it could be a migraine.
Migraine attacks normally last between 3
and 72 hours and sufferers are usually quite well between attacks.
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What
Causes Migraine?
Migraine is believed to be caused by changes in the neurotransmitters
and blood vessels in the brain but exactly what causes these changes is
still a subject for research and debate. However certain factors have been
identified which can trigger attacks in susceptible people:
- *Stress (or sometimes the relief of
stress).
- *Lack of food or infrequent meals.
- *Certain foods including products
containing monosodium glutamate, caffeine, tyramine or alcohol.
- *Overtiredness (physical or mental).
- *Changing sleep patterns (e.g. weekend
lie ins, sleeplessness or shift work).
- *Hormonal factors (e.g. monthly periods,
the contraceptive pill, HRT or the menopause).
- *Extreme emotions (e.g. anger, grief
etc.).
- *Physical activity.
- *Environmental factors (e.g. loud noise,
bright or flickering lights, strong perfumes, hot stuffy atmosphere,
VDUs etc.).
- *Climatic conditions (e.g. strong winds,
extreme heat or cold).
For most people there is not just one
trigger but a combination of factors which individually can be tolerated
but when several occur together a threshold is passed and an attack is
triggered.
Although it can be helpful to identify and
avoid your own personal trigger factors it is important not to become too
obsessive.
Everyone has the capacity to suffer from
migraine but for around 10% of the population, most probably because of a
genetic predisposition, the threshold at which attacks occur is lower. It
has been proven that there is no "migraine type" and sufferers
are not, as is sometimes suggested, neurotic, perfectionist hypochondriacs
who bring all their problems on themselves nor even, as has also been
suggested, that they are super intelligent or extra sensitive. Although
twice as many women as men suffer from migraine because of the involvement
of hormonal factors, migraineurs come from all walks of life, all areas of
the world and ethnic groups, and all social classes.
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How
does Migraine affect the lives of sufferers?
Migraine is not a life threatening condition but it can have a
substantial impact on quality of life with far reaching effects on the
lives of sufferers and their families.
Migraine is a much-misunderstood condition.
Sufferers can be regarded as malingerers, hypochondriacs or self obsessed
neurotics. Because there is no test for migraine (diagnosis depends on
careful history taking) and, outside an attack, there are no obvious
external signs of the condition, a sufferer can offer no absolute proof of
his/her condition. A broken arm can attract a great deal of sympathy but
may not cause as much pain as a single migraine attack.
As migraine patients are normally quite
well between attacks non-sufferers often find it difficult to understand
how they can suddenly become so severely debilitated. Comments such as
"but you were fine yesterday" are common. This factor also makes
migraine an excellent excuse for the unscrupulous who do true sufferers a
great disservice.
The unpredictably of migraine can cause
disruption to family, social and working life. As a result sufferers often
feel that they are letting everyone down. They become afraid to make plans
or take on responsibilities and are in fear of when the next attack will
strike. The support and understanding of family, friends and working
colleagues is vital.
Migraine can put a strain on even the
happiest of relationships. However understanding and supportive a partner
may be their patience can be tried when another outing is cancelled or
they have to "take over" yet again. Children can become upset
and confused when a parent is ill and older children can be very
intolerant when plans have to be changed at short notice. It can sometimes
be more distressing to see someone you love in pain and feel helpless to
alleviate it than to experience it yourself.
Employers can regard migraine sufferers as
a bad risk. This is unfair as, due to the unpredictability of their
condition, migraineurs are often well organised and conscientious.
Unfortunately some members
of the medical profession also lack understanding and sympathy. Some
sufferers do not receive the support that they need from their GP and are
sometimes refused drugs that can bring them significant relief.
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Is
there a cure for migraine?
Although there is, as yet, no miracle cure for migraine it is possible
to bring your condition under control There are now a wide range of
treatments available which can be very effective but migraine is a complex
condition and a treatment which is successful for one patient may have no
effect on another. It is therefore important to persevere until you
develop a management plan which works for you.
Perhaps the first stage in
understanding and managing your migraine is to keep a diary to try to
identify your trigger factors. You may find that an identifiable pattern
emerges and that by making a few minor changes to your diet or lifestyle
you can reduce the frequency and/or severity of your attacks.
Around 60% of migraine
sufferers have never consulted their doctor about their migraine either
because they "don’t like to bother him/her" or they believe
that nothing can be done to help them or that a treatment he/she
prescribed in the past did not help and they have not bothered to go back.
There are many treatments now available and new products are introduced
very frequently. Your doctor and your pharmacist are important allies in
your battle against migraine and their advice and support can be
invaluable.
Many people treat their
migraine with simple pain killers purchased from the chemist. These can be
very effective, especially if taken very early in the attack. It is
important to take pain killers quickly as, during an attack, gastric
stasis can occur and medication cannot then be absorbed from the gut into
the blood stream. Pain killers taken in soluble form or tablets taken with
a sweet fizzy drink can start to work more quickly.
For sufferers who
experience nausea and vomiting painkillers combined with an anti-sickness
ingredient can be helpful.
If remedies purchased from
your chemist are not bringing you significant relief your doctor can
prescribe stronger pain killers or painkillers combined with anti-sickness
ingredients.
Ergotamine can be effective
in aborting migraine attacks and many sufferers have found it helpful but
it is now less frequently prescribed because of fears about its addictive
potential.
There are also drugs which
act directly to correct the serotonin imbalance in the brain during a
migraine attack. These are available on prescription only and are not
suitable for all patients.
Acute treatments are
available in a variety of different forms including tablets, capsules,
powders, suppositories, injections, nasal spays and inhalers. It may be
beneficial to try a treatment in another form.
If your attacks are very
frequent your doctor may prescribe preventative medication which you will
need to take every day.
These treatments sometimes take a while to
show any benefit and seldom eliminate attacks entirely so you will also
need an effective compatible acute treatment for breakthrough attacks.
Non drug treatments and self help
measures
can also be very beneficial:
- Relaxation can be extremely beneficial
both in preventing attacks and helping to cope with the pain.
- Eat regularly to keep blood sugar levels
stable (no longer than 3 hours between food during the day or 12 hours
overnight).
- Take sensible breaks from work,
especially if you use a VDU or if your work is repetitive and/or
stressful.
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Regular
exercise can be beneficial
Herbal remedies, specially tinted glasses, dental splints, devices
that emit electronic impulses, magnetic devices, homeopathy, acupuncture,
chiropractic and various methods of encouraging relaxation have also been
helpful for some people.
Migraine is a complex and individual
condition and it is important to persevere until you find the right
treatment or combination of treatments which works for YOU.
Many migraineurs now live completely normal
lives free from attacks because they have learned to control their
condition.
Source : The Migraine Action Association
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Migraine
Misunderstanding
The Migraine
Action Association conducted a survey during migraine Action Week to
assess the extent of communication problems between migraine
sufferers and their GPs. Responses to a questionnaire were given by
429 patients and 185 GPs, which showed that 52% of the patients and
64% of the GPs felt that patients had difficulty in communicating
the true extent of their migraine problem. Underlining the
difficulty in obtaining suitable treatment, even with a sympathetic
GP, was the variable nature of migraine which affects individuals in
different ways. The survey showed showed that 71% of patients and
81% of GPs said more than one consultation (for over half, up to
five consultations) was needed to reach understanding. There was an
overwhelming need to keep a diary and other relevant information
before visiting the doctor.
Source: - Allergy
Newsletter, Winter 1999, P13
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