Wednesday 18 January 2017

Ask the GP: Migraine is incurable, but treatable

Nina Byrnes

Published 11/08/2015 | 02:30

Treatment can minimise the effect of migraines. Photo: Getty Images
Treatment can minimise the effect of migraines. Photo: Getty Images

Advice from our GP on migraine treatment and what you can do about ear wax.

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Question: I suffer with migraine. I have been buying painkillers and taking them myself but my GP recently advised me to stop these. Have you any advice about how I can manage migraine better?

Dr Nina replies: It is estimated that 10-15pc of the Irish population suffer from migraine. These headaches can run in families and are more common in women than men. Migraine is not a curable condition.

The main goal of treatment is to minimise the impact of migraines on quality of life and lifestyle.

There are two main approaches to treatment. Traditionally a stepwise approach to treatment was advised. This involves starting with simple painkillers and anti-nausea medicine and only adding migraine-specific treatment if this wasn't working. The newer stratified approach to treatment looks more specifically at individual cases of migraine and their impact on an individuals well-being and lifestyle.

The most important first step is to get the right diagnosis. I have met many patients who complain of migraine when in fact they are suffering from a different type of headache. Keep a diary of your headaches noting when and how often they occur, where in your head you feel them, how you are before, during and after the attack. Note any other associated symptoms or upset and what medication you have tried. Visit your doctor with this diary. A comprehensive chat and examination will help lead to the correct diagnosis.

If migraine occurs less than twice per month it is reasonable to try simple painkillers at first. Aspirin and Ibuprofen can be effective. It is advised to avoid painkillers containing codeine as frequent use of these can cause analgesia overuse headache. Migraine is often associated with nausea so some anti-nausea medicine may help.

If the above measures aren't working or headaches are occurring more frequently your GP may prescribe migraine-specific medicine. The most common of these belong to a group called triptans. They should be taken early in the headache and can be repeated up to once in an attack.

For those who experience regular migraine attack or for whom attacks are severe and disabling preventive medicine can be prescribed. There are a number of different types. B blockers, which are a form of heart or blood pressure tablet, can be very effective and are the most commonly prescribed. Other options include medication that has also been used for seizures, nerve pain and older antidepressants.

Lifestyle management also has a role. Identify your triggers to avoid. Ensure you drink plenty of fluids, get rest, avoid stress and exercise regularly.

Question: My ears keep getting blocked with wax. Why does this happen and what can I do about it?!

Dr Nina replies: Ear wax is produced by the glands that line the outer part of the ear. After wax is produced it slowly makes its way along the ear canal to the outside where it ultimately falls out or is washed away during showering or bathing.

Wax performs a number of important functions. It keeps the ear canal moist, thus preventing dry and itchy ears. It contains chemicals that protect the skin of the ear from infection. Lastly it traps dust, dirt and debris in the ear preventing them from reaching the eardrum.

The build up of ear wax is a very common complaint and it occurs for no particular reason.

Wax in the ear can feel uncomfortable and cause a blocked sensation or reduced hearing. When this occurs many people scratch or poke at the ear using cotton buds, their fingers or even smaller items such as paper clips and tooth picks to try and clear the blockage.

This is a bad idea as it can push the wax further into the ear canal, making the blockage worse, or more seriously damage the lining of the ear or eardrum. There is an old saying that states you should never put anything smaller than your elbow into your ear. This is true.

Old wax hardens and can be difficult to remove. It is important to soften the wax before removing it.

There are a number of drops you can buy but one of the easiest and most effective methods can be found in your kitchen cupboard. Olive oil at room temperature can soften hard wax. Put a few drops into your ear at night. Then place some Vaseline on the inside of a small plug of cotton wool before placing this in the ear. The Vaseline is a very important step as this stops the oil soaking into the cotton wool and forces it into the wax. Do this for at least a week. The wax will soften and even liquefy and may fall out itself. If it is hasn't, make an appointment with your GP or practice nurse who can irrigate the ear for you.

Ear irrigation involves flushing warm water into the ear canal gently removing the wax. This is not suitable for everyone and the water should be flushed at a particular angle to avoid damaging the eardrum so don't undertake this yourself.

Suction of ear wax may be advised in certain cases and this is usually done in an ENT clinic.

If you are prone to a build up of wax, placing olive oil in the ear canal once or twice a week may prevent the wax building up and hardening.

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