15 ways to cope with migraines

Headaches - learn your triggers

Ailin Quinlan

Migraine affects about half a million people and is estimated to cost the Irish economy more than €250 million in lost productivity every year. However, there are some simple but effective strategies to help sufferers cope

1 Get a correct diagnosis

A diagnosis of migraine is not made through a test; it is based on what the patient tells the doctor, explains Esther Tomkins, clinical nurse specialist at Beaumont Hospital headache/Migraine Clinic. "You must be able to recognise and explain the symptoms you are experiencing to the doctor, because the diagnosis is based on the history you present."

Migraine comes in two forms - with and without aura. About 20pc of migraine patients have migraine with aura. These may experience numbness or pins and needles in the arms, hands and face (paraesthesia). Other forms of the condition include a visual aura which involves a 'C'-shaped or crescent-shaped shimmer around an object, or flashing lights. Migraine with aura can also feature temporary problems with word-finding or word-articulation which last for a few minutes. The aura is often seen as a warning that a migraine attack is occurring.

It's usually followed by the throbbing one-sided or uni-lateral headache which is a hallmark of migraine. It is accompanied by a heightened sensitivity to light sound or smell, along with nausea or vomiting and symptoms such as neck pain, watery eyes or feeling slightly physically off balance, all of which are also the symptoms of migraine without aura. A headache can last anything from four hours to three days.

"If someone recognises some of these symptoms, it's very important for them to get a definite diagnosis to ensure that there is not something more sinister causing them," warns Tomkins.

2 Educate Yourself

"Understanding migraine and learning how to manage the condition is crucial because there is no cure for it.

"It's part of the biology of the brain and must be managed, so a patient needs to understand what to do and how to manage it. There is a lot of information to be had from the *Migraine Association of Ireland website," says Tomkins, who is also medical advisor to the Migraine Association of Ireland. Patients should also talk to their pharmacist or GP, she says, adding that pharmacists are well informed on both over-the-counter and prescription medication.

3 When should you consult your GP?

Many patients can manage migraine attacks with simple, over-the-counter analgesics or painkillers, such as aspirin, paracetamol or ibuprofen, says Dr Edward O'Sullivan, director of the Migraine/Headache Clinic at Cork University Hospital, medical advisor to the Irish Migraine Association and GP specialising in the management of headache disorders .

However, when these don't work, it's time to see the GP, he says: "There are specific migraine medications such as Triptans which are specific, prescription-only migraine medications.

"These are very effective, and provide relief within two hours to between 60pc and 80pc of patients."

Patients who get very frequent attacks - more than two to four attacks per month - may require a prescribed preventative medication to reduce the frequency of attacks, he says.

4 Know Your Triggers

Everyone has different triggers - they can be lifestyle-related, environmental, hormonal or dietary for example.

(A) Women and migraine: For many women, menstruation can bring on a migraine attack. Around 50pc to 60pc of women who experience migraine will report a worsening of migraine attacks around the hormonal cycle, says Tomkins.

"Lots of women are vulnerable to migraine just before their menstrual cycle when a drop in oestrogen occurs, which can trigger a migraine attack," says Dr O'Sullivan. However, there is some good news says Tomkins - following menopause many women find they become migraine-free.

(B) Environmental factors can also have an effect, says Dr O'Sullivan. Bright lights, harsh sunlight, stuffy or smoky atmospheres and even very humid days can trigger an attack, he explains, adding that patients should wear sunglasses to avoid glare.

Fluorescent lighting or artificial lighting, for example the kind used in shopping centres, can also be a trigger - many migraine sufferers will avoid going to places where there is fluorescent lighting. Loud noise such as loud music, the noise of heavy construction work or simply unpleasant sounds can also cause problems.

(C) Weekend migraine: A long, busy week followed by some weekend relaxation can bring about a migraine attack, explains Dr O'Sullivan.

"Patients can be vulnerable to a migraine attack in a period of relaxation after stress. This is something to watch out for," he warns.

(D) Diet: Common food triggers include food containing monosodium glutamate, (MSG), which can be found in processed foods such as pizzas or curries. Alcohol, particularly red wine, is a common trigger, Dr O'Sullivan adds.

"You may get a migraine attack after as little as half a glass of wine. This could be a result of not just consuming the alcohol itself, but also the preservatives it contains."

And watch your weight - studies show that people who are obese are five times more at risk of progressing from episodic headaches or migraine to chronic daily headache or migraine.

5 Keep a Headache Diary

This is a crucial part of managing migraine.

"Keeping a headache diary helps you track your triggers and recognise the frequency and severity of attacks, record the treatments you use, how effective they are, and provide information about aggravating factors," says Tomkins. "It's a hugely valuable tool because when you go to see your doctor, you have a detailed record of the frequency, severity of the attack and possible triggers. It helps the doctor to treat and manage the condition because he or she will use the diary to guide treatment. We would expect patients to keep a diary for our clinic - that is standard practise at headache centres across the world."

6 Live a structured lifestyle

The migraine brain tends to like routine, balance and structure so eat regularly, get regular sleep, stay well hydrated and know and avoid potential triggers where possible.

"Go to bed at the same time each night, get up at the same time every morning," says Tomkins.

Different treatment plans apply to episodic migraine and chronic migraine. When migraine is chronic, a structured lifestyle is very important, she warns.

7 Exercise

Exercise helps you relax and has a therapeutic value through the release of endorphins which can act as a defence against migraine and help reduce the number of migraine attacks, explains Dr O'Sullivan.

"We would recommend that patients with frequent migraine attacks take mild to moderate exercise - for example a brisk 30-minute walk - four or five days a week." Don't overdo it, he warns - excessive exercise can trigger an attack.

Aerobic exercise has been proven to help reduce the number of migraine days experienced in a month, points out Julie Sugrue, chartered physiotherapist specialising in the management of headache disorders, working at the Beaumont Hospital Migraine/Headache Clinic.

"The American College of Sports Medicine recommends 150 minutes of moderate intensity exercise per week - for most people this would be a brisk 30 minute walk five days a week," she explains.

8 Be organised

If you're anticipating a migraine attack, ensure you have ready access to medication which you have previously found to be effective, says Dr O'Sullivan.

Education about migraine, knowledge about how it affects you and experience of what works for you is crucial, he explains.

"The more you understand about it, the better able you are to build up an individual treatment plan which works for you."

9 The 'Don'ts' of Migraine


* get careless about triggers following a migraine-free period.

* forget to have appropriate medication with you at all times, for example in the workplace.

"It's very important to treat an attack early on because if you delay, the medication is less likely to be effective," says Dr O'Sullivan.

* take too many acute medications. Avoid overuse of pain-killers, particularly codeine-based products, he warns. Acute painkillers, either by prescription or over the counter should be limited to two days a week. For the 3pc to 4pc of people who have chronic daily headache there are preventative drugs which can bring about a reduction in the frequency of attacks.

* get careless about taking your medication, says O'Sullivan. Always adhere to the recommended use of preventative drugs prescribed by your GP or specialist. "These medications need to be taken for a number of weeks or months before it can be determined how effective they are in bringing about a reduction in headache days."

10 Migraine in children

About 10pc of children are affected by migraine. Some patients report experiencing their first migraine attack at the age of eight or nine, says Tomkins, adding however that it is very common in younger girls who present during puberty and adolescence.

"Children will experience abdominal cramping and upset stomach and there may be a mild headache. The complaint is quite cyclical and can be triggered by excitement over a school tour, skipping breakfast or playing a lot of sport," says Tomkins.

However, she says, children tend to sleep it off and will generally be back to normal after a number of hours. As they get older children will present with more adult-type features of migraine.

"It's important to keep a diary for managing migraine in a child, it is very important for the parent and the child - if you notice cyclical and unexplained abdominal cramping and nausea you need to see your GP."

11 Botox - not just for beauty

Botox is a medication given by injection to patients who have chronic migraine.

However, Dr O'Sullivan emphasises, it does not relieve the symptoms of migraine. "Botox is used to try to reduce the number of headache days a patient experiences. It is licensed for use with patients who have chronic migraine - such patients experience more than 15 headache days in the month, of which half are migraine-like."

12 Migraine is a Pain in the Neck

Neck pain affects about three-quarters of people with migraine, says physiotherapist Julie Sugrue.

In some people it's a trigger, in others it's a symptom, but a physiotherapy session can help whichever one it is, she says.

Muscles and joints in the upper part of the neck can send pain to the head due to a combination of several factors including poor posture and/or neck injury. Treatment includes hands-on techniques which can be carried out by a chartered physiotherapist or taught to the patient, as well as posture correction and specific neck exercises. Neck exercises strengthen postural muscles and relieve muscle and joint stiffness

13 Acupuncture and Stress Reduction

Acupuncture is believed to be helpful to migraine sufferers - a study published in the Canadian Medical Association Journal in 2012 showed that acupuncture was effective in reducing the number of headache days suffered by patients.

In 2012, Sugrue points out, the National Institute for Health and Care Excellence in the UK suggested that a total of 10 sessions of acupuncture over a period of five to eight weeks could be beneficial for some patients.

"Stress is a common trigger for migraine so learning skills to cope with the day-to-day stresses is important," Sugrue says.

One such technique is mindfulness, which is about being able to stay in the present without worrying about the future or the past.

For further information or to avail of guided mindfulness audio clips, she suggests visiting www.beaumont.ie/marc. Visit www.mindfulness.ie to check out community courses on mindfulness-based stress reduction courses

14 Natural Supplements - Vitamins and Herbal Preparations

These have been found to be therapeutic for some people, says Sugrue, who says the National Institute for Health and Care Excellence in the UK recommends 400mg of riboflavin daily:

"This is a B2 vitamin which can be found in eggs, nuts, legumes, green, leafy vegetables and dairy foods." Other options can include magnesium, butterbur, feverfew and Co Enzyme Q10.

However, she emphasises, it's very important to consult your doctor before starting on any course of supplements as some products may interact with other medications you are taking.

15 Migraine in the workplace

* If screen flicker is a trigger, make sure to take regular breaks. Use screens of 100Hz or above or plasma screens which have no flicker at all.

* Reduce work-related stress by good time-management, taking proper breaks and eliminating unrealistic targets.

* Take care with your posture at work to avoid tension in the neck and shoulders. Ensure that your working environment is as ergonomically designed as possible to avoid unnecessary twisting, stretching and bending.

* The Migraine Association of Ireland: (01) 894 1280; helpline: 1850 200 378

Website: www.migraine.ie

Email: info@migraine.ie