OVERVIEW
Migraine is not just a severe headache, but a whole disease process, one part of which is a headache. Nor are the headaches of migraine always severe, though in many cases they are absolutely appalling. I can't emphasise enough that migraine is not a different strength, but a different type of headache.
Migraine is common - roughly one in ten people suffer from it. It disrupts work, family and social life. It's responsible for missed job opportunities, it diminishes output, and it accounts for about four million lost working days, and a yearly lost income of at least ?200 million in Britain alone.
It's not actually accurate to talk about migraine as if it were a single entity, because there are many different types. The commonest form is a one-sided pulsating headache, lasting between one and three days, usually accompanied by nausea and vomiting and a sensitivity to light and noise. There is complete freedom from symptoms in between attacks.
There are many variants:
• Common migraine is what I've just described.
• Classical migraine is common migraine, but with an aura beforehand, which can last up to an hour. An aura is an inexplicable feeling or sensation which warns the sufferer that he is just about to have another attack. Aura symptoms vary, but often consist of flashing lights in front of the eyes. There are other, rarer variants.
Migraine can be split into five separate sections: the prodrome phase, where there may be food cravings, yawning, irritability, or euphoria; the aura, with flashing lights in front of the eyes, blind spots in the field of vision, numbness, or difficulty in speaking properly; the headache phase, during which the headache itself strikes, accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound; the resolution phase, during which the symptoms start to terminate and the patient is able to sleep it off; and the recovery phase, where there is exhaustion and a sense of being washed out.
This is what has been termed 'complete' migraine. Not all migraineurs will experience every single part of this complete description. Nor will the attacks necessarily follow the same pattern in the same patient - sometimes there may be an aura, sometimes not.
Women are much more susceptible to migraine than men by a factor of about three to one, largely because of the effect of the female hormone oestrogen. The relationship is complex: sometimes it is the lack of oestrogen that precipitates migraine; sometimes extra oestrogen does the damage.
In children, migraine takes two forms. In some cases children get ordinary 'head' migraines, which behave just like the adult variety; but children often get abdominal migraine, where the pain is in the stomach area, not the head. Abdominal migraine never has an aura, but otherwise it follows the same over-all pattern as adult migraine, though there are more symptoms relating to the gut.
The best way to treat a migraine is to identify as soon as possible that you're having an attack, and to start treatment straightaway. Prompt treatment can undoubtedly nip an attack in the bud; leave it for any length of time and you may have to suffer the full horrors over the next three days.
We used to think that common over-the-counter pain-killers such as aspirin and paracetamol didn't work particularly well in migraine, and that more powerful drugs like pethidine and morphine were needed to relieve the symptoms of an attack. Now we know this is not the case. The problem was not that these milder pain-killers didn't work, but that they weren't being absorbed properly. Migraine is a disease not just of the brain, but of the gut as well, and it affects the absorption of material in the stomach. Quite simply, aspirin and paracetamol often didn't work because they never got into the bloodstream.
Some of the newer anti-vomiting drugs, such as metoclopramide and domperidone, stabilise the gut, and allow better absorption to take place; once absorbed, the aspirin or paracetamol subdues the pain. In addition, the anti-vomiting drug also acts directly to reduce the nausea and vomiting.
A second important drug in the treatment of migraine is ergotamine. This is successfully used to constrict the dilated blood vessels in the head, that are thought to be involved in the migraine process. However it is a potentially dangerous drug and the dose levels recommended by your doctor must not be exceeded.
A new class of drugs has recently been used. These are the 5-1 IT agonists. 5-HT is a chemical that helps transmit messages within the brain. During a migraine, boosting the effect of 5-HT can help enormously, and may abort an attack. Sumatriptan is one drug that can do this successfully.
Other drugs that are used to abort an existing attack include caffeine, and. the non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen. Finally, if all else fails, pethidine or morphine, usually by injection, and often accompanied by an injectable anti-vomiting agent, will usually control the pain.
Prevention of migraine falls into two main areas. Many activities trigger off migraine, and the more each individual can identify his own triggers, and avoid them, the fewer attacks he is likely to have. Common triggers include chocolate and cheese, missing a meal, stress, excitement or shock, physical or mental fatigue, change of routine, bright lights or glare, loud noises, and even intense smells. In some cases hidden food allergies and smoking can trigger migraine.
Drugs can also prevent migraine. The beta-blocker propranolol is quite effective, and other drugs such as clonidine and pizotifen are frequently used. Continuous, low dose aspirin may also be useful.
There are many complementary methods for reducing the number of migraine attacks. These include adopting a healthy diet, taking adequate exercise, acupuncture, biofeedback, relaxation therapy and homoeopathy. In addition, osteopathic manipulation may correct neck problems that can trigger attacks in certain people. Complementary methods for treating an established attack include all of the above, plus aromatherapy, Bach flower remedies, acupressure and many many more. Gentle massage of the head may also help, particularly over the temple; cranial osteopathy may also assist.
Perhaps one of the more important complementary techniques comes from the herbalist. Feverfew leaves have always been used as a herbal remedy for headaches, but have recently been discovered to be particularly effective in treating migraine - so much so that there was a move afoot to take them away from over-the-counter availability and turn them into a prescription-only drug. Formal pharmaceutical investigations are currently being carried out *4\20\2*
ADULT CHILDREN OF HEART PATIENTS: WHAT ADULT CHILDREN CAN DO TO HELP
