A migraine is not just a headache, which is what some people assume (and scoff at) when colleagues aren't able to come in to work because they are suffering from one.
They can be quite disabling and, according to The Migraine Trust who quoted Shapiro & Goadsby in Cephalalgia 2007, is one of the least publicly funded of all neurological illnesses.
In the same report, they said that in the UK there are 190,000 attacks a day, and that each year, 25 million work and school days are lost because of migraines.
It is one of the most common health problems, with around 15% of the population suffering at least once in their lifetime, according to the NHS.
That makes roughly 8 million people.
Talking to HuffPost UK Lifestyle, Dr Paul Zollinger-Read, chief medical officer for Bupa says: "Migraines are probably more common than you think, affecting one in seven adults in the UK."
To mark Migraine Awareness Week, we've put together a guide featuring expert opinion that looks at the symptoms and triggers of a migraine, as well as help and advice if they keep recurring.
The symptoms can be deeply unpleasant and The Migraine Trust describes it as a 'complex condition'.
THE STAGES OF A MIGRAINE
1. 'Prodromal' (pre-headache) stage. Some people experience changes in mood, energy levels, behaviour and appetite, and sometimes aches and pains several hours or days before an attack.
2. Aura. Symptoms of aura include flashes of light or blind spots, difficulty focusing, and seeing things as if you are looking through a broken mirror. This stage normally lasts around 15 minutes to an hour.
3. Headache stage. This is usually a pulsating or throbbing pain on one side of the head. You usually have nausea or vomiting, and extreme sensitivity to bright light and loud sounds, with a strong desire to lie down in a darkened room. This stage lasts for four to 72 hours.
4. Resolution stage. Most attacks gradually fade away. Some people find the headache stops suddenly after they have been sick. Sleep often relieves the symptoms.
5. 'Postdromal' or recovery phase. There may be a stage of exhaustion and weakness afterwards.
Dr Zollinger-Read says: "The main symptom is a severe, throbbing headache, which can last for anything between four and 72 hours. The headache is usually on one side of your head. However, a migraine is much more than just a headache – other symptoms include feeling sick or being sick, sensitivity to light and noise, and disturbed vision. Symptoms can vary from person to person, but often, symptoms are so debilitating that the person will need to lie down in a dark, quite room for several hours.”
There is no hard and fast rule as to how often you may suffer from a migraine. But, there can be triggers which set a migraine off.
If you're trying to figure out what your trigger is, don't just examine what happened in the hour before you got the migraine - often triggers happen about six to eight hours before the migraine occurs. The Migraine Trust also says that your triggers may change with age, as they can be affected by levels of stress and hormones.
Women get more migraines than men - they are 18% likely to get one while 8% of men are likely to suffer from one. No one quite knows why that is, but experts have indicated that it may have something to do with hormones.
Dr Zollinger-Read adds: "Common triggers include a certain food or drink (often chocolate, cheese, alcohol and caffeine), stress, bright or flickering lights, skipping meals or becoming dehydrated. Hormonal changes may also affect when and how often you get a migraine; if you’re a woman, you may notice that you get migraines around the time of your periods or during menopause. Unfortunately, some people struggle to identify exactly what they are, even after years of trying.”
The National Migraine Centre says that one of the biggest triggers is alcohol. "Opt for white wine and clear spirits over red wine and cocktails, eat before and after drinking to prevent a drop in your blood-sugar levels. If you wake up feeling a little worse for wear eat something light and easy to digest to counteract the effects of the alcohol, try a fructose containing foods combined with carbohydrate eg. toast, honey and fruit juice. Take a couple of pain-killers if you need to, soluble or effervescent forms are useful and avoid drugs containing codeine as they worsen nausea. It’s also best to avoid caffeine as, like alcohol, it irritates the stomach."
There's no evidence, says Susan Haydon, support service manager at The Migraine Trust that certain foods can prevent a migraine but food does play a part in triggering them. "One of the most important dietary trigger factors for migraine is getting hungry or not eating enough, rather than specific foodstuffs," she says.
"Craving specific foodstuffs, often sweet, is thought to be an early symptom of an impending migraine attack. Alcohol can be an issue for some people with migraine, as they are more likely than those without migraine to experience hangover headaches."
THE LIST OF COMMON TRIGGERS:
- Shift work
- Neck or shoulder tension
- Caffeine products, such as tea and coffee
- Smoking (or smoky rooms)
- Some types of sleeping tablets
- Hormone replacement therapy (HRT)
If you are suffering from regular migraines, there are different ways of firstly identifying what might be causing it, and second, how to treat it. Dr Zollinger-Read advises: "Keeping a diary of your migraines may help you spot what triggers them. If you continue to have frequent migraines after attempting to identify triggers or avoiding things you may think might cause them, don’t suffer in silence."
The Migraine Trust elaborates and says: "Record when the head pains started, how long the attacks last and if there are other symptoms (such as where the pain is, being sick or having vision problems) It is vital that you record the number of attacks you have in a month. It is often useful noting if you did anything different prior to the attack such as missing a meal."
Migraines and stress are strongly linked, which can have a big impact on your enjoyment of life if you've been working all hours to finish a big project or are gearing up for an event such as a wedding. The last thing you need is to be bedridden when you're meant to be present at the very thing you've been working so hard towards.
If you do suffer from stress-related migraines, online meditation app and mindfulness experts Headspace recommend trying daily meditation. They quoted a case report by doctors Tzan-Fu Sun, Chung-Chih Kuo and Nien-Mu Chiu, who found that mindfulness meditation helped greatly with pain management.
"In the past 2 decades, Jon Kabat-Zinn and associates in the US successfully used mindfulness meditation (MM) for the relief of pain, including headaches. For example, among participants in a 10-week training program, 65% showed pain reduction of greater than 33%, and 50% showed reduction of greater than 50%. In individual cases, improvements were very dramatic. For example, Kabat-Zinn reported on a woman with a 20-year history of migraines who achieved remarkable relief within 2 weeks' practice. She had not been helped by repeated visits to headache clinics or by daily use of cafergot."
So what can you do for treatment? For most, there are over-the-counter migraine tablets and painkillers. More severe cases need to be referred to a migraine clinic.
"Migraines can have an enormous impact on your work, family and social life," says Dr Zollinger-Read. "Talk to your doctor, as there is a variety of medicines that he or she can prescribe you. You might also want to try relaxation techniques, acupuncture or botox. However, discuss these options with your doctor before trying an alternative therapy.”
Disclaimer - Please appreciate that The Migraine Trust is unable to provide individual clinical advice or diagnosis. This can only safely be provided by a person’s own health professionals, who are in a position to take responsibility for their patients’ health care.
The Migraine Trust (020 7631 6970)
National Migraine Centre, (020 7251 3322)
One of the oldest herbal remedies for migraines, this plant can be used in many forms, included steeped in tea or even eaten raw, according to Alexander Mauskop, M.D., a board-certified neurologist focused on headaches and the director and founder of the <a href="http://www.nyheadache.com/" target="_hplink">New York Headache Center</a>. That's because it contains a powerful chemical called <a href="http://www.webmd.com/vitamins-supplements/ingredientmono-933-FEVERFEW.aspx?activeIngredientId=933&activeIngredientName=FEVERFEW" target="_hplink">parthenolide</a>, which has been linked to warding off migraines, although Mauskop says science hasn't really offered an answer yet as to how or why, One of the first studies of the herb came out of Great Britain in the 1980s, and found that 70 percent of people who chewed a couple of feverfew leaves each day saw <a href="http://www.umm.edu/altmed/articles/feverfew-000243.htm#ixzz20Lk71tCK" target="_hplink">their symptoms improve and experienced fewer migraines</a>, according to the University of Maryland Medical Center. In supplement form -- as long as it contains at least 0.2 percent parthenolides -- 100 to 150 milligrams a day may do the trick, according to a HuffPost blog by Dr. Andrew Weil, because it can help "<a href="http://www.huffingtonpost.com/andrew-weil-md/a-better-route-to-migrain_b_526945.html" target="_hplink">prevent the release of substances that dilate blood vessels in the head</a>."
Unlike feverfew, this herb is toxic in any form but the processed supplement, says Mauskop. However, its headache-preventing properties are equally impressive. The chemicals in butterbur are thought to <a href="http://www.webmd.com/vitamins-supplements/ingredientmono-649-BUTTERBUR.aspx?activeIngredientId=649&activeIngredientName=BUTTERBUR" target="_hplink">relieve spasms and decrease inflammation</a>, which can cause headaches, according to WebMD. A small 2004 study found that patients who took 75 milligrams of butterbur twice daily had <a href="http://www.neurology.org/content/63/12/2240.abstract" target="_hplink">48 percent fewer migraines</a>, compared to a 26 percent decrease experienced by people given only a placebo. While it's been predominantly researched as a preventive measure, there's some preliminary evidence that it can also help beat a migraine as it's happening. Taking <a href="http://www.psychologytoday.com/blog/complementary-medicine/200808/migraines-easy-prevent-naturally" target="_hplink">100 milligrams every three hours</a> (up to 300 milligrams in 24 hours) just might do the trick, according to <em>Psychology Today</em>.
Mauskop's own research found that people with migraines and cluster headaches are often deficient in magnesium. He demonstrated that an infusion of the mineral helped to stop the pain. Of course, an infusion isn't the most practical of treatments when you're struck by a migraine at the office, say, but supplements can also help. One small study found daily magnesium supplements <a href="http://www.ncbi.nlm.nih.gov/pubmed/8792038" target="_hplink">reduced migraine frequency by nearly 42 percent</a>, compared to only about 16 percent in people given a placebo pill. Some people have trouble absorbing magnesium, says Mauskop, which can lead to the unpleasant side effect of diarrhea, but overall it's considered safe in 200 milligram daily doses, he says. <em>Flickr photo by <a href="http://www.flickr.com/photos/fdecomite/6257573610/" target="_hplink">fdecomite</a></em>
This B vitamin -- <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/957.html" target="_hplink">found naturally in foods like milk, meat, nuts and green veggies</a> -- was <a href="http://www.ncbi.nlm.nih.gov/pubmed/9484373" target="_hplink">linked to migraine prevention</a> in a small 1998 study, but in a very high dose, writes Weil, one that would <a href="http://www.huffingtonpost.com/andrew-weil-md/a-better-route-to-migrain_b_526945.html" target="_hplink">need to be prescribed by a doctor</a>. Riboflavin (and an <a href="http://www.webmd.com/heart-disease/heart-failure/tc/coenzyme-q10-topic-overview" target="_hplink">enzyme that acts similarly called CoQ10</a>) is involved in producing energy inside the cells of the body, Mauskop explains, so it's better to take in the morning to ward off migraines, in case it disrupts sleep.
A dose of these healthy fats can fight inflammation, which is a likely culprit in many headaches and possibly some migraines. Everyday Health recommends <a href="http://www.everydayhealth.com/headache-migraine-pictures/8-home-remedies-for-headaches-and-migraines.aspx#/slide-8" target="_hplink">flax seeds</a> but fish, like salmon, and <a href="http://www.huffingtonpost.com/2012/03/31/cause-of-headaches-foods_n_1392670.html#s829432&title=Tamer_Omega3_Fatty" target="_hplink">fish oil supplements may also help</a>. "There are so many other benefits of omega 3s, even if it doesn't help your headaches, there's no reason not to try it," says Mauskop. <em>Flickr photo by <a href="http://www.flickr.com/photos/samcatchesides/5419724548/" target="_hplink">http://www.samcatchesides.com/</a></em>
As anyone who gets headaches knows, certain smells can trigger the pain. But peppermint in particular seems to have pain-<em>reducing</em> effects, says Mauskop. "It's very individual," he says, and may not work for everyone. Or, it could just mask less pleasant smells.
This spice is well-known for being friendly to <a href="http://www.huffingtonpost.com/2011/02/23/gingers-health-benefits_n_826795.html#s244432&title=Travel_Companion" target="_hplink">upset stomachs</a>, and it can ease migraine-related nausea, too, says Mauskrop. It may also ease pain thanks to some <a href="http://www.huffingtonpost.com/2011/02/23/gingers-health-benefits_n_826795.html#s244430&title=Cramp_Reliever" target="_hplink">anti-inflammatory properties</a>. Just be sure you're getting the real thing, he says -- ginger ale doesn't cut it. <em>Flickr photo by <a href="http://www.flickr.com/photos/mfdudu/1211609716/" target="_hplink">mfdudu</a></em>
Rubbing The Temples
There may not be a body of research to support a simple head rub, but there's no denying it feels good! People instinctively rub their temples in the throes of a headache, and if it works for them, why not? "Whatever feels good, do that!" says Mauskop.
In a similar vein, a whole-body massage can help, too. Part of that is likely due to the stress relief, as tension is a known headache trigger. A small study found that frequent migraine sufferers had <a href="http://www.ncbi.nlm.nih.gov/pubmed/16827629" target="_hplink">fewer headaches following six weekly massage sessions</a>. However, it's likely that <a href="http://www.huffingtonpost.com/2011/10/30/headache-treatments_n_1064690.html" target="_hplink">you'd have to continue the relaxing practice</a> -- indefinitely -- which could get pricey!
One way to reap the stress-reducing benefits for free is a quiet meditation practice, says Mauskop, who lists meditation as one of his top two natural migraine treatments. There remains <a href="http://www.huffingtonpost.com/2011/10/30/headache-treatments_n_1064690.html" target="_hplink">little concrete evidence</a> that meditation in particular can ease the pain, Health.com reported, but it is certainly a <a href="http://www.mayoclinic.com/health/meditation/HQ01070/" target="_hplink">proven stress reliever</a>.
Drink More Water
Plenty of headaches are triggered by dehydration -- so much so that Mauskop says he has patients who will quickly drink a few glasses of H2O when they feel a migraine coming on, and actually stop it in its tracks. "They know to catch it early," he says, "that definitely can help." Not a huge water fan? There are plenty of ways to snazz up a glass or trick yourself into sipping more throughout the day <a href="http://www.huffingtonpost.com/2012/05/07/drinking-water-week-more-water_n_1474999.html" target="_hplink">here</a>. <em>Flickr photo by <a href="http://www.flickr.com/photos/gfrphoto/1695650382/" target="_hplink">Greg Riegler Photography</a></em>
There have been mixed results in the research examining this ancient Chinese medicine's effect on migraines. Most recently, a study questioned <a href="http://www.reuters.com/article/2012/01/09/us-acupuncture-sham-idUSTRE8081I920120109" target="_hplink">whether the traditional practice offered much more than a placebo effect</a>, perhaps due to the extra attention lavished by the acupuncturist. Proponents maintain that the needles trigger pain-reducing chemicals, Reuters reported, but all those visits could become time consuming and expensive, points out Mauskop. A DIY altnerative might be acupressure, he says. Try pressing on the webbed space between your thumb and pointer finger. It may only be temporary, but it can offer relief.
"Caffeine is a double-edged sword," says Mauskop. If you're too dependent on multiple cups of coffee a day (or even frequent doses of certain headache medications formulated with caffeine) you're likely to experience <a href="http://www.huffingtonpost.com/2012/03/31/cause-of-headaches-foods_n_1392670.html#s829426&title=The_Jurys_Still" target="_hplink">rebound headaches when the jolt starts to wane</a>. However, in small doses, a little bit can help reduce pain. <em>Flickr photo by <a href="http://www.flickr.com/photos/oimax/2260643716/" target="_hplink">OiMax</a></em>
Along with meditation, Mauskrop calls staying active one of his top two most effective ways to prevent and treat migraines. Of course, many people are in too much pain in the middle of a headache to even think about heading to the gym. But a few people have told him when they feel something coming on, they can go out for a jog and avoid the migraine altogether. "It relaxes you, it releases endorphins," he says. Last year, a small Swedish study attempted to find out just how good exercise is at preventing migraines and discovered a solid sweat session was <a href="http://www.sciencedaily.com/releases/2011/10/111010075500.htm" target="_hplink">just as effective as migraine medications</a> at keeping the debilitating headaches at bay. <em>Flickr photo by <a href="http://www.flickr.com/photos/dafydd359/2238925352/" target="_hplink">Dafydd359</a></em>
Cool Down -- And Warm Up
Many people will feel a chill when they get a migraine, explains Mauskop, while at the same time their heads feel "hot and cloudy" he says. For some temporary relief, try reversing the feelings -- cool your head with an ice pack while warming the body in the bath, he suggests. Granted, it's not very practical unless you're at home and have plenty of time, he says, but dilating the blood vessels in the body may help blood flow away from the head and reduce some of the pain, he says.