Ask An Adult: How Can I Tell A Headache From A Migraine?
The Debrief: Also, WTF do you do when you get a migraine...
In March 2014, I stumbled into Homerton Hospital looking for an out-of-hours GP. I’d spent two days vomiting bile as I struggled to deal with a throbbing pain in my head and an intolerance to light. I'd taken paracetemol but it hadn't helped. I was genuinely convinced I was about to have an aneurism. After being admitted onto a ward and having a CT scan of my brain and numerous blood tests, I was told I was ‘just having a severe migraine attack’ and I’d be OK after having some heavy-duty painkillers and a bit of oxygen. I was – but it didn’t make the experience any less scary. Along with 20% of women in the UK, I’m a migraine sufferer. And while they’re easily dismissed as ‘just a bad headache’, I know they’re a lot more than that.
What is a migraine?
Dr Fayyaz Ahmed, consultant neurologist at Hull and East Yorkshire NHS Trust says there’s a clear distinction between infrequent tension headaches – i.e. ones you can pop an over-the-counter painkiller and go to work with, and migraines. ‘Migraines, especially if they’re frequent, can seriously affect a person’s quality of life,’ he says. ‘If somebody has them for over 15 days a month, it can be a serious problem as it can stop them working or maintaining relationships.’
Dr Ahmed says though there’s not a definitive answer as to why some people get migraines and some don’t, most recent research points to the fact that they’re caused by abnormal brain activity from certain triggers affecting the trigeminal nerve, which is responsible for sensations in the face. After this is stimulated, it releases a series of chemicals, which in turn cause blood vessels surrounding the brain to dilate and inflame, leading to the horrific symptoms sufferers experience. There is also a link between migraines and the hypothalamus, a part of the brain responsible for hormone function.
What does a migraine feel like?
Because the hypothalamus regulates things like appetite, stomach function and the sleep/wake cycle, migraines have a range of symptoms. As well as a headache (which some sufferers don’t get, a phenomenon known as ‘silent migraine’) sufferers will have the aforementioned vomiting and nausea, sensitivity to light, sound and smell, but they can also have an upset stomach, hot and cold flushes, and tingling in their face and limbs. Around 30% of people who have a migraine will have a warning sign known as an ‘aura’ which can be seriously terrifying. ‘If it’s the first time they’re experiencing this, a lot of people think they’re having a stroke,’ Dr Ahmed says. Flashing lights that dance in front of your eyes, pins and needles and numbness down one side of the body can be common features of aura, and can often be as debilitating as the migraines themselves.
Bianca, 26, a journalist from London, says her migraines with aura have really impacted her social life. ‘I have a migraine around once a week, often accompanied with shooting pains in my neck,’ she says. ‘It’s been really frustrating as I can spend entire Sundays in bed just from having a couple of drinks, and I’ve had to cancel things last minute. They take over my whole body, and I can’t do anything except lie down in a dark room until it passes.’
What causes them?
Though there are literally hundreds of things that can trigger a migraine, studies show rich food, especially red wine, cheese and chocolate (i.e. anything delicious), stress, tiredness and menstruation can set them off. Dr Ahmed says the fact they’re more common in women (only 8% of men have migraines) shows there’s a link with oestrogen production in the body. ‘Many of my female patients have a reduction in the number and severity of their migraines after they have the menopause and produce less oestrogen,’ he adds.
Sometimes, it can be a combination of triggers, which makes them all the more frustrating. This is something Bianca knows all too well. ‘I have a migraine about once a week, and it can be down to anything, from having a lie-in one Saturday to skipping coffee one morning, so I have to be really careful to keep the same routine.’
There’s also a genetic link with migraines. Dr Ahmed says a lot of his patients have a direct relative with the condition. ‘It’s likely there’s a ‘migraine gene’,’ he says, and research into this is ongoing.
How can you prevent them?
As they can be triggered by eating certain things, keeping a food diary can be helpful for some sufferers. ‘I realised cold sandwiches in particular were causing me to have migraines,’ digital officer Sunny, 27, says. ‘I think it was the mayonnaise in them, so I avoid them now, which has helped.’
More recent research has shown drugs used for other conditions, such as low does of an SSRI antidepressant called amitriptyline and an anti-seizure medicine called gabapentin, can be helpful in preventing migraines. Dr Ahmed has found 60% of his patients have halved their number of attacks after taking these drugs, and they’ve also made their migraines less severe. Bianca has been on them for a few months. ‘They have helped reduce the pain I get,’ she says. ‘But I’m currently having my dose upped as I’m still having migraine attacks. If you’re on them and they’re not working, don’t be afraid to speak to your GP about increasing your prescription.’
Other treatments, which aren’t available on the NHS, such as acupuncture, osteopathy and seeing a chiropractor, a specialist who manipulates the spine and muscles using their hands, work for some sufferers, but research into this is still ongoing. PR Laura, 26, says after visiting a chiropractor she’s seen a noticeable difference in the amount of attacks she’s had. ‘He also told me to ice the back of my neck if I feel a migraine coming on, which really works for me,’ she says.
What should you do when you have an attack?
Though migraine with aura can be scary, as an aura can come on a couple of hours before an attack starts sufferers can use this warning to ‘stop the migraine in its tracks’ according to Dr Ahmed. This can buy you some time to take a drug known as a triptan, which reverse the changes in the brain that cause migraines. ‘If this doesn’t work and the migraine still comes on, it’s important to switch off your phone, as staring as a screen will make the symptoms worse, drink a lot of fluids, draw the curtains to make the room dark, and lie down.’
‘Resting is so important,’ Sunny agrees. ‘I usually take Solpadol, which is codeine mixed with paracetemol, with a cup of hot water or tea, then lie in bed. Doing that can really reduce my pain levels.’
However, over-the-counter painkillers, such as co-codomol or ibuprofen, are only helpful if they’re taken as soon as the headache hits, as if you wait for it to worsen it’ll be too late for the medication to work. ‘If I’m in the early stages of an attack, I take 800mg ibuprofen with a cup of coffee, as it gets it going through your bloodstream faster,’ Bianca says.
And finally, what’s the deal with migraines and the pill?
Studies show people who experience migraine with aura have twice the risk of stroke than those who don’t. Though this risk is still small, it’s better to be safe than sorry, which is why official NHS guidelines state that women who experience migraine with aura shouldn’t be prescribed the combined pill, as that also increases stroke risk. So if you’re having migraine with aura and you’re taking this, you should see your GP ASAP to discuss other forms of contraception.
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