“I’ve come to see you about my headache.” It’s a phrase that leaves many GPs with a feeling of dread. Headache is a bit of a nightmare. Most people with a severe or new headache are terrified about the worst case scenario: Cancer. Doctors worry about missing other critical headaches and, once they’ve been ruled out, trying to reassure the patient that the headache is unlikely to be sinister but…what do they do about it? What’s the diagnosis?
I have a vested interest in this subject. I suffer with migraine with varying degrees of regularity. If you’ve read my post about me you’ll know my Mum suffered with them and my sister does too. I used to be appalling at managing them: I’d take a couple of paracetamol, which didn’t take the pain away, and pop myself in a dark room until the worst of it eventually eased enough for me to carry on with the merest semblance of my normal life.
I’ve suffered with migraine since I was 12. I vividly remember my first attack. I was in the school playground, queuing for lunch and I had felt a bit more tired that usual. I felt like the sun was dazzling me (even though it was a typical cloudy, autumn day in England) and I couldn’t really see because bright spots were dancing in my field of vision. Then my head was throbbing, not the worst pain I’d had, but it bothered me. I couldn’t speak, the words just wouldn’t come out. And it lasted for the rest of the day. I told my Mum and she solemnly told me I’d had a migraine.
In my early 20s, when I was at medical school I sat in on a clinic with a GP who was headache specialist. It changed my life. I’m not exaggerating. “Does anyone here suffer with migraine?” He looked at the four of us: two medical students, two GP-trainees. I tentatively put my hand up. He figured one out of four of us would suffer. He asked what I did. Did it work? No. Why did I do it? Had I seen my doctor? No. What was the point? What could they do? Apparently, quite a lot. He gave me a little plan for what to take: Aspirin (who knew people still took that for pain?!), if that didn’t work I could try a “triptan” (more on these wonderful drugs later) and if I got them more than 4 times a month I should try a preventative medication. And it worked.
And ever since then, I’ve wanted to do the same: improve people’s migraines.
Migraine – what is it?
Migraine is the 7th most debilitating disease globally. The word Migraine comes from the Greek Hemicrania meaning half a head as historically it referred to pain which affected only affected one side. Now it is defined as a pain which can affect one or both sides of the head which is often throbbing in nature with other troublesome features such as:
- Light or sound sensitivity
- Nausea or vomiting
There are many different migraine subtypes and people do not have to experience flashing lights or other visual changes to be diagnosed with this. People that do have that symptom are described as having an “aura”. Only 10-30% of people with migraine suffer aura. Aura doesn’t have to be visual. The symptoms of aura typically start before the headache people can get:
- problems speaking
- memory loss
The headache doesn’t always have to be severe. This is the most common misconception. Like with most problems you can get mild, moderate or severe attacks. Often people can take a day or two to recover and a lot of people describe this as feeling like a hangover.
Migraine does not have to start when you’re young. It often starts at puberty and commonly affects those between in their 20s and 30s. It affects around 1 in 7 people and women are three times more likely to suffer than men.
What causes migraine?
We don’t fully understand what happens during a migraine. We know some of the substances that are involved in migraine (like serotonin and CGRP) which has helped with the development of some of the medicines used to treat it, but the full process is still a bit of mystery. We also know that it runs in families with more that half of patients with migraine having a relative who also suffers.
Impact on society
Migraine is debilitating. A lot of people find the headache bearable but try going to work and trying to carry on with
- impaired vision
- problems concentrating
- feeling queasy
- difficulty looking at a computer
- not being able to sleep
It makes simple things like checking your emails or sitting through a presentation a mammoth task. But people don’t like calling in sick for work.
“Surely you can come in… it’s just a headache”.
In the clinic I see people week on week referred in because work are concerned about their sickness absence and they give a sense that the patient is just… putting it on.
“Migraine leads to reduced productivity at work and has major implications for society” NICE CKS
Migraine costs the UK economy an estimated £2.5 billion per year due to absenteeism. It’s a big deal.
How is it diagnosed?
The most frustrating thing about migraine is that there are no tests to confirm the diagnosis: we listen to the pattern, find out if the features above are present and make the diagnosis on that basis.
The best way of knowing whether or not you have a migraine and decide on the best course of treatment is to track it. This can be done via countless apps or using a good, old fashioned diary. The National Migraine Centre has a version here.
For more information please see: