Migraine

Migraine is one if the commonest causes of headache, affecting at least 10-20% of individuals at some point in their lives.

A typical attack:

1. Pain building up over an hour or two, throbbing or steady, usually on one side of the head, sometimes confined to a small region like the eye and forehead, often more widespread.
2. Pain typically lasting half a day, but sometimes much longer, relieved by sleep. Intolerance of bright light and noise, eased in a quiet dark place.
3. Nausea increasing with pain, making it difficult to absorb tablets and less often vomiting.
4. Tenderness on touching the scalp.
5. Problems indicating disturbed brain function including sluggish thinking, difficulty in finding words, slurred speech, partial loss of sight, with dark or flashing forms, numbness and weakness on one side of the body.

Triggers include:

1. Foodstuffs, such as chocolate,cheese,other dairy products, and alcohol, notably red wine.
2. Psychological events, particularly relaxation after periods of pressure ("let down phenomenon").
3. Fluctuation of female hormone levels.
4. Various chemicals, such as perfumes and strong odours

Migraine rarely begins after the age of forty, but sometimes in childhood and usually in teens and twenties. Attacks may reduce in frquency in the 30's only to return in a new form in middle years. Fortunately the risk of serious complications is very rare. Attacks may occur with a trace of headache or none at all, usually in middle-age but sometimes in younger individuals. A family history of affected first degree relatives is present in at least 25% of patients, indicating a genetic mechanism.

Treatment

Elimination of any superficial triggers such as eating chocolate or over-indulging in cheap red wine. Systematic diary-keeping may help identify triggers. Setting realistic goals for the use of medication and avoiding excess intake of painkillers which can cause 'rebound' headaches. An appreciation that responses to drugs are individual and one may have to go through several trials to find the right combination of tablets and other approaches.

This very common problem, linked to some degree with pressures of a busy lifestyle, attracts numerous alternative approaches including relaxation methods, biofeedback (learning to respond to inner rhythms and unconscious reflexes, such as the control of temperature in the fingertips), homeopathic remedies, acupuncture and so on. Those who find a cure in this manner are probably better off than those depending on prescription medication.