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Focus on: Migraine

 Migraines affect 10 per cent of the British population.

Attacks involve far more than a headache, and can be accompanied by visual disturbance, vomiting, increased sensitivity to light or sound and muscular problems.

Migraine attacks can be debilitating, sometimes leaving sufferers exhausted for days. And 15 per cent experience neurological disturbances known as an aura.

Lasting 15 to 60 minutes, they occur before headaches begin and manifest as blind spots, flashing lights or problems with co-ordination.

Some people experience tingling or stiffness in limbs, difficulty speaking, paralysis or even loss of consciousness.

Here we investigate the most common nerological condition in the world.

WHO GETS IT?

Hormonal factors are involved in triggering attacks, and twice as many women as men are affected. Migraine sufferers come from all ethnic and social groups. The condition runs in some families, indicating that certain people inherit a genetic predisposition towards it.

WHAT CAUSES IT?

Migraine is thought to be caused by the release of a chemical called serotonin into the bloodstream.

This results in changes in chemical transmitters and blood vessels in the brain.

Factors which can trigger attacks include: stress; lack of food; monosodium glutamate; caffeine; chocolate; citrus fruit; cheese; alcohol; overtiredness or changes in sleep patterns; high blood pressure; loud noise; and bright flickering lights.

HOW IS IT TREATED?

People with mild to moderate migraine often take simple painkillers containing aspirin, paracetamol or ibuprofen. An anti-sickness ingredient can be helpful for sufferers who experience nausea and vomiting.

The Migraine Action Association advises you to take any painkillers quickly because the gut can stop functioning during an attack, meaning medication will not be absorbed.

When symptoms are severe, prescription medication using stronger painkillers and antisickness drugs can help. Ergotamine, taken within 60 to 90 minutes of the onset of an attack, can prevent headaches by reducing inflammation of blood vessels in the brain.

For severe migraine, triptans - including zolmitriptan and sumatriptan - aim to correct serotonin imbalances which trigger the symptoms.

Studies of more than 24,000 patients found that 59 per cent of those taking sumatriptan had a reduction in pain within two hours, and 29 per cent were free from headache altogether.

Daily medication, such as pizotifen and methysergide, prevents dilation of blood vessels and can reduce the frequency and severity of attacks, but rarely eliminates them. Non-drug treatments, including herbal remedies, devices that emit electronic impulses, magnetic devices, homeopathy, acupuncture and relaxation techniques can help.

NATURAL REMEDIES

Migraine sufferers were once advised to place a leaf from the feverfew plant in a sandwich. Now available in tablet form, this plant can reduce migraine symptoms by up to 60 per cent. Plant substances called lactones are thought to inhibit the secretion of serotonin.

WHAT WILL MY DOCTOR DO?

Your doctor may suggest different medications over time to discover which are the most effective.

You will be encouraged to identify the triggers for your migraines by keeping a diary of what foods you eat, tracking your moods, sleep patterns, or any stressful incidents in the few days before an attack.

REDUCING THE RISK OF AN ATTACK

Identifying the triggers and avoiding them can significantly lower the risk of attacks. Usually it is a combination of triggers, such as a bad night's sleep, eating cheese and a stressful situation at work.

Most sufferers focus on triggers that can be easily avoided, such as certain foods or alcohol, while reducing exposure to uncontrollable triggers such as stress and noise.

SHOULD I CHANGE MY DIET?

Eliminating the foods and drinks that trigger migraines can reduce attacks. Common culprits include cheese, chocolate, monosodium glutamate, caffeine and red wine.

Sudden changes in blood sugar levels can also trigger migraine. Controlling the levels by replacing sweet foods with savoury snacks and white refined bread and rice with wholemeal alternatives might be advisable.

Clinical trials in Belgium recently found that daily vitamin B3 supplements reduce the frequency of migraine attacks by about 30 per cent.

Migraine Action Trust helpline, call: 01536 461 333 or www.migraine.org.uk.

Case Study: 'I saw flashing lights and thought I was going to die'

Alison Pearson, a 34-year-old, administrator from Enfield, North London, developed her first migraine attacks aged 11. She says:

When I had my first attack at school, it was frightening and extremely painful. I had no idea what it was and thought I was going to die. I saw bright, flashing lights then developed a pounding headache. One side of my body became numb. My words turned into a slur and no one could understand me. I've suffered from auramigraines ever since. I get a tiny flashing light in the corner of one eye. Gradually, over 20 minutes to an hour, it'll get bigger and bigger until most of my sight is obliterated.

Then the headache strikes - the stabbing, explosive pains always occur on the opposite site to the flashing lights and it's agony even to blink.

I get severe pins and needles down one side of my body, followed by numbness and paralysis. I can form words in my mind, but they come out as gibberish. For days afterwards my eyesight will remain blurry and I'll be over-sensitive to light and sound - and I feel exhausted.

Thankfully, my husband and boss are understanding, but I still live in fear of the attacks. Painkillers make me throw up so I cannot take anything to dull the agony. I once took the anti-migraine drug sumatriptan for six months, but it made little difference.

I know my triggers and avoid them as much as possible - I don't eat cheese, chocolate, seafood, citrus fruit or pork. Some artificial sweeteners, such as aspartame, also trigger headaches. It's always a combination of things that set them off, such as poor sleep and stress, and eating high-risk food. I drink lots of water as dehydration can also start them.

I take Feverfew tablets twice a day, B-vitamins and magnesium to reduce the frequency and severity of the attacks.