Health

Easing Migraine Misery

Trials are taking place on the first ever drug specifically designed to treat appalling pain of migraine. Report by Judy Hobson

There are headaches- and then there are migraines. They are very different conditions, with the World Health Organisation describing migraines as one of the most disabling illnesses on earth.

Every day there are an estimated 190,000 migraine attacks in the UK, where one in seven of the population suffers from them. For some they last 72 hours and occur on 15 days out of every 30.

It is, therefore, no surprise to learn that depression is three times more common as migraineurs, as sufferers are known.

Despite 25 million work and school days being lost every year because of migraine at an annual cost to the UK economy of "2.25bn, it is the least funded of the neurological illnesses in relation to its impact.

Many people simply do not understand the devastating effect it has on a sufferer's life, with the result that they often feel marginalised and alone.

The Migraine Trust charity believes 50 percent of sufferers do not seek medical treatment and many self-medicate. The mistaken perception that migraine is "just another headache" may well be responsible for this.

Arlene Wlkie, the charity's new chief executive officer, sees it as her mission to dispel this myth, raise migraine's profile and secure its rightful place on the UL health agenda. "Unfortunately," she says, " it hasn't been seen as a priority. My ambition is to get it taken seriously so that sufferers are not embarrassed when they have to tell their boss they can't come in because they've got a migraine.

"One of the worst things about migraine is the social isolation. Sufferers can't do the things thay want to and often have to miss out on family life because they're forced to cancel and retreat into a darkened room until their symptoms subside."

Migraine is genetic and research has revealed that as many as 37 genes are involved.

Dr Fayyaz Ahmed, consultant neurologist at Hull and East Yorkshire NHS Trust, explains: "Your susceptibility to migraine headaches is passed on by one of your parents.

"There are also many triggers, some known and some hidden. One in 200 will have a particular trigger such as citrus fruit, tomatoes, orange juice, red wine and chocolate. But in the vast majority migraine is brought on by a combination of factors including stress, weather and fatigue."

He says migraine is classified as episodic when it occurs on fewer than 15 days a moth and chronic when people have attacks in 15 days or more a moth.

"People with chronic migraine," Dr Ahmed says, "find their lives ruled by it. Their attacks scan last up to 72 hours. They can'teat. If they do, they throw up. they can't stand bright light and have to stay in a darkened room.

"They can't move because any movement makes their pain worse. These patients need to take preventative treatment such as beta blockers or an antidepressant like amitriptyline. This doesn't get rid of their attacks altogether but does help to reduce their frequency and severity. Many drugs we use to treat migraine were developed for other indications but we're now trialling the first-ever drug to have been developed specifically to treat it.

"We know the chemical calcitonin gene-related peptide (CGRP) is strongly associated with migraine and is released into the bloodstream during an attack. The new drug, CGRP- antagonist, will work through the body, blocking this chemical.

"It appears to reduce the number of migraines patients experience without them having side-effects. We hope it will be available for general use by the middle of next year."

There are, he says, red-flag features in headaches that warrant further investigation:

1) If your headache starts very suddenly and it feels as if your head has been hit by a cricket bat. This could indicate a bleed in the brain.

2) If you don't normally suffer from headaches but start having them and they get worse.

3) If your headache is accompanied by loss of vision and numbness that persists for longer than an hour.

4)If you need to self-medicate a headache at least twice a week, get medical advice because you are in danger of developing a rebound headache. his occurs when the interval between needing to take painkillers gets shorter and your headaches become more frequent.

Dr Ahmed says:"the only cure is to fo cold turkey. If not, you won't get any better."

Arlene adds: "It can be difficult for a GP to diagnose migraine when a patient first presents, as an appointment only lasts seven minutes. Therefore, it helps if you keep a diary of your headaches, recording their severity and duration. Recording your daily life such as food, exercise and sleep will also help you to recognise your triggers.

"We know getting hungry and not sticking to regular mealtimes can be a trigger. They also appear to come on when people get out of their routine. For example, when they go on holiday, start working nights or relax at a weekend. We're funding research into this." The charity is also investigating cravings migraineurs have before they realise they are having an atack.

"It would appear," Arlene adds, "that some sufferers crave something sweet like chocolate while others find they suddenly become super sensitive to a change in daylight. We're keen to investigate migraine in its very early stages to see whether it would be possible to stop it occurring in the first place.

"To do this, we need to increase awareness so we can raise sufficient funding, then hopefully we will start to see specific migraine treatments being developed."

Do you suffer from migraines? What do you think of this article?

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