05 September 2017
Q: I often suffer from migraines throughout the day and rely heavily on pain killers. What can be done to help?
A: I am sorry to hear you are a regular sufferer of migraine.
Many people use the term ‘migraine’ and ‘headache’ as the same word. Headache means head pain, which covers numerous underlying causes, categorised as primary and secondary.
Secondary headaches account for less than 5% of all headaches and are caused by underlying disease processes like; meningitis, bleeds in the brain and open angle glaucoma. Most patients that come to the surgery with a new onset headache worry about brain tumours when in fact the brain does not feel pain. Brain tumours initially present with neurological problems like weakness in the arms or legs, pain in the head on lying flat, pain on coughing or straining, visual disturbance and slurred speech. They do not usually present as a headache.
Primary headaches, also referred to as migraines are much more common in young women, although it can occur at any age. The term ‘migraine’ comes from the Greek word meaning 'half head' because the commonest type of migraine causes pain in one side of the head. Migraine is a complex abnormal electrical and chemical disorder of the brain. Classic features include; severe headache, vomiting, nausea and difficulty with bright light - some patients get warning signs beforehand. Some typical triggers are; red wine, chocolate, changes in temperature, a woman's menstrual cycle and stress. A good place to start with treatment is to try and avoid the triggers.
When an attack comes on, most patients find that lying down in a quiet, dark room is helpful. There are many treatments for migraine, which are probably best divided into treatments for when the headache comes on and treatments to prevent the occurrence. Prevention is usually indicated if a patient has a regular migraine which affects their everyday life.
Evidence strongly suggests over the counter pain killers such as paracetamol and aspirin are best used to treat an attack. Many patients automatically take drugs containing codeine, however evidence would suggest this could make things worse. Triptans (available on prescription) are just as effective for migraine and would be a better option than regular pain killers.
Your history of regular migraines would warrant a visit to your GP who may be able to improve your pain relief or even prevent these attacks.
Dr Mark Coombe is a GP practising at Spire Portsmouth Hospital.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.