Migraine - live web chat Thurs 28 June 1.30-2.30

FeeTee

Despite being a 'headachey' person until recently I had only ever had one full on migraine (some years ago - blinding pain, nausea, inability to tolerate light to extent had to unplug video as the time display was too much!)

But recently have had a couple of dreadful and long-lasting headaches with nausea (feels like there is a line going from my head to my stomach) which drugs (paracetamol and ibuprofen) don't seem to touch. The head pain is always at the front - behind my ears and top of my nose)

Does that sound like migraine? If so what can I do to feel better? Lying down which seems to help isn't always practical.

With many thanks

Almost all headachiness is migraine. You don’t have to have a full-on attack all the time – it can be mild migraine. Migraine can describe the attack or also the tendency to attack. Like asthma – you can have asthma and feel fine, you can have asthma and have a bit of a wheeze, you can have asthma and be in intensive care – and migraine is the same.

Lots of people have migraine with mild head pain that can be anywhere in the head – behind the eyes, where the head joins the neck , anywhere in the head or even face, neck or shoulder. You can even have migraine without having headache: aura migraines or, in children, abdominal migraine. Headache is not an essential part.

1northernbelle

After a lifetime of migraine, including 6 hospitalisations, I asked my GP to refer me to one of the Scottish Migraine clinics in Glasgow or Aberdeen. He said no he could not refer me outside Fife and anyway there were no new treatments, only pills. He said in fact it was GPs who were the usual people to treat the condition. He said control of my stress was the key, "use meditation" was his suggestion. For many decades I have tried to control stress and feel cheated. Why can I not be sent to a special clinic? R Gordon

I disagree that stress control is helpful in migraine. Though of course we all need to look after our stress levels. The first thing to think about in treating migraine is your body clock. Try to keep to the same pattern every 24 hours. Have at least 3 meals a day including fibre-containing breakfast shortly after getting up. Don’t go short on fluids. Take it easy with caffeine and alcohol. Minimise pills. If you have migraine twice a week or more you might consider a daily medication to reduce attack frequency. Two attacks or fewer you can treat with rescue medication (ie something to take as and when required) Start with either 900mg aspirin or 600mg ibuprofen (ideally dissolved in water) and add domperidone (20mg) which sadly is not French champagne but can be bought over the counter in a pharmacy as Motilium. If that is disappointing take a triptan drug at the start of head pain. Sumatriptan prescribed as a generic drug by your GP is very good value – you can buy branded Imigran without prescription but it’s more than 10 x the price of the generic drug. Treat once at the start of the attack, aim to be pain free within 2 hours, if not rethink your acute rescue strategy. Remember not all attacks will respond in the same way. So treat 3 separate attacks before concluding lack of benefit. There are 6 other triptan drugs and it’s worth trying them all until you decide which one works best for you. Beyond pills and lifestyle the NHS in England and Wales will be offering botox injections for chronic migraine from about September this year. Specialist also sometimes use nerve block injections to treat migraine. Rarely we need to put electrodes into the brain for very severe cases. We are experimenting with electrical and magnetic devices to see if they help without pills. Nothing new? Just pills? My apologies to your GP but I disagree.

If you can face travelling all the way down to London you are welcome at the National Migraine Centre – www.nationalmigrainecentre.org.uk - where we see patients who refer themselves. Because we are not in the NHS we ask for a voluntary donation of £100 which is a lot less than it costs us to provide the service.

alchemillamollis

Can you please explain the effect of weather changes on migraines?

I only get them when thunderstorms are threatened.

Thank you so much!

Lots of people get the same thunderstorm effect as you do. Sadly we have not yet learned how to adjust the weather. It’s often worth looking at migraine triggers but obviously only the ones that we can change.

SpamW

Hi distaffgran
My migraines STARTED after the onset of the Menopause......so I agree with you that hormonal change could be the trigger!!
Let's hope that the Menopause has the reverse effect migraine wise for you

It’s easy to overestimate the effect of hormones on migraine. Women whose migraines occur only during their period have normal hormones, it’s the migraine which is abnormal. Migraine beginning after the menopause is not triggered by hormones.

distaffgran

I have suffered with migraines for about 10 years. I have given up drinking more than one glass of wine (except now and then, when I tend to regret it) and I have to ration my screen time. (I have a job that entails looking at a screen most of the day).

I have recently been prescribed Domperadone tablets to take at the onset and they do seem to be making a difference. Does this suggest that the migraines are in some way connected with my digestive system?

Someone did once tell me that migraine is linked to hormonal changes and that they might well stop after the menopause. Can you give me any encouragement on that front?

Domperidone is helpful for many people with migraine – which certainly affects the digestive system. But the trigger for the attack is in the brain not the gut. Migraine definitely improves with age though the menopause is less relevant than people often want to think. Strong visual input can worsen migraine. This doesn’t just apply to computer screens. Try changing the colours on your screen, get the best quality screen you can, possibly a screen filter.

SueDonim

I've had migraines since I was 11yo. Now in my late 50's, I'm giving up hope of ever growing out of them! I'm fortunate in that I rarely have nausea, which makes them easier to deal with.

My question is to do with the frequency and duration of the migraines. I have migraine-free spells for several weeks then they will suddenly start again. Very often each migraine will last several days, not in the 'lie-in-a-darkened-room' way but with a nagging one-sided headache that responds to nothing, it seems. I may wake without a headache but within an hour or two, it will be back, lasting all day. Or I may go to bed pain-free but wake with a headache. This pattern repeats for days at a time and makes life a bit grim.

I'm not even sure if that is indeed migraine. Sometimes I get the unmistakably crippling migraine pain but at other times although it's one sided, I can still function to a degree though I feel very 'fuzzy'. The eye on that side is often tender and sometimes my ear or my nose hurt as well, which seems most bizarre!

I've recently been changed from Co-dydramol to prescription Co-codamol tablets but both are ineffective at least 50% of the time. I've never been able to identify any triggers, food-wise or other although occasionally, eating a decent snack improves matters.

Is there anything else I can do to help myself with this, either fending them off or treating them?

You will most certainly have migraine. Co-dydramol and co-codamol are not recommended and actually quite often make migraine worse. If you abandoned these medications and took no pills at all for your migraine you’d probably have a difficult couple of weeks and then find you had a lot less migraine. If taking no pills is impossible for you try the medication suggested to 1northernbelle or ask your GP for a prescription for naproxen 250mg 3 times daily after meals absolutely regularly, pain or no pain, for two weeks to three months until your migraine becomes infrequent or absent. Overuse of these codeine and paracetamol medications is the single commonest reason for migraine to go from bad to worse.

kate1947

I agree with the previous busilizzie I have had migraine from the age of 20 and am now 64. the only time I was migraine free was when I was pregnant.

I very often wake in the early hours with a migraine and stumble out of bed and take a sumatriptan and just lie there for a coule of hours until it goes, no chance of getting back to sleep. I work 3 days and look after my 2 year old Gramdson for 2 days.

My triggers are going too long without food, alcohol any kind, flickering lights, even ironing something stripey!! can trigger it. Other than these triggers, there seems to be no explanation, I was hoping that I would grow out of them at the menopause, but no such luck!

Can I say it sounds like you have migraine tiggers not migraine triggers! Seriously though your triggers are saved by many other people and it’s often good, if possible, to avoid these and minimize sumatriptan if possible.

randomangel59

Can you advise us about the lack of balance that seems to be associated with chronic headaches please? I have tried drugs from the doctor but they did not seem to have any effect on the balance issues - it is as if I am drunk and k wearing my reading glasses whilst trying to walk in a straight line!
Thank you

Lack of balance is common in migraine. Doctors often try drugs like stemetil but they don't work well for migraine. Domperidone is usually better, you can take this 20mg three times a day when your balance is bad. If it's bad most of the time a prophylactic like amitriptyline taken for many months can be helpful both for the headache and the imbalance.

skilegs

Question for Dr Elrington:

I have been told not to take Maxalt during the aura stage - is this true?

If so, is there anything I can take to alleviate the aura symptoms?

Maxalt can work in the aura stage but only for headache not for aura. Some people find that triptans like Maxalt work only if taken when headache begins. At aura onset you could try soluble aspirin or ibuprofen, plus domperidone (see earlier answers) which may perhaps shorten the aura and can help the headache.

barbarab

I think I have migraines (severe headaches that can make me physically sick and only touched by a combination of ibuprofen and paracetamol) but my husband dismisses them as stress headaches. Who is right?

You are right and not your husband. Many people are vulnerable to stress when they’re brewing a migraine. It’s easy to think it’s the stress causing the migraine. In the hours or day before a migraine things that normally don’t wind you up become stressful because of changes in your brain. This is a good day to take care of your diet plenty of water, normal sleep pattern, no alcohol.