Migraine - live web chat Thurs 28 June 1.30-2.30

floro

I would like to know more about migraine in children. Are the symptoms different and is it more difficult to diagnose? Also - are there any natural remedies that may be suitable for youngsters?

Migraine in children, compared with an adult's, tends to be shorter, more symmetrical, more vomiting, less aura. The short attacks can be hard to treat as drugs often take a couple of hours to work. People under 16 should not use aspirin. Triptans work in children but are largely unlicensed. Regularity of lifestyle, meals and fluid are important for children with migraine. What could be more natural than that?!

gdadbob

My question is sort of related to Barbara's. When people have a cold they often say they have flu (but clearly don't) And when people have a bad headache they often say they have migraine. Is that the same sort of thing? Or is there something specific about actual migraine that differentiates it from other bad headaches?

Almost all bad headaches are migraine. The point about migraine is that it is usually headache plus either nausea or vomiting, or light and noise sensitivity. These associated symptoms can be relatively mild. Migraine is also worse with mild exercise, better with rest though this need not be profound.

BiblioQueen

Wonder why I can drink beer but not wine, which triggers a 3-day whammy? ? Anyone else have that experience?

It's often the other chemicals, not just alcohol, in drinks that can cause migraine. Dehydration can worsen migraine and you get more water with your beer than your wine.

phoenix

I have been told that my first migraine was diagnosed at 18 months! Suffered on a 6 to 8 week cycle until my periods started, which might seem weird.

Was warned that they might come back with the menopause, but so far so good. Does anyone else have, or are there any other findings of perhaps hormone related migraine?

Hormones can trigger migraine attacks but most women have attacks which are not triggered by hormones. Obviously hormones trigger migraine only from the menarche to the menopause. Before and after that, hormones are stable. It is the change in hormones (oestrogen drop) which triggers migraine. Yours are clearly not hormonally related. I wouldn't be worried about the menopause.

Grannyruth

I read somewhere that Botox has recently been recognised by the NHS as a treatment for Migraine - about 30 injections to the head and neck (not the face) every few months. Can this be true? I've suffered migraines for years and years, and I'll try anything, but this seems quite drastic. It is worth trying?

Botox is effective for chronic migraine - that is at least 3 months of headache more often than not. Botox is given every three months. About one in four people are much better after one or two sets of injections. One in four don't respond at all. One in two go on having injections for a while and improve after each set of injections. It's quite expensive so when it becomes available on the NHS for people aged between 18 and 65, they will first have had to address medication overuse, and then try three different prophylactic medications before the NHS will fund this. The National Migraine Centre (www.nationalmigrainecentre.org.uk) does not insist on these prerequisites but you do have to pay for the toxin yourself - and it's quite expensive.

praxis

Is it possible that migraines could be made worse or even caused by medication? I was recently referred to a doctor who advised me to stop taking Anadin Extra (which I had been taking daily) to rule out the possibility. I had a crashing headache for the first couple of days but then no headache for five days, which is a record for me. If medication could be to blame, any advice on how to get through the bad days without painkillers?

I wish more people knew this. If you have a tendency to migraine and take any short term treatment more than two or three times a week the migraine goes from bad to worse. Complete "cold turkey" cessation of all medications is tough particularly for the first couple of weeks. But then there is gradual improvement. Some experts like to add another drug such as regular naproxen, or Botox, or topiramate, while withdrawing overused medications. Others prefer pure cold turkey on the grounds that this works well for many and all drugs have possible side effects. How to get through the difficult days? First be sure that this is an important and efective treatment. Clear your diary. Time off work. Help with childcare. Husband cooks own meals (as if they didn't) and make some space in the spare room - and get some ice packs in the fridge. There really is light at the end of the tunnel.

This is the single commonest problem encountered by headache specialists. "Medication overuse headache" accounts for four out of ten headache patients referred to specialists. I am undermining my private practice by telling you this!

fridaygran

Can you resolve a dispute in my family? Is it pronounced mygraine or megraine?

Whatever you like! The word comes from hemicrania which means half head pain. So if you say this fast in a fake Italian accent I think you say mee-graine. But it really doesn't matter what you call it.

Mishap

I was interested to see that Dr Elrington is also interested in MS, as this was part of the differential diagnosis when I became ill. The diagnosis now seems to be atypical migraine - some of the people I've seen call it basilar migraine, others vestibular migraine.
I have never been convinced by the diagnosis, as headache is not the main feature, although it is often present, and the problem can be continuous for days or even weeks. Basically I had an attack of what was thought to be labyrinthitis about 2 years ago (although at no point did I have vertigo) - it took several days for me to be able to walk about, and then the "giddiness" never resolved. The "giddiness" consists of the bizarre sensation that I do not know where my legs are - and sometimes my arms - and I can be clumsy. I sometimes have pain (not usually severe) centred on my right ear with tingling down the right side of my tongue.
I have had every scan and test in the book and the truth is that no-one knows what is really happening.
I have learned to live with it - do I have a choice!? - and use a stick when the instability is particularly bad.
Interestingly, about 8 years ago I had a similar episode when I lost balance walking down the street and had to cling onto a wall to stay on my feet - I found I did not know where my legs were - but this resolved quite quickly and I was fine the next day.
I am now 63.

You’d be amazed that MS and migraine are sometimes confused. We have some very strong new treatments for MS and a few years ago a patient died from a side effect of one of these strong treatments and the autopsy showed no evidence of MS. With hindsight, it became clear that the patient had migraine not MS. It’s always worth rethinking diagnoses. Just because a doctor seems clever or important does not always make the doctor right.

GadaboutGran

I had my first migraine aged 13 - blinding headache, wonderful art deco aura with speech, writing and movement affected. They were sometimes linked to food (strong cheese, red wine which I now avoid) and bright sunlight but they mainly seemed to be linked to hormonal changes - around periods, pregnancy and really bad ones for a couple of years linked to the menopause. After the menopause I seemed to be free of them until recently. I've had 3 in the past 3 weeks. In my mind they seem to be linked to the slight dizziness and muzziness I've had with sinusitis linked to allergic rhinitis. Could this be the case?

I'm also interested in something I read about migraine being a symptom of Hughes Syndrome. My daughter was diagnosed with this in relation to recurrent miscarriages. Is there a link and is the condition hereditary (ie should I get tested for this)?

I think it's more likely that your rhinitis symptoms and dizziness are part of the migraine. Of course I am biased because I'm a migraine doctor. To a hammer everything looks like a nail. Doctors have to watch out for this. Hughes' Syndrome has a broad spectrum and the blood tests that diagnose it are quite commonly abnormal in healthy people. Sometimes I wonder if doctors diagnosing Hughes' Syndrome may have a bias as perhaps I do. Both migraine and Hughes' Syndrome cluster in families but are not strongly inherited. It is possible to have both. Your GP can advise you about testing for Hughes' Syndrome.

busilizzie

I started migraines at about the age of 15/16 and I'm now 67 and thankfully the days of being confined to bed in a darkened room for 36 hours every 2 - 3 weeks with a bucket by the side (after a dozen trips to the loo to be sick I hadn't the energy to get out of bed) and too exhausted to sleep, the worst of my migraines seem to be over. I have been taking Naramig for the past 10 years, but still get bad headaches -once or twice a week. I've tried taking 3 x Paracetamol (with and without codeine), ibruprofen (I can't take aspirin) immediately I sense a headache coming on and they dull the pain but only the triptans completely remove it together with the sense of disorientation and heightened reaction to sound and light. Sometimes I can take one and carry on, sometimes I still need to go and rest. I call them my 'magic pills' Fortunately my doctor is very empathetic and is still happy to prescribe them and I have a review every 3 months. I have always been a 'headachey' person, but wonder if I will ever be free of headaches. They have plagued my life and stopped me from doing so many things. It seems to be the extremes which set things off - too much sleep or not enough, getting overtired, getting too hungry before eating or not eating enough Sometimes I can drink a glass of wine (never red), sometimes a mouthful will set of a headache. I'd love to be a party person but no chance !!Getting chilled in the winter can do it - so can very bright sunshine (especially when it flickers through the tree branches) .There is never any rhyme or reason to it. What will set a headache off one day, won't on another !

I agree that paracetamol with and without codeine is not good for migraine. You might find increasing ibuprofen does to 600mg (ask your doctor for this on prescription – the granule preparation) and take it in water with domperidone 20mg which makes the stomach empty properly (the stomach goes on strike in migraine) It may work almost as well as Naramig. But if Naramig (naratriptan) works well why not take it each time? Perhaps because it’s more expensive than generic sumatriptan – though there should be a generic naratriptan available soon. You are right that triggers don’t always set migraine off: it doesn’t always rain when there are clouds in the sky.

tidymind

My 12 yr-old grandson has very suddenly started getting headaches, which the GP has diagnosed as migraine although he says the pain is at the back of his head, rather than behind one eye, which is my experience of migraine.

He has had three of these headaches in the last fortnight. Mostly they come on in the afternoon but one lasted nearly three days. They have all been accompanied by fairly violent nosebleeds. He has twice vomited with them (this not violently, but still). He goes very pale. The latter two were cured after long sleeps.

Do you have any sense of what's going on? Should we be worried? And what can we do?

Pain localisation is non specific in migraine. Does your grandson need a drink and a snack when he gets home from school? Sleep is certainly a good treatment for migraine but better to avoid the attack if possible with a regular diet and plenty of water.

Cerasus

After a lifetime (60 this year) of migraines I have finally found medication that works for me. I wanted to go back and hug the GP (she also has them) the first time I took the tablet and it worked. Her advice was to take 3 aspirin (max 900mg) if it seemed to be a migraine coming on waking - mine often start in the morning when I wake up but sometimes start at night. If the aspirin hasn't worked after an hour I take one tablet.

It is called Maxalt Melt 10mg Oral Lyophilisate

This has worked on every occasion since I was given the prescription - sometimes I have a head ache but can still function or it is a very weak version. (A full blown migraine for me can last up to 3 days usually in the darkened bedroom and means I can't work which is stressful in itself. )

Can't do webchat I am not retired!!

Humbertbear

I used to have cyclical migraines and I took epilim for a long time. This is an epilepsy drug but it worked and eventually I could cut down and finally stop taking it. It was prescribed by a consultant at Kings College Hospital in London and my GP was happy to prescribe.

Is anyone else up against the NHS cut backs? I have been told I can no longer have Imigran but have to have the generic Sumatriptin which does not work as well for me.

Humbertbear

Just looked up Maxalt and it is cheaper than sumatriptan and considered to be more effective. Need to make an appointment to see the doctor!

Maxalt is a brilliant medication. It is slightly cheaper than branded sumatriptan (Imigran) 100mg but more than ten times the price of generic sumatriptan. I’m sorry that humbertbear is disappointed with generic sumatriptan but it really contains exactly the same chemical as branded sumatriptan. Are you sure that the dose didn’t change? Sumatriptan 100mg helps about one in ten patients who do not respond to sumatriptan 50mg. Not all attacks respond the same. If you were picking it off a supermarket shelf at 30p versus £6 which would you choose?

SpamW

I have been plagued by migraines for over 10 years.
I have tried desperately ,without success,to identify any triggers and have tried stopping certain foods and drinks,but to no avail !
When they 'strike' they are totally debilitating .......I feel as though my head is about to explode,my temples are sore to touch and the merest movement of my eyes is excruciating !
It also feels to be in my nose too ??
I end up spending hours with my head/face pressed into a hot water bottle after taking as many co-codamol tablets as I dare
I have been several times to my GP who has prescribed over the years things such as Immigran and Maxalt ......but I am yet to find my 'wonder drug'.....oh how I would give anything to find that magic pill that would take away the horrendous pain!
My GP once sent me to see a Neurologist some 60 miles away ,who, although very nice, told me that if I had been having them for so long he was sure there was " nothing about to go pop " ......no tests were carried out?!
I have also tried using sinus wash solutions wondering if that is the problem?
If ANYONE could offer any advice or solutions that could eliminate these dreaded and awful headaches that plague my life I would be eternally grateful !!

Sinus washing won't work. And co-codamol may well make matters worse. Keep trying with different triptans - there are five others - and be very picky about what time in the migraine you take the triptan. As soon as possible after pain begins. Cutting foods out is a waste of time.

You don't say how often it's happening. Consider keeping a migraine diary. there are good ones on the Migraine Centre's website. Talk to your GP about a prophylactic drug to take every day, once you've got a couple of months on your diary. Reassuring to hear your neurologist was very nice - we don't always have a good reputation, as we see so many incurable diseases. But migraine can be helped. People with migraine do not need any tests or scans.

feroshus

I know roughly what my triggers are - alcohol, too much eye strain, lack of sleep (though there may be others). But although I can definitely do something about the first of these, there's a limit to what I can do about the others. Do I have to accept migraine as part of my life?

(I have had migraines for about 15 years now and I get them on average once a fortnight. I never have one on holiday, but I am not able or prepared to give up work. I tend to take over the counter medication.)

Health means the tolerance of imperfection. But you should be able to do something about your migraine. If your GP or local specialist can't help why not come to National Migraine Centre?