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Migraines in the UK

Learn about the different types of migraines, their causes, and effective management strategies in the UK. Discover how to identify migraines, triggers, and avoid medication overuse headaches. Find ways to cope with stress, improve sleep and diet, and seek medical advice for menstrual-related migraines.

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Migraines in the UK

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  1. Migraines in the UK Mohammad Moazzam Fazlee & Punnam Mittu

  2. Migraine in the UK • WHO has classified headache as a major health disorder and has rated migraine amongst the top 20 most disabling lifetime conditions. • 1 in 7 people in the UK suffer from migraine. • Twice as many women as men. • All age groups (even young children) and all social classes. • Migraine costs the UK around £2.25 billion per annum. • One attack can last for between 4 and 72 hours (with an average of 13 attacks each year). • Around 60% of sufferers never consult their GP because they mistakenly think that nothing can be done to help them. • For most people there is not just one trigger but a combination of factors which individually can be tolerated but when they all occur together a threshold is passed and a migraine is triggered.

  3. Types of Headache • Tension - the common "everyday" headache most people will experience at some point in their lives. In some cases people have tension headaches on most days of the month. • Migraine - severe headache that can last for several days. It gets worse with activity and often comes with nausea as well as sensitivity to light and sound. • Cluster - extremely severe pain around the eye and side of the face, also includes swelling and a red watery eye. Some people report eight attacks a day, which can last up to three hours. • Medication overuse - feels like a tension headache or a migraine, but is due to taking too many painkillers. • However, there are more than 200 types of headache.

  4. How do you know when it’s a Migraine? • Assessment Is it a primary headache (tension, migraine or cluster? Is it secondary to an underlying cause? • Headache History Time • Onset (recent or long time sufferer) • Frequency (daily? Quantify) • Patterns • Duration of attack • Character • Site (where does pain start, does it spread) • Intensity (scale of 1-10) • Duration of pain

  5. How do you know when it’s a Migraine? Causes • Family history? • Triggers/aggravating factors/relieving factors Response • Patients actions during attack – what they do to relieve headache i.e. medication used • Limitations during an attack – does medication work completely/partially/make it worse? • Is patient symptom free between headaches Intervals • State of health between attacks – concerns, anxieties and fears about attacks? • How does patient feel between attacks?

  6. Migraine • Typically recurrent, episodic • Moderate or severe pain • May be unilateral/and or throbbing • Duration – from 4 hours up to 3 days • GI + visual symptoms common • Activity limited • Dark/quiet preferred • Free from symptoms between attacks

  7. Phases of Migraine Attack • Prodrome • 60% migraine sufferers experience • Occurs within hours or up to days before an attack Physical symptoms: stiff neck, cold, ↑ thirst, ↑ urination, loss of appetite, diarrhoea, constipation, sensitivity to light/sound Psychological symptoms: Depression, Euphoria, Restlessness, Drowsiness, Fatigue, Irritability, Impaired concentration, Scalp tenderness, Mood changes

  8. Aura • 20% sufferers experience right before an attack • Develops 5-20mins before attack, lasts no longer than 1 hour Symptoms: • Numbness or tingling of the face arm, or hand on one side of the body, Muscular weakness • Mild paralysis on one side of the body • Difficulty speaking or loss of speech

  9. Analgesics • Aspirin 75-900mg • Paracetamol (little efficacy on own) 125 – 500mg • Ibuprofen 100-600mg Common side effects • Drowsiness • Flushing (redness of face) • Dizziness • Feeling sick (nausea), being sick (vomiting) • Pain sensations • Tingling and Heat sensations

  10. ‘Brain gets used to painkillers’ Warwick Medical School • “Anyone taking painkillers for more than 15 days during a month were likely to suffer from analgesia-induced headaches’. Dr Brian Hope • "This can end up getting into a vicious cycle where your headache gets worse, so you take more painkillers, so your headache gets worse and this just becomes worse and worse and worse’’ Prof Martin Underwood • This is a huge problem in the UK population. The figures in terms of the number of people who have medication overuse headache are one in 50, so that is approximately a million people who have headaches on a daily or near daily basis because they're using painkillers.

  11. Trigger or predisposing?

  12. Management strategy • Stress: Relaxation and coping strategies may help with specific stress or anxiety present. • Yoga and meditation. • Alter poor sleep or eating patterns. • Diet: Exclude suspected food from diet for several weeks to see an improvement, and consult a dietician to avoid malnutrition. • Avoid particularly energetic sessions. However, maintain good physical fitness. • Migraine related to menstruation can be more difficult to treat than migraine related to other factors i.e. hormonal factors.

  13. Advice • Diary to monitor patterns + triggers – review after at least 5 attacks • Improving physical fitness • Physiotherapy (but no evidence) • Acupuncture • Psychological therapy • Relaxation (yoga + meditation) • Stress reduction • Coping strategies • Biofeedback 1st line if underlying cause e.g. anxiety/stress

  14. Things to include in diary… • Date of Attack      • Time Started        • Time Finished        • Aura – Yes/No • Severity – severe/moderate/mild • Time needed off school, work or other activities – Yes/No • Other Symptoms • Feeling Sick – Yes/No      • Vomiting – Yes/No      • Other

  15. Things to include in diary… • Medication • Dose • Time Taken • Relief - yes/partial/no • Time to Relief • Possible triggers • Food and drink taken 6-8 hours before attack • For women: record periods

  16. References • http://www.bbc.co.uk/news/health-19622016 • http://www.migraine.org.uk/index.php?sectionid=11

  17. Thank You For Listening

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