Migraines in the UK

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