A bad headache is one thing, but shouldn’t be confused with migraine. Barbara Lantin explains the difference

There are many different kinds of headache and each has its own distinctive symptoms. The most common is the tension headache. The pain is dull and heavy, as if a band is being tightened around your head. Tension headaches tend to worsen as the day progresses and can last several days. The cause, as the name suggests, is usually stress, and painkillers may not help. Instead, try lowering stress levels, perhaps through relaxation techniques, yoga or meditation.

Identifying migraines
Migraines are very different. They last between four hours and three days, commonly affect only one side of the head and are often characterised by a throbbing or pulsating pain. The headache may be accompanied by nausea, sensitivity to light or sound and neurological problems such as difficulty in focusing or speaking. When it is preceded by visual disturbances – hallucinations, starbursts or flashing lights – it is known as migraine with aura. Menstrual migraines are those that always occur just before or during a period.

If you suddenly start to experience frequent headaches, you should visit your GP to check out the cause: different types of headache are managed and treated in different ways. Around 60 per cent of migraine sufferers have never consulted their doctor, probably because they believe that nothing can be done. However, new products are frequently being launched.

There is no test for migraine and nobody knows its exact cause, though it is now thought to originate in the brain stem and be due to some kind of hypersensitivity. Peter Goadsby, professor of clinical neurology at the National Hospital for Neurology and Neurosurgery in London, describes migraine as an inherited predisposition to headache attacks that strike at particular times in the sufferer’s life and are provoked by external factors (known as triggers). The most significant of these he believes, is change.

‘The migrainous brain does not seem to tolerate variation as well as everybody else. If you have a tendency to headache, extremes of behaviour – such as skipping meals, sleeping in late or getting up too early, too much stress or, paradoxically, too much relaxation – can aggravate that tendency.

What triggers migraine?
Many believe that some foods can trigger a migraine, but research has produced conflicting results. One study of 500 people with dietary migraine showed that the major culprits were cheese, chocolate, citrus fruits and alcohol. Another, in which 90 patients were given elimination diets and then challenged with either ‘good’ or ‘bad’ foods, resulted in the same number of attacks in both groups. Only alcohol, and especially red wine, was clearly shown to bring on an attack in some sufferers.

Keeping a detailed daily diary that covers about six migraines and includes what you eat, your activities and emotions and external factors like weather conditions and environmental pollution, can help to identify underlying patterns.

How is it treated?
The treatment of migraine depends on the frequency and the severity of the attacks. Many sufferers use over-the-counter painkillers containing aspirin, paracetamol or ibuprofen, sometimes with an added anti-sickness ingredient. It is important to take any medication as soon as you start to experience symptoms because migraine can interfere with the ability of the gut to absorb. Soluble painkillers may enter the blood stream more quickly.

If over- the- counter remedies do not work, your GP can prescribe a stronger drug such as ergotamine or one of the triptans. These come in various forms, including tablets, suppositories, injections and nasal sprays: one form may work when another does not. For very frequent and debilitating attacks, your doctor may prescribe preventative medication such as beta-blockers or tricyclic antidepressants, though these may not stop the migraines altogether.

Healthy alternatives
Some people have found complementary therapies beneficial. Biofeedback, which uses relaxation to raise skin temperature, has been shown in clinical trials to be helpful, as has acupuncture. The herb feverfew has come out well in at least three trials, though some researchers are not convinced of its effectiveness. Feverfew can be grown at home or bought dried in capsule form. It should not be taken during pregnancy.

For further information visit the websites of the Migraine Trust and the Migraine Action Association