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& other headaches
Dr Anne MacGregor
Published by Family Doctor Publications Limited in association with the British Medical Association

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This book is intended not as a substitute for personal medical advice but as a supplement to that advice for the patient who wishes to understand more about his or her condition. Before taking any form of treatment YOU SHOULD ALWAYS CONSULT YOUR MEDICAL PRACTITIONER. In particular (without limit) you should note that advances in medical science occur rapidly and some information about drugs and treatment contained in this booklet may very soon be out of date.
All rights reserved. No part of this publication may be reproduced, or stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. The right of Dr Anne MacGregor to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988, Sections 77 and 78.
© Family Doctor Publications 2002–2006 Updated 2004, 2005, 2006 Family Doctor Publications, PO Box 4664, Poole, Dorset BH15 1NN ISBN: 1 903474 •• •
Introduction to common headaches ............... 1 Different types of migraine ............................. • Migraine triggers ............................................ •• Living with migraine: self-help ........................ •• Living with migraine: seeing a doctor ............. •• Living with migraine: complementary treatments ............................. •• Headaches in women ..................................... •• Headaches in adults of both sexes .................. •• Headaches in children .................................... •• Headaches in elderly people ........................... •• Chronic daily headache .................................. •• Cluster headaches & chronic paroxysmal hemicrania ..................................................... •• Other causes of headaches ............................. •• Common questions & answers ....................... ••• How to help the migraine clinic doctor help you ••• Useful information ......................................... ••• Index .............................................................. ••• Your pages ..................................................... •••

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1 iv Fewer than two per cent of the population claim
never to have had a headache. For most of the rest of us, headaches are fortunately infrequent and the cause is usually obvious, whether it is a hangover from too much alcohol, a deep pain over your eyes from a sinus infection or a throbbing pain in your cheek from a dental infection. Other headaches may not have an obvious cause and, if they are frequent and severe, can cause significant concern and anxiety. Although doctors classify migraine and cluster headache (see pages 4–5) as benign (non-serious) conditions, they can seem very serious to the sufferer, who may be extremely disabled by attacks. It is not even just the attacks themselves that are disabling; fear of the next attack can affect a person��s ability to lead a normal life. This book has been written to help anyone suffering with head-aches to find ways to reduce the frequency and severity of the attacks and to lead a better quality of life. If you are prone to headaches, this book will help you to understand what is triggering your symptoms and how you can combat them more successfully. There are chapters on migraine triggers and living with migraine, as well as on other types of headaches Dr Anne MacGregor is Director of Clinical Research at the City of London Migraine Clinic; she also works at St Bartholomew��s Hospital, London. Her non-clinical work includes General Secretary of the International Headache Society and Medical Adviser to the Margaret Pyke Memorial Trust.
About the author Introduction

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such as chronic daily headache. The chapters on headaches in women, children and elderly people highlight common causes of headaches in these specific groups of people and provide some possible self-help measures to ease the symptoms. This book is not intended to help you diagnose the cause of your headaches yourself. Information in this book cannot replace the advice of a doctor or medical specialist, who will be able to confirm the suspected diagnosis and offer advice suitable for your individual case. Certainly, if the nature of your headaches is uncertain, if the attacks become more frequent or severe or if your symptoms change in any way, you must seek medical advice immediately. Severe headaches are rarely the result of anything sinister, such as a brain tumour or stroke. However, these causes must be ruled out before the more likely headaches, such as migraine, can be confirmed.
Recognising your headache
Each headache has its own particular pattern of symptoms. The table on the following two pages shows the usual pattern of symptoms of some of the more common types of headaches. As there are no diagnostic tests for most of the common types of headaches, listening to the story told by the patient is usually the only way in which a doctor can make a diagnosis of the type of headache. These non-migraine headaches are discussed in more detail in later chapters.
The brain and spinal cord form the central nervous system (CNS). The brain performs many complex functions, for instance it is the source of our consciousness, intelligence and creativity. It also monitors and controls, through the peripheral nervous system (PNS), most body processes – ranging from the automatic, such as breathing, to complex voluntary activities, such as riding a bicycle.
Brain Brain stem Spinal cord Femoral nerve Sciatic nerve Tibial nerve Intercostal nerves

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Characteristics of the more • • common types of headaches
Characteristic Migraine Muscle contraction Stress/depression Chronic daily Cluster headache headache headache headache (rare) Age at onset Childhood/teens/20s Any age but rarely Any age 30s/40s 30s of headaches children Frequency with Episodic: average one Episodic or daily Usually daily Daily Episodic: average of which headache to two attacks per month one to two attacks occurs but very variable per day for six weeks Chronic: average of one to two attacks per day Duration of Part of a day up to Hours to weeks Continuous Continuous Half-an-hour to two headache three days hours Principal Often unilateral Localised All-over pressure All over Unilateral, centring symptoms on one eye Severe Tender to touch Band around your Diffuse and dull head Throbbing Weight on your May have additional head migraine attacks Associated Nausea Tender neck/shoulder Mild Mild unless additional Affected side: eye symptoms muscles migraine attacks and nose waters Vomiting Affected side: eye reddens Photophobia (dislike of bright light) General malaise (feeling unwell) Mood during Usually normal but can be Normal Depressed Flat/��suppressed�� Normal headache associated with depression General health Well Well General malaise General malaise Normal but often (feeling unwell) (feeling unwell) smokes or history of smoking How often Episodic Episodic Frequent, often None or daily, Episodic is medication daily particularly if associated taken to treat with overuse of acute symptoms? medication Effect of Right medication Response in 20 to 30 Minimal response Minimal response Right medication medication usually gives relief minutes usually gives relief

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. Severe headaches are rarely the result of
anything sinister
. Each headache has its own particular
pattern of symptoms
What is migraine?
The name ��migraine�� is derived from the word ��hemicrania�� meaning a one-sided headache, although the migraine headache can be generalised. Migraine headache is often described as a throbbing pain that gets worse on physical activity. Although the pain may be severe, migraine is not in itself life threatening, although a bad attack often feels like it. Migraine is, however, more than just a headache and the headache is not necessarily the major symptom. Some attacks are preceded by visual disturbances. Other typical symptoms include nausea, vomiting, and sensitivity to light, noise and smell. Many sufferers cannot bear even the thought of food, whereas others find that eating takes the edge off their nausea. Migraine has been likened to a power cut. During a migraine, you may find that your whole body seems to shut down until the attack is over. Lethargy (a lack of energy) is a common symptom and every task may seem to take twice as long – if it is possible to tackle it
Different types of migraine

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at all. Your stomach may stop working normally, making it harder for medication to be absorbed into your bloodstream, especially if treatment is delayed. Many people have to lie still in a quiet, darkened room until the attack is over. If medication doesn��t control an attack, you may find that your symptoms improve after a good sleep. Other people find that vomiting will relieve their symptoms. Migraine lasts anything from four hours to three days, with complete freedom from symptoms between the attacks.
Who gets migraine?
At a conservative estimate, migraine affects about 10 to 12 per cent of the population at some time in their life. In the UK, this amounts to over six million people. It is difficult to give a precise figure because some
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Do you have headaches that last between 4 and
72 hours?
Is the pain usually one-sided and/or throbbing? Do you feel sick or vomit with the headaches? Does light or noise bother you when you have a
Do you find it difficult to concentrate when you
have a headache and sometimes have to stop and sit or lie down?
Is your general health good between these
attacks? If you answer ��yes�� to most of these questions, you probably have migraine.
Do you have migraine?
people may have only three or four attacks in a lifetime and not recognise them as migraine.
Migraine affects more women than men in a ratio of about three to one. Hormonal changes in women are the obvious reason for this difference between the sexes and account for the fact that, until puberty, migraine is equally prevalent in boys and girls. In one large survey, researchers found that, of those questioned, 8 per cent of men and 25 per cent of women had had a headache with features of migraine at some time in their lives.
At least 90 per cent of people who get migraine have their first attack before the age of 40. For most people, migraine starts during their teens or early 20s, although it has been diagnosed in young children and even babies. It is rare for anyone over the age of 50 to experience their first attack of migraine, although migraine can return at this time of life after years of respite. Even though migraine starts when you are young, it is often not a problem until later life when attacks become more frequent. Studies show that women are most likely to have problems with migraine, particularly when they reach their 30s and 40s. In men, the pattern is fairly consistent through-out their lives. Migraine usually improves in midlife for both sexes, although an unfortunate few do continue to have attacks.

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What are the different types of migraine?
The two most frequently encoun-tered types of migraine differ only in the presence or absence of an ��aura��. An aura is a group of neuro-logical symptoms that precede the headache, most often visual (see below). About 70 to 80 per cent of migraineurs (people who suffer from migraine) experience attacks of migraine without aura (formerly known as common migraine); 10 per cent have migraine with aura (formerly known as classic migraine); 15 to 20 per cent have both types of attacks. Less than one per cent of attacks are of aura alone with no headache developing. Other types of migraine are extremely rare (see page 13).
What are the symptoms of migraine?
Migraine is more than just a headache. You may feel that your body has had a power cut – it shuts down for a while and you want to hide away. During attacks, you may experience a heightened sensitivity to light, sound and smell, not want to eat, experience nausea or vomiting, have an inability to concentrate and feel generally extremely unwell. These other symptoms may cause you more distress than the headache itself. In fact, migraine can be divided into five distinct phases:
1 premonitory (warning signs) 2 aura 3 headache 4 resolution 5 postdromal (recovery).
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Premonitory phase
Two-thirds of migraineurs experience these warning symptoms, although you may not recognise them for what they are until you know what to look for. These symptoms include very subtle changes in your mood or behaviour, which may be more apparent to your friends and family than they are to you. They include:
Mood changes: irritability, feeling ��high�� or ��low��. Behavioural changes: hyperactive, obsessional,
clumsy, lethargic.
Neurological symptoms: tired or yawning, difficulty
finding the right words, dislike of light and sound, difficulty in focusing your eyes.
Muscular symptoms: generalised aches and pains. Gut symptoms: nausea, craving for certain foods
(often sweet), not wanting to eat, constipation or diarrhoea.
Changes in fluid balance: thirst, wanting to pass
water more often or fluid retention. These symptoms are sometimes blamed as triggers for the attack. For example, if you crave chocolate, eat it and then wake up the next morning with a migraine, it wasn��t necessarily the chocolate that caused the migraine. It is much more likely that the craving was a symptom of an attack that had already started. Premonitory symp- toms usually begin subtly and develop over a period of up to 24 hours before the headache starts.
Many people, doctors included, mistakenly think that it can��t be migraine unless an aura occurs. But only 20 to
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