Practical tips to cope with migraine

The UK's Migraine Trust estimates that 25% of people with migraine drop out of work altogether, rising to 33% who suffer from chronic migraine.

Described as “a common, chronic neurological condition that causes recurring, moderate-to-severe throbbing head pain, typically on one side of the head”, migraine is extremely variable so it's never one size fits all when it comes to treating it.

Symptoms before or after the headache include feeling sick or vomiting, sensitivity to movement, light, sound or smell. Other symptoms can depend on the type of migraine - migraine without aura - an intense headache but no warning signs; migraine with aura - includes warning signs before the attack such as seeing flashing lights; silent migraine - aura or other migraine symptoms but no headache.

Rosie Scott is an osteopath and one of only a handful of UK clinicians qualified as a Specialist in Headache Disorders by the Danish Headache Center. She founded Erin Health after seeing how many women reach a specialist years too late, having been told their attacks were stress, hormones or dehydration. The overlap with perimenopause can muddy the picture. Often a ten-minute GP appointment is insufficient describe a condition that has a dozen symptoms before the pain even starts.

She advises sufferers not to track their triggers.

“An attack begins hours, sometimes more than a day, before the pain does. Yawning, thirst, mood changes, a stiff neck and craving something sweet are all part of that early phase, which involves the hypothalamus, the area of the brain in charge of keeping your body in a stable internal state” she explains.

“It's often why bright lights, chocolate and neck problems get the blame, when they may just be a sign the body is already on the path to an attack. Being hyper vigilant about triggers adds to your mental load and signals to the brain that these are things to be cautious of, potentially making an attack more likely or more severe.”

Around 80% of pain diagnosed as chronic sinusitis turns out to be migraine. If your sinus headaches come without increased discharge or fever, but with nausea, or you find yourself wanting the lights off and the sound down, you are probably treating the wrong condition. No amount of decongestant spray will touch it, and you're simply storing up rebound congestion from overusing it, she believes

Neck pain is unlikely to be the cause of an attack - most of the neck symptoms that come with migraine are the migraine, not a neck problem causing it, the osteopath believes.

“Migraine is a neurological disorder that musculoskeletal medicine alone cannot solve. Where hands-on work genuinely helps is making sure the body isn't adding to the load on the brain: how you breathe, how you sit, tension in the jaw or shoulders, and whether the neck is truly restricted.”

If you're double-jointed, look at the whole picture as hypermobility often goes hand in hand with chronic migraine and with POTS, where the heart races on standing.

“If you have a list of symptoms as long as your arm, that's worth exploring with your GP with migraine in mind, because treating the hypermobility or POTS can bring the migraine severity down too. You can get a rough sense of POTS at home: lie down for ten minutes, check your pulse, stand up and check it every minute for ten more. A rise of around 30 beats a minute is worth speaking to your doctor about.”

There are seven different drugs called triptans that are prescribed for migraines. How you respond to one doesn't predict how you'll respond to another, says Rosie.

“Around a third of people don't respond to any triptan, which means most people will, yet almost nobody is offered a second, let alone a third. Taking the full dose as soon as the pain starts, rather than when it's too severe to push through, is fundamental to how well it works. The guidelines say that if two attacks in a row go completely untreated on one triptan, go back and ask to try a different one.”

If you're sick during attacks, your tablet may never be absorbed. Adding an anti-sickness medicine alongside a painkiller improves how well it works, and there are nasal sprays and injectable versions of some triptans for people who vomit early in an attack.

Medication overuse headache is common, miserable and preventable, and patients often feel guilty about it even though nobody warned them. Count days, not tablets: needing something for your head, or any pain, on more than two days a week is the point to go and talk to someone about a different strategy rather than buying another box.

A predictable attack is a plannable one. If attacks cluster in the couple of days before or during a period and follow a reliable pattern, there are short-term preventative options recommended for exactly that pattern. Keep a diary for three cycles and take it to your GP. Anything new, sudden or different about a headache needs checking properly.

Here she outlines the steps she takes when she feels one coming on.

"Early is everything. An attack usually begins hours before the pain does, with yawning, thirst, a stiff neck, a change in mood or a sudden craving for something sweet. If you learn your own version of that pattern it gives you a genuine head start on treating it effectively.

"Eat and drink something if you haven't, then take yourself out of the noise for ten minutes: somewhere quiet, low stimulation, sitting down properly. Cold on the forehead or the back of the neck helps a lot of people, and warmth across tight shoulders helps others. Neither will do you any harm and it is entirely personal preference, so try both and find out which one is for you.

"And don't try to walk it off unless you know that helps you early on. Once a migraine attack is in full swing it is likely made worse by ordinary physical activity, so a brisk turn round the block is the wrong instinct. Fresh air at an open door, absolutely."

"Early is everything. An attack usually begins hours before the pain does, with yawning, thirst, a stiff neck, a change in mood or a sudden craving for something sweet. If you learn your own version of that pattern it gives you a genuine head start on treating it effectively.

"Eat and drink something if you haven't, then take yourself out of the noise for ten minutes: somewhere quiet, low stimulation, sitting down properly. Cold on the forehead or the back of the neck helps a lot of people, and warmth across tight shoulders helps others. Neither will do you any harm and it is entirely personal preference, so try both and find out which one is for you.

"And don't try to walk it off unless you know that helps you early on. Once a migraine attack is in full swing it is likely made worse by ordinary physical activity, so a brisk turn round the block is the wrong instinct. Fresh air at an open door, absolutely."

Three quick ones for everyday tension - unstick your tongue from the roof of your mouth and let the jaw hang, look at something 20 feet away for 20 seconds, and roll the shoulders back to open the chest.

For online consultations with Rosie at Erin Health, email [email protected].