The problem: One in 10 people are victims of migraine yet many suffer in silence, unaware that effective treatments exist. About 60% of sufferers never consult their GP, believing their complaint is too trivial or their doctor cannot help. Others are still not prescribed effective medication. Doctors may fail to diagnose migraine, not know which treatments work, or be reluctant to prescribe costly medication.
Symptoms: Symptoms and triggers of migraine vary significantly. People typically suffer throbbing headaches, but other symptoms include nausea and vomiting, flashing lights or tunnel vision, sensitivity to light, noise and smells, and pins and needles in the limbs. Attacks may be triggered by certain foods, stress, going without food and too little or too much sleep.
Treatment: There is no cure for migraine. Most people treat themselves with over-the-counter painkillers. Yet they are ineffective for many people. A worldwide review of migraine treatments by the pain relief unit at Oxford's Churchill hospital found that triptans - prescription-only drugs developed in the last decade - can effectively reduce and eliminate migraine pain. The review found that sumatriptan (brand name Imigran) by injection works best, curing headache for about half of sufferers within two hours. Of the tablets, rizatriptan 10mg (Maxalt) and zolmitriptan 5 mg (Zomig) work well, but are less effective at lower doses. Tolfenamic acid (Clotam) - not a triptan - appears to work equally well. Imigran 100mg tablets and Imigran nasal spray are fairly effective while the lower dose tablets are less so. There is less evidence for the effectiveness of two tablets, naratriptan (Naramig) and Cafergot (a different drug group), the review found.
Prevention: Avoiding triggers can help. If attacks are frequent, prophylactics, like Sanomigran and Deseril, can help but may have unpleasant side effects. The herbal remedy feverfew shows good results in trials but, on current evidence, homeopathic treatment works no better than placebos.
More information: Oxford's pain relief unit has a website with research on interventions for pain at www.ebando.com. Or send an SAE to Migraine Action, 178a High Road, Byfleet, Surrey KT14 7ED (01932 352468).
