Migraine patients suffer one of the most agonising conditions in the human experience. Few medical conditions have been recognised as long as migraine, which was described by Aretaeus of Cappadocia in the second century AD.
A migraine is more than just a throbbing headache: it may also involve nausea, sensitivity to light, vomiting, loss of power, speech difficulties, vision disturbances and weakness. Migraine can even mimic a stroke. Attacks are unpredictable and vicious, last 12-24 hours and typically leave sufferers feeling washed out, so that they may take days to recover, resulting in sick days from school and work. Migraine attacks may occur only a few times a year, or as often as once per week. Quality of life can be so dramatically reduced that some sufferers even become suicidal. "Migraine is a hidden disability," says Audrey Craven, chairwoman of the Irish Migraine Association. "A study in the US on chronic physical conditions such as arthritis, asthma and heart disease found that people who suffered migraine were comparable only to those with active HIV."
If you want to know what migraine is like - ask around your family and friends of all ages. One in 10 Irish people is a migraineur - and the condition is inherited in 70 per cent of cases. Migraine usually begins by the age of 20 and can start in early childhood - manifested as abdominal pain. Many children who wake in the middle of the night vomiting and in pain, are actually in the throes of migraine attacks.
Yet despite being so common, migraine is grossly under-researched. Migraineurs have, traditionally, had trouble being taken seriously, perhaps because while migraine can wreck your quality of life, it doesn't kill you and many doctors don't like working with incurable conditions. And then there's the fact that for hormonal reasons, migraine affects three times as many women as men.
"Women with migraine have been seen as over-emotional, stressed-out people with personality problems, when in fact, migraine is a biological, neurological, physical disorder with a strong genetic component," says Craven, who was recently made board member of the World Headache Alliance. A life-long migraineur, suffering bouts at least once per week, she says that "migraine hasn't ruined by life but it has certainly ruled it."
She and the Irish Migraine Association have been on something of a crusade to get a migraine clinic for the Republic. "I want to make things better for migraineurs in general and for my own daughter, Janet, in particular, who also suffers from migraine. I don't want her to have the life I've had."
Tomorrow, the Republic's first Headache and Migraine Clinic, a pilot project partly funded by the British Migraine Trust, will be officially opened by Gay Byrne at Beaumont Hospital, Dublin - 28 years after the first migraine clinic opened in the UK. Although the clinic has no Government funding, Beaumont is providing the facilities and medical expertise, the pharmaceutical industry is contributing funds and the Irish Migraine Association is committed to providing £15,000 through fund-raising.
The clinic will be overseen by Dr Orla Hardiman, consultant neurologist, who says that anyone getting migraine attacks once a month or more needs preventative drug therapy. Unfortunately, however, many migraineurs are not benefiting from the new drugs available due to underdiagnosis. A new family of drugs, available in the Republic since 1997, holds important clues to the mystery of migraine. Sumatriptan, the first of this family of drugs, acts on serotonin receptors; serotonin is a brain chemical involved in the pathways which control pain. The exact mechanism of Sumatriptan's action is still under investigation, although it is believed to constrict brain blood vessels by its positive action on the 5HT1D receptors in the blood vessels. It has been shown, in experiments, to prevent neurogenic inflammation of blood vessels in the linings of the brain. "The cause of migraine is probably a matching between neural activity, chemical processes like serotonin and the blood supply to the brain," says Dr Hardiman. "It's very hard to study because you can't use animal models due to the simple fact that it's impossible to know if an animal has migraine. But new imaging techniques, capable of looking at the active brain, have enabled researchers to induce migraines and then watch the brain to see the neurological impact."
Dr Hardiman would eventually like to start an emergency migraine clinic - a service common in the US for 25 years - where sufferers receive intravenous drugs during attacks. In an attempt to stave off the inevitable anguish, some sufferers are administered opiates by their GPs, but these merely put the sufferer to sleep, rather than treating the underlying problem.
Traditional medicine doesn't yet have all the answers to managing migraine. Dr Hardiman often recommends alternative therapies such as aromatherapy, acupuncture, reflexology, biofeedback (see Coping panel, left), massage and yoga to help sufferers deal with the lifestyle triggers of migraine.
Alternative therapies may be useful because stress can sometimes precipitate or exacerbate migraine, although many migraineurs are reluctant to accept this connection for fear that their condition will be dismissed as psychological, rather than the biochemical condition which it genuinely is.
Becoming your own medical detective and discovering what triggers your own migraine is the key to managing it. Dietary triggers, which cause migraine in 15-20 per cent of sufferers, famously include chocolate, coffee, red wine and mouldy cheese. Other people have attacks after being exposed to odours, noise or bright lights. Irregular sleeping patterns and disruption of the circadian rhythm are an important factor in Saturday morning migraine, which is brought on by sleeping on, eating later and, ironically, by letting go and relaxing after the tension of the week.
Then again, your Saturday morning headache may be just a tension headache. How can you tell the difference? If you feel as if your head is being crushed in a vice and if the feeling lasts for five-10 days, it's not a migraine, says Dr Hardiman. Migraine attacks are sudden, dramatic and self-limiting, usually clearing within 12-24 hours. "Common migraine" is a sharp, one-sided, throbbing headache, rapid in onset and associated with photophobia (fear of light), nausea and vomiting. Sufferers cannot "walk it off" and have to lie down and wait for the migraine to abate.
"Classical migraine" is heralded by vision disturbance, for example, zig-zag lines which grow from one side to the other, accompanied by an area of visual loss. This is followed within 30 minutes by a throbbing headache with vomiting and nausea. "Complicated migraine" involves a feeling of pins and needles or weakness down one side of the body, confusion and difficulty in speaking. "Familial haemiplegic migraine", in which the sufferer is temporarily paralysed down one side of the body, is one type of migraine for which two genes have already been identified. An abnormality of calcium build-up across nerve membranes is suspected.
"Basilar migraine" appears like a stroke; sufferers become confused, lose consciousness, experience double vision, fluctuating blood pressure and heart rate, often terrifying their carers. "Cluster headaches" are the most excruciating type. An unbearable pain develops behind the eye, typically waking the sufferer from deep dreaming sleep around 4 a.m., leading to the suspicion that a disturbance in brain activity during REM sleep causes the headache.
Anyone developing dramatic headaches has the dreadful fear that they may have a brain tumour. Since 90 per cent of migraine manifests itself before the age of 40, anyone older than 40 developing migraine-like symptoms for the first time - especially morning headache, nausea and vomiting - should have a comprehensive neurological investigation.
The diagnosis of migraine is not an easy one, since there is no cure. However, more research is being done internationally. Audrey Craven intends to use her influence to have a major migraine research project into the genetic basis of the condition conducted in the Republic and, knowing her, she'll succeed.