Millions of working days are lost each year through migraine. The sufferers are said to have included Lewis Carroll, Darwin, Freud, Joan of Arc, Rudyard Kipling, Nietzsche and Jefferson. It has been said that 10% of the population have migraine attacks from time to time. The symptoms vary a great deal but, in addition to a searing headache, many patients vomit. Before the headache there may also be a warning ‘aura’. Some sufferers see flashing lights and visual disturbances are common. Migraines usually begin in the sufferer’s teens and may persist throughout the victim’s life. They occur at irregular intervals, sometimes once or twice a week, usually less frequently.
The cause of migraine is still something of a mystery, but it seems likely that the blood vessels supplying the brain constrict and then dilate, reducing and then increasing the flow of blood to the brain. The initial constriction causes the aura, the following dilation produces the pain. In tension headache the pain is caused by too much blood flowing into the brain. The same thing happens in high blood pressure. In migraine it is often the blood vessels on one side of the head that are affected; hence the result that the headache occurs on one side of the head.
Migraine attacks are ‘triggered’ off by many different things. Some- times a specific factor can be found which causes the attacks. Chocolate, cheese, oranges, lemons, shellfish, alcohol, tobacco, bananas and fried foods have been described as causing migraine attacks. To find out whether or not any of these ‘triggers’ is responsible a migraine sufferer must keep a close record of all he or she consumes for a month or two. Only then may a pattern showing some relationship between migraine attacks and a foodstuff be discovered. Making lists may be tiresome but it does frequently help pinpoint a cause.
When migraine attacks are caused by stress they usually occur when the subject is relaxing, and often at weekends. Any form of excitement may produce the telltale symptoms of a migraine attack and pleasure as well as unhappiness can produce the pain.
When an attack occurs the pain and discomfort may be relieved by ordinary painkillers but often something more powerful is needed. The classic treatment is a drug called ergotamine tartrate which helps by constricting the dilated arteries supplying the brain. The ergotamine does not, however, help relieve the visual symptoms. Other drugs are said to help by reducing the responsiveness of the cranial arteries.
Migraleve is one of the best-known products used in the treatment of migraine and available without a prescription. There are pink and yellow tablets. The pink ones contain buclizine dihydrochloride (an antihistamine), paracetamol, codeine phosphate and dioctylsodium sulphosuccinate (which is described on p88, and which is presumably included to counteract the effects of the codeine). Two pink tablets are used at the first sign of an attack. Yellow Migraleve tablets, used at the rate of two every four hours if pain persists, consist of paracetamol, codeine phosphate and dioctylsodium sulphosuccinate.
There does not seem to me to be any great advantage in using these tablets as opposed to ordinary painkilling tablets. Many other products are available only on prescription and patients who suffer regularly from migraine attacks should consult a doctor.