“If a migraine is just a headache, then Godzilla is just a lizard”

One in seven of us will suffer from migraines, so there is a good chance that someone you know suffers with migraines – it might even be you.

It is estimated that there are nearly 200,000 migraines every day in the UK. More common in women than in men, it can affect us at any age – even as children.  On average, a migraine sufferer will have 13 attacks a year, lasting up to 72 hours at a time.

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Migraine is a complex problem and the truth is that medical science isn’t entirely certain on its cause. Whilst many people with migraines will experience headaches (usually a severe, throbbing, one-sided headache), there are many other symptoms and features of a migraine, such as: flashing lights or visual changes or sensitivity to the light, sensitivity to sound or smells, nausea or vomiting, numbness or pins and needles, slurred speech, irritability or abdominal pain. Sometimes, someone with a migraine will not even have a headache.

Migraines are thought to occur in five stages: prodrome, aura, main attack, resolution, recovery.

The prodrome can be tricky to pick out from normal day-to-day life, but those who can recognise it will talk about feelings of lethargy or irritability, or just feeling a bit off.

For some this will be followed by an ‘aura’. This would typically happen up to an hour before the attack. Someone might notice flashing lights, changes to their vision or speech, or other neurological features such as tingling or numbness. Migraine aura’s do not happen with every migraine, and it is estimated around one-fifth of migraines are associated with an aura.

I suffer with migraines – thankfully very rare these days, but when I get one they wipe me out. I don’t usually suffer with an aura when I do have a migraine  – but it has happened. If I do get one, it will be flashing lights – strange flickering light towards the edge of my vision – just enough to make me wonder if I have seen it at all – and I get a bit muddled – almost as if my brain is suddenly wading through thick treacle and I feel I have to work hard just to think. 

The main stage of the migraine is the ‘attack’ phase – this is when a headache (if present) will occur and can last up to 72 hours.

In the resolution and recovery phases, the headache and any other symptoms start to ebb away but patients will often say they feel particularly tired or wiped out, sometimes for a couple of days.

So if you suffer with migraines, what can you do about them? First off, it’s really important that if you are experiencing new, changing or worsening headaches you get these checked out by your doctor. If your doctor agrees that you are suffering with migraines you might then want to think about ‘triggers’.

Many migraine sufferers have triggers unique to them and there are so many possible triggers out there. To be able to start working out what might be setting your migraine off, a headache diary can be a great tool. You can download pre-set diaries or just use your calendar on your phone. Do this for a month or so and then look back over the information you have collected and see if any patterns jump out at you.  For me, it’s lack of sleep – every time!

Common triggers are: emotional upheaval whether that be happy or sad, worry or anger, poor sleep or over tiredness, changes to environment, periods for women (as well as contraceptive pills and the menopause), dehydration, citrus, caffeine, cheeses, chocolate, alcohol, pork and monosodium glutamate.

Treatments vary depending on the type of migraine, how often they happen and your medical history, Broadly speaking these can be divided into ‘acute’ treatments – ones you take when an attack is happening and ‘preventative’ treatments – ones to take to try and stop attacks from happening. Simple measures such as paracetamol, anti-inflammatories such as ibuprofen and rest in a darkened, quiet room can be enough for some people. A word of warning about using codeine containing medications though – codeine and other opiates can can worsen or even cause headaches so should be avoided unless your doctor has advised you specifically to use them.

So if you’re one of the one in seven people in the UK who are thought to suffer from migraines, first off I feel for you and share your (head) pain. Secondly, don’t suffer in silence.

Migraines cannot be cured, but they can be managed. To talk about treatments that might help, speak with your doctor. As with so many medical conditions, there is a lot we can do to help ourselves – so why not consider keeping a headache diary and see what you can learn about your migraines.

Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.