Migraine is the world’s sixth most disabling disease, but steps can be taken to tackle a disorder that sees 500,000 work days lost yearly, writes David O’Mahony
Imagine your head being stuck in a vice for days on end. Movement makes you want to vomit (when you can move). Now add throbbing, spots in front of your eyes, confusion, a lack of co-ordination, or being unable to even stand. In a worst-case scenario you could be paralysed or lose consciousness. When you recover you feel half dead.
Welcome to migraine country. The WHO considers migraines to be the sixth most disabling disease in the world. Surprised? I can understand why. But when you can’t stand or function because of a pain in one side of your head, that’s pretty disabling.
None of this is fun when in the middle of work, or when driving across the country (both of these have happened to me). I had the start of one while writing this and a brief but exhausting one while with my family on holidays in Mallorca recently. I just about made it to a bench in a city square and was stuck there, unable to move or even think straight, until painkillers and a cold drink kicked in.
I don’t like missing work through illness but in the past year I have had a number of migraines which affect my ability to do my job (disclaimer: I work for the Irish Examiner). I have to plan, read a lot, troubleshoot, and think on my feet, which is a bit hampered when my head feels like it’s melting or my eye feels like it’s about to explode out of my head.
Jane Whelan of the Migraine Association of Ireland says while some people can manage during a migraine if they take their medication, many need to get away from what they’re doing.
“Generally people are lying in their bedroom; nobody sees you when you’re at your worst, they don’t realise how incapacitated somebody is … when people are at the worst of an attack they maybe can’t speak, can’t stand up, can’t do anything.” Others experience “stroke-like symptoms” like paralysis.
That doesn’t happen to me, but last year I lost days to a stress-induced ocular migraine. Yes, a migraine in my eye. It was bad to begin with and was being managed with painkillers, but returned with fury after my car battery died while out with my wife and twin toddlers. I was angry with myself and with what had happened (as if I could have stopped it) because we were stuck … and within an hour I was crippled again.
I remember my wife needing to go out briefly the next day so I watched the kids. Inasmuch as somebody lying broken on a couch can watch anything. I don’t think the boys knew what to make of their father.
Since then I carry painkillers and things called triptans. These disrupt the signal in your brain that causes the migraine, but can only be taken when it has started and dissolve on the tongue.
Stress and fatigue are my biggest triggers, but Jane says it’s “usually a culmination of things” rather than just one. She advises knowing your triggers, and keeping a daily diary to narrow them down. Chocolate is a myth though. For 24 hours before an attack your brain is, in effect, preparing. Jane says people will yawn more, urinate more, feel tired for no reason, and crave sugar. “So they’ll start eating chocolate, and then they’ll get the headache and they’ll think ‘I shouldn’t have eaten the chocolate’ … [but] the attack will have already started.” Doctors, she also notes, “on average only get about four hours of training on primary headache [a headache with no other cause than itself, like a migraine]”. I’m not saying don’t go to a doctor, just that you need to do some groundwork yourself.
Routine is good. Simple things like eating regularly and keeping hydrated are among Jane’s recommendations.
An estimated 500,000 work days are lost in Ireland every year due to migraine. But presenteeism — going to work while unwell — is also a big issue, according to Jane. People aren’t as effective or efficient as they could be, she says, whereas if they had some more flexibility at work they could be able to treat the attack sooner, thus returning to work well sooner. Pushing through a migraine is often counter-productive for me, although it’s not always possible to drop what I’m doing.
Jane advises that employers talk to the people affected and ask them what they need. That might be needing some time away from regular duties to take medication and rest, for instance. People having a migraine attack may not just be in severe pain, but may find everything too loud and too bright. She stresses that understanding and flexibility “is probably the biggest thing an employer can do to help somebody”.
So let’s keep our painkillers to hand, bunker down in a darkened room, and we’ll get through this together. Migraineurs of the world unite (if you’re not incapacitated)!
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