The final episode in the six-part podcast series, Beyond Migraine, brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland, focuses on how to cope with an unexpected migraine attack. Appearing in this episode is Ciara O’Rourke, a nurse who has been living with migraine for 20 years, Patrick Little, the former CEO of the Migraine Association of Ireland and Dr Martin Ruttledge who is a consultant neurologist at the Migraine Clinic at Beaumont Hospital and the Hermitage Medical Clinic.

Why do unexpected migraine attacks occur?

“The first thing to say is that about 90% of people living with migraine will experience episodic migraine” according to Dr Ruttledge. “So, that’s a nicer place to be than chronic migraine. In other words, they will have episodes of migraine and then periods of normality in between.”

Unfortunately for those with episodic migraines, they don’t occur on a routine basis. They can arise at any time. “Your brain doesn’t really care what you think. It doesn’t mind that you have three small children or that you have to go to work or that you’ve planned a birthday celebration next Saturday. Your brain will do what it wants to do and that leaves you in the situation where it’s very unpredictable as to what’s going to happen next,” added Dr Ruttledge.

Patrick Little, former CEO of the Migraine Association of Ireland said, “Migraine is such an individual condition, it’s not always easy to treat, so it may take time and during that time, you still have to get on with your life. But there’s a lot of things people can do to manage their condition. Number one is to always be prepared for an unexpected attack and carry your medications. The second thing I would say is to try and keep to a routine, and finally let colleagues and your family and friends know that you are living with migraine, educate them so they have some concept and understanding of what migraine is and can support you if an attack occurs.”

Warning signs

– Aura and Prodrome

Dr Ruttledge highlights the distinction between aura and prodrome. “The prodrome and aura are slightly different things. The prodrome is between six to 18 hours before you actually get the headache. The aura phase is usually 30-60 minutes before the migraine onset and is usually quite short. So, if you’re lucky enough to recognise the symptoms of the prodrome, you can treat the migraine early and you can treat it with a combination of medicines.”

Sometimes these signs take a while to correlate with the onset of migraine. For nurse Ciara O’Rourke, she and her husband figured out the signs of oncoming migraines. “I would have always said that I don’t get aura. I would never know when my migraine was going to happen as they can happen whenever. However, I yawn all the time before I have a migraine and my consultant told me that yawning is a tell-tale sign that a migraine is coming.”

Diagnosing migraine

Diagnosing migraine, and more so, identifying yourself as someone who is prone to migraines, is vital in obtaining the right help and treatment required when an attack occurs. It can take some time to differentiate a migraine from a headache, or something worse. “There was a time that I was so convinced there was something else going on in my brain because I work in a hospital”, said Ciara. “I got a CT scan, and an MRI scan, because I was convinced that this couldn’t be normal. But my diagnosis only came after going to my GP, then getting a referral to a neurologist, and meeting with a migraine clinical nurse specialist to figure out it was migraine.”

Dr Ruttledge lives by a policy of believing everything that his patients tell him. If it looks like a migraine, it most likely is. “Migraine is the one condition where you have to believe the patient because there’s no signs. There’s nothing on scans. There’s nothing on investigations. There are no signs of the condition except what the patient is telling you.”

Build a support system

According to Ciara, when living with migraine, “Building a support system, particularly one that includes people in the medical profession who can affirm your symptoms and effects of migraine, is crucial. I regularly text my clinical nurse specialist for advice. It’s so important to know that you’re not going mad, that these things are real and that it does affect other people. What I’ll say about that is, not one size fits all, it’s important to go and seek the right treatment and get the right help.”

You can listen to the Beyond Migraine episode featuring Dr Martin Ruttledge, Ciara O’ Rourke and Patrick Little here.

The series can be streamed via the Migraine Association of Ireland website as well as wherever you listen to your podcasts.

If you experience migraines, speak to your GP. For more information about migraines, visit www.migraine.ie.

People living with migraine can also check out Life Effects. Life Effects is an initiative shaped by patients, for patients. It explores the latest science and thinking around your condition, it contains tips and patients share stories about the reality of living with chronic conditions. Find out more about migraine on lifeeffects.teva/eu/migraine.

This article is part of a sponsored series linked to each Beyond Migraine podcast episode brought to you by the Migraine Association of Ireland and Teva Pharmaceuticals Ireland.

The Beyond Migraine podcast is supported by funding from Teva Pharmaceuticals Ireland. Speakers have received an honorarium for their contribution to the podcast.