Attitudes to migraines have changed and there is now help at hand. Laura Slattery reports
Around 10-12 per cent of the Irish population suffer from a neurological condition characterised by a severe, throbbing, one-sided headache, often accompanied by nausea, intolerance to noise and light, visual distortions and vomiting.
This is migraine. Attacks last from four hours to 72 hours, with the average clocking in at about 24 hours.
For some, the symptoms strike just once or twice a year, but the average sufferer experiences an attack once or twice a month. Others, about 10-20 per cent, get at least one attack a week.
Yet, despite its debilitating nature, it is estimated that 50 per cent of all sufferers have never been diagnosed. About a third treat themselves with over-the-counter pills, but for some these may be only partially effective.
Susan Lyons (28) suffered from migraine attacks since she was a child, aged three or four.
"My poor mother didn't know what was wrong with me, she had me tested for meningitis, she took me off chocolate at one stage and cheese at another stage, trying to find a food link."
Certain types of food, including alcohol, citrus fruits and fried foods, are said to be among the trigger factors that can bring on an attack.
After years of experimentation, Ms Lyons could not find a food trigger.
"In my case, it seems to be stress and having too much or too little sleep."
In common with 40 per cent of women who have migraine, her attacks were sometimes linked to her menstrual cycle, but they also struck at other times.
"It's basically the pain of it. Everything else you can put up with," says Ms Lyons.
"It affects your work, when you ring in at 8 o'clock in the morning and say you're only going to bed now because you have been up all night with a migraine.
"It affects your social life: you can plan a night out with your friends but you know you might get a migraine and have to stay at home. My friends would know by looking that I have a migraine because I go pale and I have fluctuations in temperature and I am usually puffy around the eyes."
At the age of 25, Ms Lyons contacted the Migraine Association of Ireland, established 10 years ago by Audrey Craven.
The association recommended that she attend the migraine clinic at Beaumont Hospital, headed by neurologist Dr Orla Hardiman.
Up to then, she had taken medication at the time of the migraine (acute therapy), but doctors at the clinic prescribed a preventative migraine drug: a beta-blocker sometimes used to control blood pressure.
"I take one tablet every day and I haven't had a migraine since," says Ms Lyons.
"I would still consider that I suffer from the condition though, and I still have to be careful about stress."
Not everybody has such luck, Ms Lyons says. What works for one person might not work for another.
Nevertheless, improved diagnosis of recurrent headache disorders and the development of specific anti-migraine drugs over the past 10 years have helped thousands of migraine sufferers, according to Dr Eddie O'Sullivan, director of the migraine clinic at Cork University Hospital and medical adviser to the Migraine Association.
Triptans, effective in up to 80 per cent of cases, represent a significant advance in the treatment of acute attacks, Dr O'Sullivan says, while in recent years, more preventative types of treatment have come on the market. Further advances are expected in the next decade.
After about nine months, if the preventative drugs have been successful, the dosage is usually cut. Eventually the patient will go back to managing their migraine by using acute treatment rather than a daily tablet.
Self-help approaches to controlling migraine attacks are also encouraged by the Migraine Association of Ireland and the Beaumont and Cork University Hospital clinics.
"Only 30-40 per cent of people can identify a trigger. That's why we get patients to keep diaries. If they can spot something, they can eliminate it," says Dr O'Sullivan. "But for many patients it can be a frustrating exercise because they may have low susceptibility to several things."
Hormones, stressful events, irregular meals, interrupted sleep and alcohol are the "big five" migraine triggers that Esther Tomkins, specialist migraine nurse at the Beaumont clinic, sees in patients.
Most people who go to the clinic go on a course of preventative drugs, having tried all other options on their own or through their GP. The diaries help medical staff monitor how effective these drugs are.
Patients come back to the clinic every three to four months. In between times, they can contact Ms Tomkins if they have any concerns.
"Maybe someone is trying to conceive and they don't want to take the preventative drug treatments, so I would talk to them about complementary medicine," she says. "Or sometimes they want to talk about the side effects of the drugs."
Meanwhile, the Migraine Association of Ireland is also there to give information, campaign for an increase in services (such as a clinic in Galway) and raise awareness.
There are many myths about migraine that the group wants to explode, such as "there's nothing I can do about my migraine", "migraine only affects women" (it is, however, three times more common in women than in men), "migraine is just a headache" and the damaging idea that "migraine is all in your head" - a psychological rather than a biological, neurological condition.
People are becoming more understanding, says Ms Lyons. "Years ago, people used to say 'oh you've got a headache', but it's not just a headache. And people can think you are making it up because migraine is not something you can quantify, it's not like walking around with a cast on your arm," she says.
"At work, I have a very understanding manager, but people I have met with migraine have had trouble.
"They say their boss doesn't believe them and because their boss doesn't believe them, they are under even more stress."
Migraine Association of Ireland helpline: 1850 200 378.