Easing the agony

'SOME of my patients just want to die quietly in the corner, it is the most severe pain they have ever experienced in their lives." This is how Dr Manuela Fontebasso described the effect of migraine on the patient she sees at the headache clinic she runs at York Hospital.

"They feel sick, they don't like bright lights or loud noises and they want the whole world to go away. They can't think straight, speak straight or do anything," she added.

As Dr Fontebasso clearly demonstrates, migraine is not just a bad headache.

Migraine is a condition of recurring headaches which may be linked with other symptoms such as sensitivity to light and noise, nausea, vomiting, dizziness and eyesight changes.

This is Migraine Awareness Week and this year the focus is on young sufferers. An estimated ten per cent of school age children are affected by migraine with the first symptoms appearing at as young as four years of age.

Although the symptoms of migraine are basically the same in adults and children, sickness may by the major part of the child's attack rather than the headaches. This can make migraine harder to recognise in young people.

One North Yorkshire mother, who like her husband suffers from migraine, was upset to discover that their son developed the condition at the age of six.

The 30-year-old Harrogate woman, who preferred not to be named, said: "People think that it's just a headache, but it's not.

"You can't just carry on with life when you have a migraine. You've just got to stop, you can't function as a person, you just have to take yourself off. Each footstep on the floor feels like thunder going through your head.

"When you see your child suffering in the same way, it's just awful."

Her son, now aged nine, was given extensive tests by a headache specialist and now controls his condition by taking pain killers as soon as a headache threatens, by wearing tinted glasses and by ensuring he eats and drinks regularly.

His mother said: "We started working with the school and if a slight headache started they would give him some painkillers really quickly, which stopped it progressing.

"We had a few mishaps, where he didn't get the drugs in time.

"That's when he goes absolutely white in the face. Then the tears start and he would have to take the next day off school because he felt so bad.

"But most of the time it has worked really well.

"He also makes sure he eats regularly and he doesn't drink Coca Cola because it can trigger an attack.

"It was harder when he was younger to explain why he couldn't drink it, but now he knows that he will be in pain later so he tends to avoid it. He hasn't had a migraine since April."

Dr Fontebasso said she sees very few young children at her clinic in York, and she fears that many young sufferers may be missing out on treatment for the condition.

She said there are so many barriers in the way of young children getting help.

These include:

Parents' expectations of migraine treatment. If a parent has not managed to be treated for the condition they may not expect much help for their child

Many migraine drugs are only licensed for adults, with only some licensed for over 12s. Epilepsy drugs are now known to be effective in the treatment of migraine, but are not licensed for use in migraine

Problems with access to painkilling drugs, regular water and regular snacks in school

A child is often unable to describe their pain and migraine is sometimes difficult to diagnose.

Dr Fontebasso said: "It can be a long process finding out which mix of treatments works best for any individual.

"Some adults don't want to take medication, some parents don't want their child to take medication and what we have to do is break down the barriers to actively explain to them why we want them to use a certain drug and why it's in their best interest.

"But we have to give them realistic expectations. We can only expect to reduce the number and severity of attacks in some people, rather than stop them altogether."

Dr Fontebasso said she was pleased to see the new information pack being circulated around schools.

She said: "Anything that gets the message across is crucial.

"This pack allows children to express in ways they know what their headache is like.

"We have to target teachers, GPs, pharmacists, and get the message across to everybody.

"It's important to inform an individual and then empower that individual to go and seek the right advice."

According to the Migraine Trust the best way of managing migraine in children is to stop the attacks from happening.

Children are particularly likely to get migraines if their sleep pattern is disturbed by having too much sleep or not getting enough. Dehydration is a key cause of migraine, especially in children who are very active. Some children may have to seek permission to drink water during class.

The start of a migraine may trigger a craving for a certain kind of food. This can make it difficult to decide if the food eaten before an attack caused the migraine or if the attack was starting anyway.

Regular meals and snacks may help to reduce the number of attacks.

Sudden physical exercise can trigger a migraine, although regular exercise rather than avoiding it may help stop attacks.

Other triggers include bright lights, stressful situations, and other illnesses such as a cold or stomach bug.

Migraine - A Guide For Young Sufferers, sponsored by the Lloyds TSB Foundation, is available from The Migraine Trust on 020 7436 1336 or by visiting www.migrainetrust.org

Updated: 09:44 Monday, September 01, 2003