Migraine Awareness week ended on 8th September, so I’m a bit late making my annual rant on the topic, but Dr Ann Robinson in The Guardian has made me cross.
The NICE guidelines which have been been in the news are for the Diagnosis and Management of Headaches in Young People and Adults. If my experience as a migraine sufferer is anything to go by, the guidelines are badly needed. However, the only aspect of them to catch the media’s attention has been the topic of painkiller overuse headaches. That’s not news, they’ve been known about for a long time, but we are still in the silly season so I suppose the media have to find something to print. However, I don’t understand what prevented the Guardian consulting an expert, rather than Dr Ann Robinson, their favourite GP stroke media pundit, who proceeded to give a perfect illustration of GP ignorance of migraine.
Robinson starts by making the assertion that the number of people with headaches is increasing. She attributes the increase to computer screens and (curiously) mobile phones, but admits that she has no data to support her statement. ”Solid evidence is hard to come by” she says. Well not really. Take the report of the All Party Parliamentary Group on Primary Headache Disorders for example, which quotes statistics showing that days off work because of headache disorders cause significant economic loss to the UK, but not that they are increasing. If they were increasing, surely they would have mentioned it? The computer screen/mobile phone hypothesis of headache causation appears to be all Dr Robinson’s own.
Next she says that many of her patients are taking handfuls of painkillers in an average week. Quite possibly, particularly if they have headache disorders that could be treated by other means, but that Dr Robinson is failing to diagnose.
So Robinson tells them to give up the painkillers and if the headaches don’t go away, then she wants to identify the underlying cause. That’s good, but unfortunately she goes on to demonstrate that she is incapable of accurate diagnosis:
A tension-type headache is the variety most of us would recognise. It can feel as if your head is in a vice, with pressure on both sides of the skull, especially at the temples. The whole scalp can feel sensitive, so even brushing your hair hurts, and you may feel sick and sensitive to light and noise. In the short term, a couple of paracetamol or ibuprofen may help, but the best advice is to move away from all screens, get some fresh air, have a non-caffeinated drink and, if you can, shut your eyes for a few minutes in a quiet place.
Wrong. Sensitivity to light and noise are typical symptoms of migraine, not tension headache. If Robinson had bothered to read the NICE guidelines, instead of skimming them for ways to blame her patients for their own illnesses, she would have come across a table which puts these symptoms clearly in the migraine column. I’m betting that up to now, she has been under-diagnosing migraine in her patients. Hopefully she will read the guidelines. Then she might not only make more accurate diagnoses, but also give less contradictory advice than getting some fresh air and shutting your eyes for a few minutes in a quiet place.
Robinson also seems to be unaware of the possible consequences of failure to diagnose migraine. She says: “Fewer than 1% of all headache sufferers referred to a neurologist will turn out to have a serious underlying cause”. I know what she means. Migraine will not kill you outright, unlike a brain tumour. But, sufferers are twice as likely to have a stroke as the rest of the population, and the risk is increased further for certain types of migraine. That alone makes diagnosis important, quite apart from the fact that once diagnosed, migraine can be treated far more effectively than with over-the-counter painkillers.