Headache service

Migraine and headache are very common among young people. In fact, almost three-quarters of young people in the UK experience headaches and some will have migraine or other types of severe headache conditions.

Listening to you describe your headache helps us to work out the type that you have. There are various types of headache conditions – some of the most commonly diagnosed are:

• Migraine without aura (common migraine)
• Migraine with aura
• Tension type headache
• New Daily Persistent Headache
• Cluster Headache
• Medication overuse headache

For many of these, separate information sheets are available from the Great Ormond Street Hospital Children (GOSH) website, by browsing the Headache Service page. Additionally, more information can be found on the Migraine Trust website.

Managing headache involves a combination of approaches – it starts with getting the right diagnosis and learning about your condition. Then it’s about making some lifestyle changes, like getting enough sleep, staying active with regular exercise and activities, and having support both at home and in school. Psychological help can also be really important. Plus, figuring out what triggers your headaches and how to avoid them, along with taking the right medication, all play a big role in helping to keep your headaches under control.

There are two types of medicine:

• reliever – these medicines are used during or at the beginning of a headache.
• preventive – these medicines are taken every day to prevent headaches from occurring

There are several different types of treatments and interventions that can help you manage your headache symptoms. By identifying your known triggers, you can then actively try and avoid those triggers. Some young people can easily identify triggers for their migraine, such as stress, not drinking enough water, tiredness or pushing yourself too hard.

Caffeine and alcohol

These are two known triggers that can cause migraine. It is important to be honest with your migraine team to help to establish any migraine causes. Drinks with caffeine, such as coffee and energy drinks are not recommended for headache sufferers generally.

Dehydration

This is a big trigger for migraine. That’s why it’s important to drink water regularly to stay well hydrated as this can help prevent migraines.

Eating 

Eating regularly and having a well-balanced is known to be an important factor in avoiding migraine. There is no current research to link any other foods (including chocolate and cheese) or any non-caffeinated drinks with migraine but eating everything in moderation is encouraged to prevent attacks.

Routine 

The migraine brain needs thrives on routine, so changes in routine can often trigger a migraine. This would include getting up out of bed later than usual or going to bed particularly late. Participating in a lot of exercise one day and nothing the next will upset your routine and may cause more migraine attacks.

Chronic pain reduces stamina and can cause you to feel very tired. On a ‘good day’ when you feel better, you might push yourself (or be pushed) to do more than they usually would. But this can then result in a severe, migraine attack, once you get home and start to relax again.

School, college or work 

Migraine and headache conditions should not create a barrier to education, college, university, or work. However, if your headache condition impacts on your ability to function fully, at all times, then you should be honest about this. This way you can avoid unrealistic expectations being set and get the support you need to succeed.

Tell your place of education or work about your headache condition and the potential for it impacting on occasion. If they have little knowledge about the condition, then educate them and explain the kind of support that you will need.

Speak to the Migraine Trust Advocate if you require additional support.

Social life 

Making and managing friendships is an important part of every young person’s life. This is no different if you have headaches and migraines. In fact, making and keeping supportive friendships may be even more important for when you are feeling unwell. Friends can help you to stay involved with activities and school, to stay positive and can provide you with support if things feel tough.

Finding a balance between doing too much or too little socialising is important for many young people. When you have headaches or migraines, you may need to find creative ways to stay in contact with your friends.

Alcohol 

Although the legal age for consuming alcohol in the United Kingdom is 18 years, we recognise that you may be tempted, or be allowed by parents, to try alcohol earlier than this. Research tells us that alcoholic drinks are a clear trigger for headache and migraines for those with a known underlying headache condition.

Also, your recovery from alcohol consumption is likely to take longer than your family and friends who do not have a headache condition and you are likely to suffer with a bad head the day after an evening that involved drinking alcohol. You can try to address this a bit, by drinking good quantities of water between alcoholic drinks and remembering to take any prescribed headache medication.

Smoking or nicotine vapes

The recommendation for all is to never start smoking or vaping. It is an addictive habit with only negative health implications, including an increased risk of heart disease, lung cancer and blood clots.

We know that nicotine, the addictive chemical in cigarettes/ vapes, causes the blood vessels in the body to narrow, reducing blood flow to the brain, which can trigger a migraine.

Drugs 

We strongly advise you to avoid any illegal drugs or legal highs. These drugs are incredibly unpredictable, and all are potentially detrimental to both physical and emotional health. It is acknowledged that many of the legal highs have very similar effects on the body to illegal drugs.

Relationships

Your headache condition should not prevent you from having a full and fulfilling relationship. It is important to speak to your partner about your condition, so that they can provide support and understanding.

It is important that you recognise how your headache condition affects you, so that you can prepare a partner. During a headache episode you may withdraw, have a mood change and struggle to communicate for example. If you explain these things early on, then problems are less likely to arise when a bad attack occurs.

Contraception 

We know from studies that the hormones in contraceptive methods can trigger headache and migraine for some females, supporting the theory that migraines can be hormone sensitive.

Therefore, when considering your family planning method, it may be worth trialling something that can be stopped quickly first, like the contraceptive pill; rather than the longer acting options, such as the injection, which once administered will have an irreversible effect for 12 weeks. Alternative methods, such as barrier methods (for example condoms) can be useful for those who find hormonal contraception unsuitable.

Some women will find that their headache condition will improve when they take a contraceptive and the newer forms with lower levels of hormones are recommended.

The combined oral contraceptive pill is not recommended for females who have a diagnosis of migraine with aura, due to an increased risk of stroke for this group. Progesterone only contraceptive options are generally a good alternative.

Pregnancy 

If you are planning on trying for a baby, or find yourself pregnant, then discuss this with your headache doctor, who can advise about the medication that you are taking, possible effects and non-medical alternatives. Due to the hormonal link with headache and migraine, headaches can be better, or more rarely, worse during pregnancy.

We usually find as you get older there is a natural improvement in migraines. This is why we won’t usually start discussing transition until around 16 years old.

We will encourage you to take a more active role in your own headache management, as transition draws closer, because the adult teams will expect you to lead on your care, rather than your parents or carers.

Here are a few examples of how you can start preparing for adult services:

• Take responsibility – learn about your condition, which medications are you taking and what your treatment options are
• Ask and answer questions about your health and treatment yourself
• You are welcome to speak to the specialist nurse or doctor by yourself. For example, you can attend the first half of your appointment alone and be joined by your parents for the second half to increase your confidence in talking to health professionals.
• Keep track of your own appointments
• Contacting the specialist nurse team independently
• Making decisions for yourself, for example the pros and cons of medications, lifestyle and functioning

Depending on your geographical location, diagnosis, and current needs we will discuss where we feel will be best suited for you to continue your adult care. This maybe at a GP, adult neurologists, or a specialist adult headache service.

To look for migraine services available in your area.

If you meet the criteria, you may be offered to transition through our joint clinic run with King’s Health Partners. The clinic is run at Guy’s Hospital, London and is joined by the GOSH nursing team alongside an adult consultant Neurologist, Dr Diana Wei. This helps to facilitate care for patients wishing for their adult care to continue at King’s College Hospital, Guys and St Thomas’.