Dr. Martin Rutledge
Consultant Neurologist, Beaumont Hospital
Migraine is a complex neurological disorder which is underrated by many. It is the most common primary headache disorder presenting to doctors and the more chronic forms can be very disabling.
There are approximately one million migraine sufferers in Ireland, some having a couple of migraine attacks every decade and others experiencing multiple attacks each week. The peak migraine prevalence for women is between ages 15-49. The lifetime prevalence is 42% in females1 . From a monetary perspective, it directly costs the Irish economy at least €252 million per year2. Migraine is therefore a cause of significant societal burden, both medically and financially. Unfortunately, it is often misdiagnosed, underdiagnosed and undertreated.” says Dr Martin Ruttledge, Consultant Neurologist at Beaumont Hospital. This is not just in Ireland, but it is a worldwide problem.
Dr Ruttledge, Dr Mary Kearney and Ms Esther Tomkins co-authored The ICGP Migraine Quick Reference Guide (QRG) in 2019, a “teaching manual” developed to help primary care doctors and other community Health Care Professionals (HCP) to better understand migraine, and to facilitate better diagnosis and management in primary care.
Keeping a diary of symptoms
Some patients can experience relatively few migraine attacks throughout their life, while the average patient can experience one to two attacks per month. In addition, approximately 10% of all patients suffer weekly attacks. The authors of the above ICGP document recommend that patients should keep a headache diary, documenting frequency of attacks and medication taken.
There are approximately one million migraine sufferers in Ireland.
The diary should also document associated symptoms, duration and severity of each attack, together with possible trigger factors such as female hormone fluctuations, weather or skipping meals. The authors suggest that when a patient visits their GP with recurring headaches, they should be advised to keep a detailed headache diary. This usually provides very useful clinical information and can help confirm the diagnosis.
Dr Ruttledge concludes: “It’s all about just sitting and talking to the patients, taking their medical history and explaining the condition in straightforward language.” However, it takes time and investment to develop Headache Specialists. More training for doctors and specialist headache nurses is a must for Ireland going forward.
 Frederick IO, Qiu C, Enquobahrie DA, Aurora SK, Peterlin BL, Gelaye B, et al. Lifetime prevalence and correlates of migraine among women in a pacific northwest pregnancy cohort study. Headache 2014 Apr; 54(4):675-685.
 Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z. Migraine is first cause of disability in under 50s: will health politicians now take notice? J Headache Pain 2018 Feb 21; 19(1):17-018-0846-2.