We are discovering more, new ways to diagnose and treat migraine, but sometimes the pain outstrips our best efforts.

ON a bad day, Mary Smyth wishes everyone else could experience a migraine just once so they could understand the severity of the pain. Sometimes, when the pain moves into her face, she believes she would pull out each of her teeth if she could get her hands on a pair of pliers.

The 47-year-old migraine sufferer is one of an estimated 400,000 people in Ireland who face a daily struggle with this little-understood condition.

Medical advances mean diagnosis of migraine is now much clearer and, while the condition cannot be cured, new research is constantly delivering more efficient ways to manage the pain. Nonetheless, to the outside world, a migraine is still often seen as nothing more than a bad headache.

Clondalkin woman Mary has been living with this problem since the age of 15. Her mother, too, suffered from migraines but was never given a diagnosis. And while Mary takes a proactive approach to dealing with the situation, sometimes not even the strongest medication can stave off a severe migraine.

Disconnects

She explained: "It's like I get a stroke. It's almost like something disconnects from the brain, even my speech is affected. It's a throbbing pain, always on the left side and goes to the back of the head. It affects my vision and on occasions I wouldn't be physically able to see. I have to lie in a darkened room with ice packs."

Close attention to pain management means that Mary has been able to forge a successful career as a higher executive officer with the Revenue Commissioners. However, even the positioning of her desk in the office can trigger another attack.

If light bounces off a car outside and reflects off the window, Mary knows immediately she's in line for a serious headache. The cinema is a rare treat and she is unable to watch television in the dark.

Sometimes, when the migraine strikes overnight, she rises two to three hours before work and takes tablets to bring the pain down to a manageable level.

And despite the impact on her working and social life, Mary still considers herself lucky, since she doesn't suffer from nausea, one of the common sideeffects of migraines.

However, she is one of an increasing number of migraine sufferers who have developed Medication Over-use Headache (MOD), a problem which affects 170,000 people in Ireland.

MOD arises when over-the-counter medication is consistently used to dull the most severe pain. Used more than three times a week, over-the-counter medication can lead to sufferers developing longer-lasting pain.

Mary explained: "In my 20s, the migraine started to change and it became a chronic daily headache. This could be partly attributed to taking over-the-counter medication. I started off with one type of painkiller, and eventually that didn't help any more so I tried a different one.

"I got used to taking them but it was probably contributing to a chronic daily headache. At this point, I wouldn't know what it's like to be pain-free.

"Somewhere along the line, I became conscious of the fact that I was continually buying painkillers. I thought MOD didn't apply to me because I might just take two a day, every day, but that's enough to do the damage."

MOD will be the topic of discussion at the launch of European Migraine Action Day, which takes place in Dublin for the first time on Friday, September 12. The Migraine Association of Ireland will take the opportunity to launch its information leaflet on MOD, to increase awareness among those affected in Ireland.

Over the past 10 years, there have been a number of welcome developments which have led to clearer diagnoses, according to Esther Tomkins, clinical nurse specialist in headache and migraines at Beaumont Hospital.

Today, she says, migraines can be loosely divided into two different types.

"Migraine without aura is a unilateral, throbbing or pulsating headache, with sensitivity to light, sound or smells. It usually lasts between four and 72 hours," explains Esther.

"The migraine with aura is where people lose part of their vision, or they may see shapes which get bigger or smaller, or lines and flashing spots. They may also get pins and needles or a weakness in the arm, or sensations in the face and tongue."

Hormonal

She added: "Migraine is three times more common in women than in men. The numbers are equal among boys and girls in childhood, but once they reach adolescence, the hormonal trigger is huge for a lot of women."

Experts now know that the brain chemistry is affected during a migraine attack, and while the genetic condition usually improves after the age of 60, it can cause a lifetime of suffering.

With no known cure and sometimes not even strong enough medication to take the edge off the pain, management is the only key.

Red wine, chocolate and cheese are some of the most commonly named triggers, while skipped meals, stress or a lack of sleep can also have an impact.

Former Republic of Ireland soccer star Tony Cascarino is among those who live with the condition, as is Fair City actress Gemma Doorley. Days lost through migraine cost Irish businesses some €252m each year.

Thanks to pain management and flexible working hours, Mary Smyth has been able to concentrate on her career despite the condition.

However, she explains: "Because I can usually function, people assume that it's not a bad pain. Sometimes I'm okay with just a painkiller. Other times, if I don't go home and lie down for a few hours and take serious painkillers, it'll get really bad for about eight hours. After the pain lifts, it's like an out-of-body sensation. I feel so tired and have no energy."

Sufferers

Like many migraine sufferers, Mary has also to deal with secondary pain in her face, known as "facial migraine".

"I thought I'd heard of everything before then," she said. "It started last year, with pains in my cheekbones and jaw. I was referred to an orofacial pain specialist.

"I've discovered that the pain receptors in my brain are quite high. It's like the switch in my brain has decided it's played enough with my head and is moving the pain elsewhere! I'm now taking epilepsy medication to try and retrain the brain chemistry."

Even now, Mary never leaves the house without painkillers. She knows only too well how holidays and days out can be ruined by the onset of migraine and has become used to living with daily pain. But in spite of this, and the continuous planning she needs to live a normal life, she remains upbeat.

"Before I was diagnosed, sometimes I thought I was just going crazy. It was a relief to know that there was actually something wrong so I could begin to do something about it.

"I've always considered myself as being lucky, but if I could live most days without a headache in exchange for a few bad episodes each year, I'd be happy".

- Aoife Finneran