A 47-year-old company employee in Adachi Ward, Tokyo, began to suffer from painful migraines starting about 15 years ago.
About once every two months, his entire head would be hit by a throbbing pain that would make him feel like vomiting. The painkiller he was prescribed at a nearby clinic did not work, and he began taking over-the-counter medicine.
The medicine was effective for a while, but in the last few years the frequency of his headaches increased, and he began taking medicine nearly every day.
Sometimes the pain would continue for half a day and force him to leave work early. Last summer, he became concerned about abnormalities in his brain, but an examination revealed nothing unusual.
At that time, he learned of Fumihiko Sakai, a doctor who specializes in the treatment of migraines as the head of the Saitama International Headache Center at the Saitama Neuropsychiatric Institute in the city of Saitama, and went to be examined in November last year.
He was diagnosed with chronic migraine, which means having migraines for more than 15 days in a month. In addition to stress from work, the many medicines he was taking were blocking his body's ability to regulate pain.
The onset of migraines is thought to be related to the nuerotransmitter serotonin.
Lack of sleep, strong light, changes in hormones, or certain foods can stimulate the secretion of serotonin, expanding blood vessels and releasing chemicals that inflame the nervous system, causing migraines.
There are thought to be 8.4 million adults who suffer from migraines.
Sakai prescribed the triptan drug Relpax to the man, to take when migraines occur. Triptans have the effect of shrinking enlarged blood vessels and restraining the release of inflammatory chemicals.
Separately, Sakai prescribed an attack-prevention drug and an anti-inflammatory drug.
So the man wouldn't rely only on medicine, Sakai also instructed him to take a short walk when the pain was minor.
The treatment had an immediate effect, and the vomit-inducing migraines disappeared.
"In the past, I was really uneasy about what would happen to me, but this treatment course has given me hope that I will recover," the man said.
It has been 15 years since the approval of triptan drugs, which have a powerful effect at the onset of migraines.
According to a survey Sakai conducted in 1996 with about 4,000 men and women aged 15 or older nationwide, among people with migraine symptoms, only 31 per cent have received treatment at a medical institution, while 57 per cent used over-the-counter medicine.
Nineteen per cent of sufferers took no medicine at all. It is possible that this ratio has changed, but there are still many patients who use only over-the-counter medication.
Sakai said: "Both patients and doctors have a tendency to think of migraines as 'just a headache' and not a serious ailment. We need to raise awareness that this is something that can get better with treatment."
Children need support from school
It is not well known that children can also have migraines. According to pediatrician Mitsue Fujita at Tsukuba Gakuen Hospital in Tsukuba, Ibaraki Prefecture, who has been treating child migraines for nearly 30 years, the symptoms are not different from adults, and the prevalence among middle school students is 4.8 per cent, meaning that 1 or 2 students in most classes suffer from migraines.
However, it is widely believed that children do not get migraines, which means in most cases they do not receive the treatment they need.
Since he was in kindergarten, a now 13-year-old middle school boy in Tsukuba suffered from vomiting whenever he became nervous.
He received an intravenous drip infusion filled with dextrose and vomit suppressant, but the ailment did not improve, and he was occasionally hospitalised.
After he entered primary school, the vomiting stopped but was replaced by migraines.
Fujita diagnosed the boy with migraines, and prescribed him an attack-prevention drug. His mother, 42, also has migraines, and recalls, "I was shocked to hear that children had them, too."
She gave his homeroom teacher a letter asking that he be allowed to take his medicine and rest in the school infirmary when attacks occur. Because there were teachers at the school who also suffered from migraines, the request was granted, and he was able to rest during attacks in the school infirmary.
He takes his preventive drugs, and also the anti-inflammatory ibuprofen, which is recommended for children, to suppress symptoms when attacks occur.
"If a child with migraines goes to the school infirmary and doesn't have a fever, sometimes they are not allowed to lie down," Fujita said.
"It is important for people to understand that it takes a few hours lying down in a dark and quiet place for the pain to subside."
To reduce symptoms, it is also important to manage one's daily rhythm. Nowadays, children attend cram school and do other activities after school while also spending a lot of time watching TV, playing games and looking at their smartphones at home, so it is common for them to go to sleep late.
Fujita has her patients and their guardians fill out a migraine diary to write down things such as on which day attacks occur, how bad they are, what the patient was doing and how much sleep they got that day.
Based on what is written in the diary, Fujita instructs patients to go to bed earlier or advises them to take a break from their extracurricular activities. In some cases, this has reduced the frequency of migraines.
Puberty can sometimes cause psychological unrest that makes treatment difficult.
In the case of a child who was frequently absent from school due to complaints about migraines, a brain scan was conducted but found no abnormalities, and after preventive drugs and painkillers did not work, additional counseling revealed the cause to be stress at school.
With the understanding and co-operation of teachers and the child's guardians, the migraines were reduced, and the child was able to go to school again.
"With children, it is essential to consider not just the symptoms, but also their daily habits and relationships as well," Fujita said.