All about Migraine

It is more than a headache. It is called migraine

Suffering from migraineThe history of headache dates back to the beginning of time. The first, classical description of headache appears in the earliest writings dated to the third millennium BC.

Migraine, the more common type of headache, finds mention in the Bible. Migraine affects about 60-80 per cent of the population at any time and many famous personalities - Julius Caesar, Napoleon, Vincent van Gogh, Karl Marx, George Bernard Shaw, Sigmund Freud, Elvis Presley, Elizabeth Taylor, and others - were known to have suffered from migraine.

Migraine is three times more common in women. This may be due to hormonal influences; also, four out of five have a family history of migraine. While migraine can occur in childhood, it is more common in your twenties or thirties.

An attack of migraine can be more than just a headache. It may be preceded or accompanied by certain neurological phenomena: nausea and vomiting. Just how all these occur as part of one problem is as yet unclear, although it is known to involve both the blood vessels and the nervous system.

Triggers

Many possible triggers have been implicated in the causation of migraine. Migraneurs often blame stress, over-illumination or glare, alcohol, too much or too little sleep and weather for their headaches. While some women experience migraines in conjunction with monthly menstrual cycles, too much of caffeine, monosodium glutamate [MSG], aspartame, aged cheese, high carbohydrate meals [processed and refined grains, and sweets], chocolate, processed and canned meat and fish, citrus fruits and vegetables, like onion, have all been blamed for migraine.

Intense physical activity and stress at work or home can instigate migraine and hard work followed by relaxation may lead to migraine at the weekend. Bright lights and sun glare are also known to trigger head pain. Unusual, unpleasant and strong odours such as perfume, flowers, paint thinner and smoke can also induce headache. Migraine can just as well occur without any such "trigger." Keeping a "headache diary" may, therefore, help you to identify such correlations, and avoid them.

Managing migraine

Management of migraine is three-pronged - avoiding the triggers, treating the acute attack and, if necessary, using medications to prevent such attacks from recurring. As soon as the headache starts, a pain-killer can be tried. Those who get severe attacks can try new drugs like triptans. Ergot preparations, effective and widely used before, to treat acute attacks, have lost favour in recent times. Sleep, even for a short while, helps. Many migraineurs try their own method - a cold or hot head shower, tying a warm or moist cloth on the head, resting in a dark, silent room etc., Many resort to sipping a cup of coffee; but, too much caffeine and its withdrawal itself may trigger migraine. What's more, caffeine may postpone sleep.

Taking pain-killers far too often can also have adverse effects and even cause frequent headaches due to rebound. Instead, it is better to start drugs that prevent the attacks.

To prevent migraine, one has to carefully avoid the triggers -

  • Stay away from refined, processed and packed food [look carefully for additives like MSG], sweets, chocolates, junk-food etc.,
  • Avoid bright sunshine; use an umbrella for protection
  • Adequate sleep and regular exercise are a must
  • Smokers may be advised to kick the habit and women taking birth control pills, or hormone replacement therapy, may have to reconsider in consultation with their doctors
  • Muscle relaxation techniques, meditation and yoga may benefit some. Relaxation for at least half-hour each day and listening to music, gardening or reading may also be useful.

Dr David Buchholz, a neurologist at Johns Hopkins Hospital, US, feels that food, sleep and exercise, hold the key to prevent migraine. Dietary triggers are both prevalent and potent and may remain unrecognised. Getting enough sleep [eight hours on a regular basis] and exercise for at least 30 minutes a day could help in preventing attacks, he says.

If nothing works and one has migraine attacks twice, or more often, in a week, preventative medications may be needed. Many drugs like propranolol, verapamil, amitriptyline, flunarazine, sodium valproate etc., have been effectively used. Preventative medication has to be taken on a daily basis, usually for a few weeks, before their effectiveness can be determined. You may also need to use them for months, or years.

In certain cases, headaches need to be investigated. Change in the pattern or severity of headache indicate evaluation. An abrupt, severe headache like a thunderclap, headache with fever, rash, mental confusion, seizures, double vision, or other deficits, or a chronic headache that is worse after coughing, exertion, straining or sudden movement and/or a new headache that starts after the age of 55, should also prompt evaluation.

Living with migraines is a challenge. These headaches are unpredictable, incapacitating and may interfere with your job, relationships with family and friends.

Although newer treatments offer better options for pain management, migraine headaches may not be completely controlled. Put simply, judicious use of medications, regular exercise, relaxation, adequate rest and sleep and avoiding known triggers, as well as junk-food, hold the key to effective control of migraine.

Agony All the Way

Each one suffers his/her migraine in a unique way. Most often, migraine begins as a dull ache and develops into a constant, throbbing and pulsating pain, usually at the temples, or front, or back of the head, on one side or either sides. Often the pain is accompanied by nausea and vomiting, and sensitivity to light, noise and physical activity.

The two most prevalent types are migraine with aura [formerly called the classic migraine] and migraine without aura [the common migraine]. About one-third of migraine sufferers experience an aura prior to the headache. The aura precedes the headache by 5-30 minutes and may occur as wavy or jagged lines, dots or flashing lights, tunnel vision, or blind spots in one, or both eyes. The aura may also take the form of hearing hallucinations, disruptions in smell [such as strange odours]. These events usually fade as the headache begins. Some may have a premonition [prodrome] — in the form of mood changes, cravings for sweets, or thirst.

The migraine headache can last from a few hours to days in very severe cases. It can begin at any time of the day or night, but with sleep, the headache usually aborts or lessens. Sometimes, a sufferer may wake up with headache, but a migraine will rarely awaken a person from sleep. The frequency of attacks can also vary from one or two a year, to one every few days. In rare instances, there may be a temporary motor paralysis and/or sensory disturbances on one side of the body followed by the headache. This is called hemiplegic migraine.

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Srinivas Bevinje
Srinivas Kakkilaya Bevinje, MD, is a Mangalore-based consultant physician. His areas of interest include metabolic medicine, infectious diseases, and community health.

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