Migraine

migraine

Migraines are recurring headache that cause moderate to severe throbbing or pulsating pain. Usually the pain in migraine is unilateral i.e. only one side of the head. This can be associated with nausea, vomiting, weakness and sensitivity to light and sound. Migraine is often underdiagnosed and undertreated.

Migraine is seen in both males and females but females are three time more likely than man to have this problem. Headaches tend to affect boys more than girls during childhood, but by the time of puberty or beyond more girls are affected. Most of the migraine sufferers have family history of this disease. The  patient with migraine may also have other medical conditions like depression, epilepsy, sleep disturbances, bipolar disease and anxiety. Women may have migraine during menstrual periods.

Though migraine is mostly considered to have a genetic basis, the following conditions can also trigger this disease:

  • Anxiety
  • Stress
  • Hormonal changes in females.
  • Flashing light
  • Loud noise
  • Medicines
  • Inadequate sleep
  • Change in weather
  • Tobacco
  • Physical exertion
  • Caffeine or highly caffeinated drinks
  • Skipped meals
  • Alcohol especially wine
  • Chocolate
  • Fermented or prickled items
  • Yeast
  • Processed meat
  • Strong smell
  • Sexual activity
  • Oral contraceptives, nitroglycerin may aggravate migraine

Symptoms:

Warning symptoms (aura) of migraine may occur before or with headache. These are flashes of light, blind spots, tingling on one side off face or in arm or leg. The disease often begins in childhood, adolescence or early adulthood. There are 4 stages of migraine, however, all patients may not experience all 4 stages of the disease.

  1. Prodrome: Patient may feel few symptoms one or two days before upcoming migraine. This may include constipation, mood changes, food craving, neck stiffness, increased thirst and urination and frequent yawning.
  2. Aura: Most patient develop migraine without aura. It may be seen in few patients before or during headache as symptoms of nervous system. These are wavy or zigzag vision and flashes of light. There could be a touching sensation as someone is touching the person, muscular weakness, difficulty speaking, hearing noises or music and uncontrollable jerking. These symptoms lasts for 20-60 minutes          
  3. Attack: An attack of migraine lasts for 4-72 hours if untreated. The frequency of attack varies from rare to several times in a month. Patient experiences moderate to severe pain on one side or both sides of head, nausea, vomiting, blurred vision and light headedness that sometimes is followed by fainting. 
  4. Post-drome: This occurs after attack of migraine. Patient feels drained out, and exhausted. In next 24 hours there could be confusion, dizziness, weakness and sensitivity to light and sound.     

Diagnosis:

Migraine is essentially diagnosed by taking detailed  medical history. Doctors also do a physical and neurological examination. Doctor may ask to go for few blood tests, CT scan or MRI to exclude other medical conditions.  

Treatment:

There is no cure for migraine. Three approaches to treatment of migraine include avoidance of environmental triggers, drug treatment for acute pain and  prevention of migraine attacks. Drug treatment is required in most of the patients, but avoidance of triggers alone may be effective in few cases. General principles of drug treatment for migraine are as follows:

  1. Response rate to drug treatment varies between 50-70%
  2. Initial drug choice is individualized based on age, co-existing illness and side effect profile of the drugs.
  3. When acute attack requires additional medication 60 minutes after the first dose, then the initial drug dose should be increased or new class of drug can be given.
  4. Efficacy of drugs used for prevention of migraine may take several months to assess with each drug.
  5. Mild to moderate attacks of migraine sometimes respond to standard pain killers if take early

There are different types of medicines to relieve symptoms. They include triptan drugs, ergotamine, and pain relievers. The effect of these medicine is more pronounced if taken early.

Other remedies to help reduce the pain are resting eyes in a quiet dark room, placing cool packs on foreheads and drinking fluids.

Recently a device similar to headband with attached electrodes  (transcutaneous supraorbital nerve stimulation) is approved by FDA as a preventive therapy for migraine. These are certain class of medicines that are used for prevention of migraine like calcium channel blocker, beta-blockers, antidepressants, and anti-epileptics. There are specific drugs in each class that are used for prevention of migraine.  

Besides above, some lifestyle changes may prevent migraine viz. stress management, hormone therapy in women whose attacks are linked to menstrual cycle, losing weight may help in obese patients. Certain natural treatment such as Vitamin B2 (riboflavin) and Coenzyme Q10 may help prevent migraine.       

Contact your doctor immediately in case any of the following signs or symptoms appear:

  • An abrupt severe headache like thunderclap
  • Headache with fever, stiff neck, mental confusion, seizures, weakness, double vision or numbness
  • Headache after head injury
  • A headache that is worse after coughing, exertion, straining or sudden movement.
  • New headache pain if older than 50 years.  
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