All you need to know about migraine headaches
What is migraine?
Migraine is a common type of headache that results in pain in one or both sides of the head. It usually lasts between 2 – 6 hours and can be moderate to severe in intensity. Sometimes migraine headaches can last for days.
How do migraine headaches typically occur?
Migraine can affect anyone at any age. It is more common in ladies between 15 – 45 years of age. It affects about 15% of the population. Most people with migraine will have a familial history of migraine.
Some people may get an ‘aura’ – a symptom suggesting the headache is going to come. The headache is unilateral in about 60% of patients. It is pulsatile in nature and may be associated with nausea and vomiting. Most people with migraine will have increased sensitivity to light (photophobia) and sound (photophobia). So, migraine suffers usually prefer a quiet, dark room during the headache. Physical activity may increase pain.
What factors can trigger migraine attack?
A lot of trivial factors can trigger a migraine attack and avoidance of these migraine triggers can improve quality of life.
a) Life style triggers: Inadequate sleep and skipping meals are common migraine triggers. People susceptible to migraine have to stick to a standard time for sleep and require minimum of 6 – 8 hours of sleep every day. Skipping or delay in meals can trigger migraine attacks.
b) Food triggers: Common food articles like cheese, chocolate, excessive coffee or tea, aerated drinks, alcohol, tyramine, processed food, etc can trigger migraine attacks. Careful observation and avoidance of these food articles can improve quality of life.
c) Environmental triggers: Sometimes, loud noises, flashy lights can trigger migraine. Excessive smell, smoking etc are triggers. Physical and emotional stress can trigger as well. Menstrual cycle fluctuation and intake of oral contraceptive pills can sometimes increase migraine attacks.
If migraine sufferers can carefully identity these migraine triggers in their life style and avoid them, it can improve quality of life and reduce number and intensity of attacks.
How to confirm migraine diagnosis?
Kindly consult your physician to confirm your diagnosis. He may listen to your clinical history, perform a neurological examination and request for CT/ MRI scans, as per requirement. Similar clinical conditions like cluster headaches, tension headaches, headache due to sinusitis / refractory errors are to be ruled out. Usually in classic migraine, CT/ MRI and blood tests are normal and it is a clinical diagnosis made by your physician.
How to treat migraine?
Self-medication with over the counter pain killers like NSAIDS is not a good idea. Long term intake of NSAIDS like diclofenac, ibubrufen and high dose aspirin can cause gastro intestinal, renal and cardio vascular side effects.
Your physician may prescribe medication for migraine prophylaxis like propranolol, valproic acid, topiramate and amitriptyline. These drugs reduce the frequency and intensity of migraine attacks. They need to be taken on a long term basis. Medications to abort a migraine attack like sumatriptan, rizatriptan may also be prescribed.
What are the latest advances in treating migraine?
Recently Botulinum (Botox) injections have been approved by US FDA for treatment of chronic migraine. This provides excellent relief from headache for patient with severe debilitating headaches. Botox injections are safe procedures done in pain clinics by pain physicians, but may need to be repeated. Bio feedback and neurostimulators are also being tried in select patients.
What is the long term prognosis in migraine sufferers?
With life style modifications and migraine trigger avoidance alone, significant improvement in quality of life can be achieved. Generally migraine symptoms lesson with age. Relaxation techniques, regular exercises, more socially active lifestyle, positive outlook, yoga, meditation helps in migraine sufferers.
When should you attend to headaches on an urgent basis?
See your physician immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:
- An abrupt, severe headache like a thunderclap
- Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- Headache after a head injury, especially if the headache gets worse
- A chronic headache that is worse after coughing, exertion, straining or a sudden movement
- New headache pain if you’re older than 50
Dr Karthic Babu Natarajan, MD, DNB, FIPP (USA),
Consultant Pain Physician, Apollo Hospitals, Chennai.
Dr Karthic Babu Natarajan is a consultant pain physician at Apollo Hospitals. He is a Fellow in Interventional Pain Practice (FIPP) awarded by the World Institute of Pain, Texas Tech University, USA. He is the Honorary Secretary of World Institute of Pain, India and a faculty in Daradia Pain School, Kolkata.
Dr Natarajan, a gold medalist during his MBBS, has completed MD from Kasturba Medical College, Manipal Academy of Higher Education and went on to complete his Diplomate of National Board in Anesthesiology.
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