MIGRAINE: More Than Just A Headache
A typical migraine headache is unilateral, of gradual onset, throbbing, moderate to marked in severity and aggravated by movement and lasts 4-72 hrs in adults. However, 40% of patients can have bilateral headaches.
Symptoms of anorexia, nausea (in almost 90% of migraine patients), vomiting (occurs in 1/3rd of migraine patients), sensitivity to light and sound are common. According to IHS, Migraine constitutes16% of primary headaches and affects 18% of women and 6% of men. Prevalence varies with age, highest between 20-40yrs. WHO ranks a migraine among world’s most disabling medical illnesses.
A migraine is not uncommon in children. Estimates indicate that 3.5–5% of all children will experience recurrent headaches consistent with a migraine. Children typically have bifrontal, bitemporal, or retro-orbital headache of shorter duration than in adults; nausea; abdominal cramping; vomiting; photophobia; phonophobia and a need to sleep.·
In about 20% of migraine patients, headache is preceded or accompanied by warning symptoms known as aura. Visual aura, such as seeing various shapes, bright spots or flashes of light are most common. Other aura symptoms can include vision loss, pins and needles sensations in an arm or leg, weakness or numbness in the face or one side of the body, difficulty speaking or hearing noises or music.
A number of factors may trigger migraines, including:
- Hormonal changes in women. Fluctuations in estrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in estrogen.Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines.
- Foods. Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
- Food additives. The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.
- Drinks. Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.·
- Stress. Stress at work or home can cause migraines.
- Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds.
- Strong smells, including perfume, paint thinner, second-hand smoke can trigger migraines in some people.
- Changes in the wake-sleep pattern. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
- Physical factors. Intense physical exertion, including sexual activity, may provoke migraines.
- Changes in the environment. A change of weather or barometric pressure can prompt a migraine.
When to see a Neurologist?
Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.
See your doctor immediately if you have any of the following signs and symptoms, which may indicate a more serious medical problem:
- An abrupt, severe headache like a thunderclap
- A headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
- A headache after a head injury, especially if a 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
- A positional Headache: a headache that substantially changes in intensity in association with changes in position – e.g. standing from lying
- Substantial Change in Headache Pattern: a significant increase in headache frequency or significant change in headache characteristics.
- Migraine treatment involves acute(abortive) and preventive (prophylactic) therapy. Patients with frequent attacks usually require both. Measures directed toward reducing migraine triggers are also generally advisable.
- Acute treatment aims to reverse, or at least stop, the progression of a headache that has started. Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient's quality of life. An overview of migraine treatment is shown in the image below.
Role of Headache clinic
Headache clinic is the most effective way of providing comprehensive evaluation and treatment of migraine patients. A team of neurologist, neuro-ophthalmologist, psychiatrist and neurosurgeon as per the need of the patient, evaluates and provides a comprehensive treatment plan along with lifestyle management advice.