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'Migraine is the most common cause of head pain but because of prevailing myths and misunderstandings, migraine is often diagnosed as everything else except migraine!' |
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What is migraine?
Migraine is the most common of primary headaches that can often be quite debilitating and can devastate lives of chronic sufferers. Yet, migraine sufferers often do not get the sympathy and understanding they need. Unlike a fracture or a sprain, there is little physical evidence of a headache and because there is no neurological deficit, and because they often look well, and recover completely once the attack is over, migraineurs are not taken seriously. In fact, one of our migraine patients jokingly remarked, 'I wish I could move around on a wheel chair, so that people would believe that I am sick!'
Approximately, one in ten people suffer from this disorder. Most sufferers have their first attack between their early teens and the age of forty. Children are also susceptible to migraine, though often they do not suffer in the same manner as adults. Until puberty, migraine is about equally common among boys and girls. After puberty, it becomes almost three times more common among females.
And for those of you who think migraine is a product of modern times, please note that migraine is mentioned in the oldest medical manuscript found in a 3200-year-old tomb in Egypt. Throughout history Julius Caesar, Rudyard Kipling, Thomas Jefferson, Charles Darwin, Leo Tolstoy, Sigmund Freud, George Bernard Shaw, Richard Wagner and Lewis Carroll were some famous people who suffered from migraine. So, if you are sad because of your migraines, do not despair, you are in exalted company! |
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How does one recognise migraine?
A typical episode of migraine is generally a gradual build-up of a severe throbbing headache starting on one side of the head and later becoming generalized. The headache recurs at varying intervals and is often accompanied by nausea or vomiting. There may be hypersensitivity to light and sound.
Migraine attacks follow predictable phases. There is the prodromal phase, followed by the headache phase, where the head pain is accompanied by other symptoms like nausea, vomiting, light and sound hypersensitivity; and finally the resolution phase - all this can last for anywhere between 4 - 72 hours. Attacks tend to vary in their severity and |
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| presentation in the same individual, as well as from individual to individual. |
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80%of migraineurs have what is called ‘Common Migraine’ or ‘Migraine without aura’. The less common type is called ‘Classic Migraine’ or ‘Migraine with aura’. Here the neurological aura, or accompaniment, may last from a few minutes up to an hour and can take the form of disturbed vision |
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or speech, or sensations like numbness or 'pins and needles' in the limbs. There are other varieties of migraine which, however, are seen rarely.
Headache Specialists have noticed that some people, who begin with occasional attacks of typical migraine, eventually go on to experience milder, but more frequent, headaches that occur on a daily basis. This condition, which, in some cases, appears to be a natural progression of the disorder and which, in some cases can occur due to overconsumption of painkillers that contain caffeine or codeine, or due to depression, is now called "Chronic Migraine". This condition cannot be managed with self-treatment and will definitely need expert medical help.
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Why does migraine occur?
Migraine is a due to a vulnerability of the brain caused by an electrical and chemical instability of certain key brain centers that regulate blood vessels around the head and neck and controls the flow of pain messages into the brain. This proneness or susceptibility to migraine is largely hereditary.
There are many factors that can trigger off this instability such as
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Those related to your body - like stress, sleep, food, schedule changes, hormonal factors.
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Those related to the environment - like pollution, odour(s), noise(s), sunlight, light(s), weather changes.
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Those related to food - like alcohol, cheese, processed meats, certain Indian foods, monosodium glutamate (found in Chinese food), citrus fruits, chocolate, caffeine-overuse/withdrawal.
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What is done for the patient at our Headache Clinic?
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A detailed patient history is taken to arrive at the right diagnosis as to the cause of the headache.
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Following a detailed general and neurological examination, additional investigations are done, if required to rule out a serious cause of the headache.
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Appropriate pharmacotherapy falls into two main categories - Acute treatment & Preventive treatment.
Medication that is taken only when you have an attack is referred to as acute, abortive, symptomatic or rescue medication. Patients should take pain medications, as recommended, only when necessary.
Patients with frequent migraine attacks or attacks that are long or severe may be candidates for preventive medications, also called prophylactic medications. Preventive medications are taken on a regular daily schedule in order to reduce the frequency of migraine attacks.
It is important for patients to follow the physician’s instructions carefully in order to receive full benefit from these medications.
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A Non-Pharmacological Approach like Yoga or Biofeedback Training also helps in reducing headaches.
Based on various myths and misunderstandings, there are many unconventional and debatable treatment options some of which have worked at some time or the other. |
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What more can you do to deal with your migraine headache?
Some self-help measures that will be useful are : |
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Chronobiological Control : Migraine sufferers may benefit merely through the simple maintenance of a regular daily routine, with regularly scheduled meals, bedtime and awakening times.
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Trigger Control : Dealing with the triggers which are within your control.
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Keeping A Headache Diary : Keep a diary and record each attack.
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Consulting Your Doctor : It is very important that you see your doctor to confirm the diagnosis of migraine, as there are some headaches that can mimic migraine.
- Proper Compliance and Regular Follow-up.
- Avoiding self-medication.
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'And finally you need to remember that
Treatment of migraine is much more than just a Prescription!' |
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| The cartoons used in this site are the copyright of Dr. K. Ravishankar. |
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