MIGRAINES

OVERVIEW

We have all referred to a headache as a migraine at one or the other time in our life, despite the fact that migraine is a particular kind of headache distinct from other types. It is less common than other types of headache, and the pain can be more severe and can last up to several hours to a few days at a time.

Migraine can disturb activities of daily living due to severe pain, and so help should be sought if you suspect you may have migraine. In susceptible patients, a migraine attack can be triggered by certain foods such as those with increased salt content such as cheese and processed foods, physical and mental stressors, hormonal changes in women, exposure to bright lights and loud sounds, and certain medications such as oral contraceptives.

 

PECULIAR FEATURES OF MIGRAINES:

Migraine headaches are usually associated with peculiar symptoms, which are aura, prodrome, the migraine attack itself, and then the post-drome. All of these stages have specific features which are listed below:

AURA: An aura is a warning symptom that may come on with or before the onset of a migraine headache. Auras preceding migraines usually include blind spots, flashes of light or zig-zag vision. Auras in migraines are usually visual, although in some patients they may include speech disturbances or movement abnormalities. Pins and needles in arms and legs may also be present occasionally.

PRODROME: One or two days before a migraine, you may notice subtle changes that warn of an upcoming migraine, including constipation, mood changes, food cravings, neck stiffness, increased thirst and urination and frequent yawning.

ATTACK: Migraines attacks can last up to a few days if untreated. They can be very painful, and cause severe limitations to daily activities. The kind of pain experienced during a migraine attack includes one sided pain in the head, throbbing or pulsing sensation, discomfort upon exposure to light or sounds, pain at the back of the eyes, blurring of vision, nausea, and altered taste.

POST-DROME: post-drome is the final stage which is experienced when the attack passes. Moodiness, decreased appetite, sensitivity to light and sound, and weakness are the hallmark features.

 

MANAGEMENT

Migraines can be diagnosed on the basis of a good history and physical examination, but sometimes severe migraines may be confused with serious conditions such as a bleed in the brain, and in such suspected circumstances it is of benefit to do a CT scan, MRI, and even a lumbar puncture (spinal tap) to rule out serious pathology. Blood tests may also be performed to make sure no underlying infection is present.

Treatment of migraines is by using medication to treat the current episode, as well as medication to prevent further episodes. Ibuprofen, paracetamol, and certain combination medicines with caffeine are all effective treatments for mild to moderate migraine attacks. Medicines for migraines should be used with caution, as overuse can cause other problems such as stomach ulcers, as well as cause overuse headaches. Anti-nausea medications can also be used to relieve other symptoms of discomfort.

If migraine attacks recur 4 or more times a month, pain relieving medication is not effective, or if individual attacks last more than 12 hours, patients can be started on preventive therapy, the commonest of which is Beta blockers, more widely used and famous for their role in heart disease. Antidepressants also play an important role in preventing migraines in susceptible patients.

Vitamin B-2, Magnesium, acupuncture and herbal teas have also been shown to reduce the occurrence of migraines.

 

 

 

 

Dr. Annie

Physician, mom and wife

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