Migraine

What is Migraine?

We all get Headaches. But, if your headaches make negatively affect your work or school, then it might be time for you to visit a doctor. Not everyone experiencing sharp, throbbing or dull aching head pain (aka, headache) needs to see a doctor or use special medications. However, if headaches start to interfere with your daily activities and quality of life, then the cause of your headaches has to be sought.

• It usually interferes with one's ability to work and enjoy daily activities
• Migraine is a moderate to severe type of headache
• Potent, safe and effective treatments are available

What is the difference between Migraine and Headache?

Everyone can get a headache, but not every headache is a migraine. Unlike common headache, migraine pain tends to be moderate, severe or very severe. The migraine pain attack can last for a few days, and each attack is usually preceded by alarming symptoms (aura). Migraine pain is defined as being 'throbbing', and usually involves just one side of the head. The highest incidence of migraine attacks occurs in the middle age group patients between 35 and 45 years old. Migraine tends to target mainly young, healthy females in their reproductive years. Statics show that migraine affects females nearly three folds more than males, that about 40% of women are under time-life risk of getting a migraine (compared to only 18% of men), and that around 1 in 6 individuals around the world has a migraine.

Causes and Risk factors for Migraine

There are no definitive causes of migraine. Migraine is attributed to the presence of multiple causes and triggers (genetics, environmental, psychological, dietary), rather than a single factor.

Genetics: Studies of migraine incidence show that if one of two twins suffers from migraine, the other has a risk ranging from 30% to 50% for developing a migraine. This suggests that genetic factors play a role in the initiation or worsening of the disease, as twins have the same exact genes. In the same way, if you have a family history for migraine, then you are at increased risk.

Psychological triggers: Attacks of a sharp headache for people with migraine may increase significantly if the patient is subjected to stress, hunger, or fatigue. However, this varies from one patient to another.

Dietary trigger for Migraine: The direct dietary trigger for your migraine can be difficult to identify. However, the common dietary triggers include caffeine, chocolate, aged cheese and meats, spicy foods, alcohol, MSG, citrus fruits, and foods/drinks containing aspartame.

How to diagnose Migraine?

Migraine is diagnosed mainly by history and symptoms, as migraine headache usually occurs with no clear underlying cause. Blood tests, CT, MRI, or lumbar puncture may be recommended by your doctor to detect any suspected abnormality that worsens the headache, like infection, tumours, or bleeding in the brain. Your doctors look for the frequency of the attacks, whether they are preceded with aura or not, pain intensity, presence or absences of pulsating pain, nausea, vomiting, and sensitivity to lights or sounds.

Treatments

There's no cure for migraines, but a number of treatments are available to help reduce the symptoms these include:

• Painkillers – including over-the-counter medicines like paracetamol and ibuprofen
• Triptans – medicines that can help reverse the changes in the brain that may cause migraines
• Anti-emetics – medicines often used to help relieve people's feeling of sickness (nausea) or being sick
• During an attack, many people find that sleeping or lying in a darkened room can also help.

Preventing migraines

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines.

It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you have tried avoiding possible triggers and are still experiencing symptoms, a GP may prescribe medicines to help prevent further attacks.

Medicines used to prevent migraines include the anti-seizure medicine Topiramate and a medicine called propranolol that's usually used to treat high blood pressure. 

It may take several weeks before your migraine symptoms begin to improve.

The Symptoms of Migraine

The main symptom of migraine is a severe headache that gets worse if you try to carry out your normal activities, including work.  Typical migraine headache is unilateral, meaning you only feel the pain on one side of your head. However, a migraine headache can also affect both sides of the head.

Classic Migraine attacks occur in three stages:

Prodromal Stage: Normally occurs hours to days before the attack. It is characterized by symptoms like drowsiness, fatigue, hunger, or thirst.

The Aura: Directly precedes the headache. It’s a neurological phenomenon which consists of visual changes (like the scintillating scotoma, which is a transient spot deficit in vision field which interferes with the usual activities like reading). Some cases of aura are characterized by other types of changes, like auditory hallucinations, tingling and numbness, or loss of position sense.

The Pain attack: The pain starts in the temple or around the eye and spreads to involve the whole side of the head. The pain is of throbbing nature, increases with bright light or loud sounds, and passes away with sleep. The pain lasts for several hours or days and is associated with nausea (and occasionally vomiting), pallor and coldness of the face and limbs. This stage usually resolves in less than 3 days if left untreated. Frequency, severity, triggers, response to medications, and the presence of pulsating pain vary from one patient to another.

Note that only 15-30% of migraine headaches are preceded by an aura, while the rest occur spontaneously without any warning before. Moreover, sometimes the aura occurs with no migraine after, which is known as 'silent headache'.

After the attack ends, most patients experience a hangover, mood changes, abdominal disorders, weakness, or cognitive difficulties.