By Dr Ritesh Kohli, M.D.
What is a migraine headache?
A migraine headache is a throbbing or pulsating headache that is often one sided and associated with nausea, vomiting, sensitivity to light, sound, smell, sleep disruption and depression. Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.
Migraine triggers
Whatever the exact mechanism of headaches, a number of things may trigger them. A trigger is any stimulus that initiates a process or reaction. Commonly identified migraine triggers include the following:
● Alcohol (eg, red wine)
● Environmental factors (eg, weather, altitude, time-zone changes)
● Exertion
● Foods that contain caffeine (eg, coffee, chocolate), monosodium glutamate (MSG − found in Chinese food), and nitrates (eg, processed foods, hot dogs)
● Glare, contrasting patterns
● Hormonal changes in women
● Hunger
● Lack of sleep/change in sleep-wake patterns
● Certain perfumes
● Stress
Symptoms
A typical migraine attack produces some or all of these signs and symptoms:
● Moderate to severe pain, which may be confined to one side of the head or may affect both sides
● Headache with a throbbing quality
● Pain that worsens with physical activity
● Pain that interferes with your regular activities
● Nausea with or without vomiting
● Sensitivity to light and sound
● When left untreated, a migraine typically lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or just once or twice a year.
Not all migraines are the same
The two most common types of migraine headaches are the classic and the common types. The classic migraine begins with a stage characterized by feelings of lethargy or irritability 24 hours before a second stage of visual sensations of flashes, dots or tunnel vision (referred to as an aura) 10 to 30 minutes prior to headache onset.
Common migraine headaches are not preceded by an aura but may be associated with symptoms of tiredness, fluid retention, or mood alteration.
When to seek medical advice
Migraines are long-term disorders, often undiagnosed and untreated. If you experience signs and symptoms of migraine, track and record your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches and decide on a treatment plan.
Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. See your doctor 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, rash, 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
How is migraine diagnosed?
A definitive diagnostic test for migraine headache does not exist. Diagnosis by a physician is based on physical examination results and patient medical and headache history. A CT or MRI may be taken to rule out structural abnormalities such as tumour, bleeding vessel, or aneurysm.
Treatments and drugs
A variety of drugs have been specifically designed to treat migraines. In addition, some drugs commonly used to treat other conditions also may help relieve or prevent migraines. Medica-tions used to combat migraines fall into two broad categories:
● Pain-relieving medications − Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
● Preventive medications − These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.
Choosing a strategy to manage your migraines depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. Your doctor can help find the right medication for you.
Prevention
Whether or not you take preventive medications, you may benefit from lifestyle changes that can help reduce the number and severity of migraines. One or more of these suggestions may be helpful for you:
● Avoid triggers − If certain foods seem to have triggered your headaches in the past, eat something else. If certain scents are a problem, try to avoid them. In general, establish a daily routine with regular sleep patterns and regular meals. In addition, try to control stress.
● Exercise regularly − Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, like walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.
Self-care at home
Most migraineurs can manage mild-to-moderate attacks at home with the following strategies:
● Using a cold compress to the area of pain
● Resting with pillows comfortably supporting the head or neck
● Resting in a room with little or no stimulation (light, sound, odours)
● Withdrawing from stressful surroundings
Lifestyle and home remedies
Self-care measures can help ease the pain of a migraine. Try these headache helpers:
● Keep a diary − A diary can help you determine what triggers your migraines. Note when your headaches start, how long they last and what, if anything, provides relief. Be sure to record your response to any headache medications you take. Also pay special attention to the foods you ate in the 24 hours preceding attacks, any unusual stress, and how you feel and what you’re doing when headaches strike. If you’re under stress, tell your doctor.
● Try muscle relaxation exercises − Progressive muscle relaxation, meditation and yoga don’t require any equipment. You can learn them in classes or at home using books or tapes. Spend at least a half-hour each day doing something you find relaxing − listening to music, gardening, taking a hot bath or reading.
● Get enough sleep, but don’t oversleep − The average adult needs seven to nine hours of sleep a night.
● Rest and relax − If possible, rest in a dark, quiet room when you feel a headache coming on. Place an ice pack wrapped in a cloth on the back of your neck and apply gentle pressure to painful areas on your scalp.
