How to Beat Migraine
A throbbing forehead and you feel that you are almost going blind, no trigger or provocation, but your head feels like it will split into two any minute! These are typical signs of a migraine, a type of headache that can also come with vomiting and nausea.
Doctors say it is imperative that patients don't attempt to treat it at home.
Dr Harirama K Acharya, Senior Consultant Neurologist and Head: Department of Neurology at Fortis Hospitals says migraine is a vascular headache that is more common in women during their reproductive years and is three to six times more common in them due to hormonal cycles during menstruation.
Symptoms include unilateral throbbing headache on both sides of the head at the temples, back of the head, around the eyes and over the sinus area. "Some patients mistake migraine as a sinus. When someone has recurrent episodes of headache, it is not sinus, it is migraine," Dr Acharya warns.
Unknown Causes
Doctors say that to point out the exact reason for migraine is very difficult. It arises when there is a problem with the blood flow in the brain.
"Very often it runs in the family. It can occur anytime, but mostly occurs during morning hours. There are cyclical variations and may occur more in summer," he explains.
Migraine can be triggered when there is an exposure to bright light, loud noise or strong smell. It may also be brought on by emotional distress. "In addition to light and sound, certain foods like cheese, chocolate, wines and stress too may contribute to it. Susceptible people should try and avoid exposure to loud noise and bright lights," said general physician Dr BC Rao.
He added, "Though symptomatic treatment often works, physician consultation is helpful as there is increased incidence of strokes in migraine sufferers."
A migraine headache may sometimes be preceded by visual and/or other transitory neurological symptoms. Dr Rao says that migraine is caused by abnormal transmission of neural messaging with opening of blood vessels outside the skull.
Dr Manjunath R, Consultant Physician and Clinical Cardiologist at Dr Malathi Manipal Hospital says allergies and allergic reactions could also be a cause. "Alcohol, menstrual cycle fluctuation, Obsessive Compulsive Personality Disorder, foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs, and some beans), monosodium glutamate (MSG), or nitrates (like bacon, hot dogs, and salami) trigger migraine," he says.
How migraine is treated
Migraine treatment involves preventing frequent episodes and abortive treatment during the attack of migraine. Dr Acharya says a neurologist decides the course of treatment on individual patient basis. "Medication like aspirin, naprosyn or stronger medication are prescribed by a physician as part of abortive treatment. Medication without supervision is not advisable," he says.
Greatest cause of absenteeism from work
Dr Chandran Gnanamuthu, Senior Consultant Neurologist, Sakra World Hospital, observes that migraine was the commonest cause of absenteeism in the work area.
Warning that what appears like migraine may turn out to be a stroke, meningitis or bleeding inside the brain, "There is another type of migraine, which is less common and is characterised by visual symptoms along with headaches called 'Classical Migraine'," he says.
If any close relatives suffer from migraine attacks, this should be mentioned to the treating doctor. "Migraine can occur at anytime of the day or night. Generally the headache subsides in 3-6 hours either with or without an analgesic. However, some headaches can go on for 2-3 days," he says.
Dr Gnanamuthu says that migraine should not be confused with Tension Headache, a more common type of headache. "The latter is a constant dull pain in the same areas mentioned, but usually does not have the throbbing nature," he says.
First Aid
While treatment is done symptomatically for mild headaches that are not frequent, severe and frequent headaches must be treated prophylactically by taking a tablet regularly. "The safest pain relieving medicine to take is Tablet Paracetamol 1 gram. This can be repeated again after six hours. Various balms can be used to apply on the painful areas, with fair success in many cases," advises Dr Gnanamuthu.
"These decisions are taken by a doctor specialised in treatment of headaches, generally a neurologist," he says.
Over-the-counter medications such as naproxen, ibuprofen, acetaminophen (paracetamol), and other analgesics like Excedrin (aspirin with caffeine) are often the first abortive therapies to eliminate the headache or substantially reduce pain. Antiemetics may also be employed to control symptoms such as nausea and vomiting. “Another class of abortive treatments are called ergots, which are usually effective if administered at the first sign of migraine,” says Dr Manjunath.
Migraine is common around puberty and at the menopause and sometimes increases in severity or frequency with hormonal contraceptives, in pregnancy and with the onset of hypertension
Ergotamine derivatives are the mainstay of oral therapy and are available in both oral and sublingual forms. Next drug of choice is Sumatriptan, a 5-HT receptor agonist, that is available in both injectable and oral forms. Now many of drugs are available for prophylaxis and the most common drug used is Topiramate.
What triggers migraine?
■ Smell of perfume
■ Smell of spices
■ Long hours of looking at the TV or computer screen
■ Delayed meals (causing low blood sugar)
■ Lack of adequate sleep
■ High stress levels
■ Exposure to the sun
■ Oversleeping
Home remedies for migraine
■ Avoid caffeine drinks
■ Take vitamin supplements every day
■ Avoid smoking and alcohol
■ Eat a well-balanced diet
■ Stay hydrated. Drink plenty of fluids every day.
When to see the doctor
■ When the headaches are significantly intense, increasing in intensity and frequency, it is time to meet you doctor.
■ Vomiting associated with headache, blurred vision, weakness of the hand or leg should all alert us to something significant.
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