Migraine Horrible Headache

Migraine headache cause intense, throbbing or pulsating pain in one area usually half of the head. It is usually  accompanied  by nausea, vomiting and extreme  sensitivity to light and sound. Migraine attacks can last for hours to days. Sometime attacks are so severe that patient prefer dark, quiet place to sit or lie down. Some migraine attacks are preceded or accompanied by sensory warnings (aura) such as flashes of light blind spots in front of eyes tingling in arm or leg.

Proper treatment, self help remedies and life style changes can reduce the frequency and severity of migraine and can make life easier.

Symptoms

Migraine headache often begins in childhood adolescence or early adulthood. Attacks are of varying duration and severity. Attacks may progress through four stage – prodrome, aura, attacks and post drome But everyone don’t have four stages. Attacks can occur any time but usually get worse in hot humid weather.

Prodrome

One or two days before a migraine attacks person may notice subtle changes like constipation, depression, diarrhea, food craving, hyperacidity, irritability neck stiffness etc that may signify the impeding attack.

Aura

Most of people have migraine headache without aura, Aura are usually visual, but can also be sensory, motor or verbal diaturbance. Aura  symptoms usually begins gradually builds up in several minutes, they commonly last for 10 to 30 minutes  Aura includes seeing various shapes, bright spots or flashes of light, vision loss in some point (scotoma), pins and needle sensation in arms or legs, speech or language problems. Less commonly an aura may appear as upper arm or leg weakness of one side (Hemiplegic migraine)

Attack

If untreated, a typical migraine attack last for 4 to 72 hours. Frequency  and severity of migraine varies from person to person. Attacks may be several times in a month or much less frequently. During attacks some of the following symptoms usually occur.

-Pain on one side of the head.

-Patients become sensitive to light, sound and sometimes to smells.

-Some patients have nausea with or without vomiting.

- Blurred Vision.

-Diarrhoea.

-Light headedness some time followed by fainting.

Postdrome

Final phase of attacks occurs after migraine attacks when patients may feel drained and washed out. Some people have feeling of mild euphoria.

Types of Migraine

Migraine can occurs in various severities along with other associated symptoms.

Migraine without Aura (common migraine/ Hemi crania simplex)

It is  most common form of migraine. Headaches are usually unilateral pulsating of moderate to severe intensity lasting for 4 to 72 hours. It is usually  aggravated by routine activities and usually associated with nausea, photophobia, This type can occur in same females in the pre menstrual period  (menstrual migraine) starting any time between two days before the expected date and before the last day of menstruation.

Migraine with Aura (Classical Migraine)

This occurs along with neurological symptoms (aura), related to localized area of cerebral cortex or brain stem. Aura usually include homonymous visual disturbance  (loss of vision on right or left side) hemi sensory symptoms hemi paresis dysphonic or any combinations of these symptoms. Visual aura is most common. Aura last for 4 to 72 hours. It may be prolonged up to one week mimicking transient ischemic attacks or stroke.

Basilar migraine are characterized by symptoms of brain stem dysfunctions.

Ophthalmic pelagic migraine is due to weakness of external ocular muscles (one or more). Benign Paroxysmal Vertigo of child hood and alternative hemi plegia of childhood may be migraine equivalent or precursors of migraine  in childhood.

Status Migrainosus

When migraine last for more than 75 hours in spite of treatment. Headache is either continuous or intermittent with headache free intervals of less then 4 hours. It usually associated with prolonged drug use.

Migrainous infarction

Here typical neurological deficit is not completely reverse within 7 days. CAT shows ischemia, or infarction in relevant areas of the brain.

 Causes

Mechanisms and cause of migraine is not clearly known. But genetics and environmental factors seems both to be responsible for migraine.

Migraine may be caused by changes in the brain stem/ brain bllod flow an its interaction with the trigeminal nerve. In balance in brain chemical especially serotonin which help to regulate pain sensation in nervous system seems to cause migraine. Serotonin levels drops during migraine attacks, which may trigger trigeminal system to release neuro peptides which travel to the brain outer covering (meninges) resulting in headache.

Migraine Headache Trigger

Many things, situation may trigger a migraine attack. There is individual variation. Any thing can be trigger for migraine, but half of the attacks are due to stress like examination, jobs interview etc, foods (Milk, citrus fruits chocolate. food additive) caffeine, alcohol.

COMMON MIGRAINE TRIGGERS ARE THE FOLLOWING

Hormonal changes in women

Fluctuation in Estrogen hormone may trigger the headache in many women who are suffering from it. These women may have attacks immediately before or during the periods when they have a major drop in estrogen level. Other have increased tendency to develop migraine during pregnancy especially in first trimester or menopause. Hormonal medication such as birth control pills and hormonal replacement therapy also may worsen migraine. Though some women get relief from migraine during third trimester of pregnancy.

Foods

Some migraine appear to be triggered by certain foods. Most common being alcohol especially beer, red wines, aged cheese, chocolate aspartame. Over use of caffeine, mono sodium glutamate (Chinese salt) salty food, processed foods. Skipping meals or fasting also can trigger migraine.

Stress

Stress at work or home can instigate migraine.

Sensory Stimuli

Bright light, sun glare, can induce migraine so the loud sound, music, smoke unusual smells (including pleasant scents such as perfume) and unpleasant odours such as paints. Even second hand (Passive) smoking can also trigger migraine. Watching T.V for long time can also induce migraine.

Change in wake sleep pattern

Either lack of sleep or too much sleep can trigger migraine in some people.

Physical Factors

Intense physical exertion including sexual activity may provoke migraine.

Change in Environment

A change of weather or barometric pressure can precipitate migraine. Attacks are more likely to occur in hot, humid, weather and at high altitudes.

Medication

Certain medicine such as oral contraceptive pills, vasodilators (Nitroglycerine) etc can induce or aggravate migraine.

Risk Factors

Certain factors make persons more culpable to suffer from migraine.

Family History

Up to 90 per cent people suffering from migraine have family tendency if one or both of the parents have migraine then there are good changes that offsprings will also be sufferer.

Age

Migraine can begin at any age though most experience their first attack during adolescence. By age od 40 years most people with migraine have their first attack.

Gender

Women are about three times more likely to have migraine than men.

Complications

Efforts to control severe, frequent pain can cause problems.

Abdominal  Problems

Many pain relieving medicine such as Ibuprofen & Aspirin etc may cause abnormal pain, bleeding  and ulcer especially if taken in large dosage or for long period of times.

Rebound Headache

If consumed pin reliever medicine more than nine days per month or in high doses, then medicine may become in effective . They can increase the dosage and trapped in a vicious cycle.

Seretonin Syndrome

The potentially life threatening drug intraction can occur if people consume tripans (migraine preventing drug) such as sumatriptan along with antidepressants (SSRI)

Treatment

Variety of drugs available to treat migraine.

Pain Relieving Medication

Pain relieving drugs such as Ibuprofen, disprin, Acetominophen, Indomethacin, caffeine or even Pethidine can be taken during migraine attacks to stop symptoms like pain, nausea, vomiting. These are more effective in the start of attacks rather than when attack are full blown. So don’t wait, be careless, tale medicine when feel that you are likely to get attack.

Preventive Medication

These drugs can be taken regularly often daily to reduce the severity and frequency of attacks and to reduced the degree of disability caused by headache  along with other associated problems due to migraine.

Various derivatives of the Tripatans (like sumatriptan etc) are, one of the most common drugs for treatment of migraine. It relieves pain nausea, vomiting and sensitivity to light and sound , but these drugs should not be given to people who are at risk of stroke and heart attacks. Beside triptans. Ergotamine are also found to be effective in treatment of migraine. But these drugs should be only consumed on doctor’s advice.

For preventing migraine, Beta blockers (propanolol/ inderal) Calcium channel blocker (Verpanil), anti seizure drugs (gababintan) antihistamine (Lypohidine) can be taken Even. Botulium toxin type A (Botox) injections are effective in preventing the migraine.

Beside consuming the preventive medicine, persons suffering from migraine should also do.

Muscle relaxation exercises.

Should de meditation.

Should get enough sleep, but they should not over sleep. Average adults need 6 to 8 hours of sleep at night. Go to bed and wakeup at regular time.

Identify the trigerrs, avoid or control them as for as possible.

To ease of stress tension, spread work load. Face tension in relaxed way.

If suffering from other diseases such as high blood pressure etc, get proper treatment.

Alternative methods of treatment

Nontraditional therapies may be helpful in chronic migraine.

Acupuncture

In this treatment a practitioner insert many thin disposable needles into several specific areas of skin at defined points. Research have shown that acupuncture may be helpful for migraine pain.

Biofeed Back

This relaxation technique uses special  equipment which monitor certain physiological responses occurring due to stress such as muscle tension heart rate, respiratory rate etc. Patients are told to do relaxation exercises and they can observe the results of exercise and become motivated.

Manual Therapy

Massage and chiropractic treatment can give relief from migraine. It can also improve the quality of sleep, which can help to prevent migraine attacks.

Herbs, Vitamins, Minerals

There are several evidences that certain herbs, fever brow, butter beans may be effective for migraine pain or reduce its severity High dosages of riboflavin (vitamin B-2) may benefit by correcting its deficiency in brain cells. Co-enzyme  Q-10 supplement may decrease the frequency of migraine, but it has little effects on its severity. Some study have shown Magnesium supplementation is also beneficial in these patients.

Whether or not consuming preventive medication, one has to change the life style which can help to reduce the number and severity of migraine.

Try to control stress, yoga, meditation are excellent ways.

Exercise regularly, regular aerobic exercise reduce tension and help prevent migraine. Obesity is also thought to be factor in migraine so keep weight under control. In women having migraine and estrogen seems to trigger, they must avoid birth control pills and hormone replacement therapy.

Dr. J.L.Agarwal, Prof. & Head,

Dept of Physiology,

3, Gyan Lok Mayur Vihar,

E-Shastri Nagar,

Meerut (UP) 250 004

Thanks,

Health-Nov-2012