Migraine: Not just a Headache!

By Dr. Nishat Girkar,
Doctor of Pharmacy.

“I was 15 years of age when I encountered something nerve-wracking. It started as a sharp pain in my head leading to loss of vision in my right eye, making me feel as if I was having a stroke. I felt weak and felt the right side of my body drooping,” says Miss J who suffers from chronic migraine from the past 4 years.

Migraine, a debilitating condition is often described as the mother of all headaches with the pain almost comparable to childbirth sometimes. It is the third most prevalent and seventh leading cause of disability worldwide but still, people with migraines are tagged ”attention seekers” or their attacks are regarded as  “just a common headache”.

What exactly is migraine? 

Difference between headaches and migraines?

Trigger factors for migraine?

Diagnosis of Migraine?

Management of migraines.

Some natural remedies for migraine?

WHAT  EXACTLY  IS MIGRAINE?

A migraine is a neurological condition that is characterized by severe throbbing pain or a pulsing sensation, usually presenting only on one side of the head. It occurs along with nausea, vomiting, and extreme sensitivity to light and sound. These “Migraine attacks” can last for hours to days, with pain so excruciating that it may interfere with your daily activities.

Women are more prone to suffer from migraines than men. Also, family history is one of the most common risk factors for having migraines.

There are typically two types of migraines: migraine with aura and migraine without aura. An aura is a visual occurrence (flashes of light or blind spots) or other neurological disturbance that occurs within an hour of an attack. Other heralds can include loss of vision, difficulty speaking, numbness, or muscle weakness. These could also be signs of a stroke so check with your doctor if you ever have these symptoms.

Other forms of migraine include chronic or menstrual migraines. If you have had migraines 15 days out of the month, or for three months or more, you are considered to be having chronic migraines. While women suffering from hormone-triggered head pain during or just before their monthly period are said to be having menstrual migraines.

DIFFERENCE BETWEEN HEADACHES AND MIGRAINES.

Headaches are only one symptom of migraines, and they can range in severity lasting up to only a few hours While, migraine can cause intense, throbbing headaches that last anywhere from a few hours to several days.

 Tension-type headaches are the most common type of headache and are caused by tightness in the muscles in the face, neck, and shoulders, usually as a result of stress, anxiety, or depression. The pain typically affects both sides of the head. On the contrary, people suffering from migraines experience pain on one side or both sides of the head.

A migraine attack can occur in four distinct stages, though not everyone experiences every stage. The stages are:-   

Warning stage- symptoms may include:- unexplainable mood changes, food cravings, stiffness of the neck, frequent yawning and constipation or diarrhea.

Aura stage: It affects a person’s vision, touch, or speech. Some examples are:- flashing lights, blind spots that expand over time and unintelligible or muddled speech, etc.

Headache stage: This stage involves head pain which can be mild or severe, even unbearable. It is often described as pressing or crushing pain accompanied by nausea and vomiting.

Postdrome stage: The postdrome stage occurs after the headache stage subsides. People may feel exhausted, confused, or typically unwell during the postdrome stage.

All in all, if your headache does not have these above mentioned tell-tale signs or stages, then your headache in all probability is not a migraine and could be a mixed headache or a tension headache which could be easily relieved by taking pain killers or relaxation techniques like yoga.

TRIGGER FACTORS FOR MIGRAINE

 Not everyone has the same triggers, and not every time—and that makes the migraine trigger a  difficult quarry to catch. There is, however, general agreement about the most common triggers which are:-

 Not everyone has the same triggers, and not every time—and that makes the migraine trigger a  difficult quarry to catch. There is, however, general agreement about the most common triggers which are:-

Emotional stress 

Missed meal 

Physical Exertion and traveling

Sleep deprivation

Fasting 

Weather change 

Perfumes

Food products like chocolate, sour cream and, marinated and pickled food products.

According to a study, there is less prevalence of food products as trigger factors in the Indian population as compared to western

Diagnosis of Migraine

There’s no specific test as such to diagnose migraines. For an accurate diagnosis to be made, a General Practitioner (GP) must identify a pattern of recurring headaches along with the associated symptoms.

A General Practitioner may plan to refer you to a neurologist, one who  specializes in conditions affecting the brain and nervous system, for further assessment and treatment, if: 

• The diagnosis is vague  

• You experience migraines for 15 days or more.

• Treatment is not helping to regulate  your symptoms

If your condition is unusual, complex or suddenly becomes severe, tests like MRI and CT scan may be required to rule out other causes for your pain like strokes, tumors or other medical problems causing headaches.

During an attack

You might find the best course of defense against a migraine attack to be either sleeping or lying in a darkened room. Applying hot or cold compresses to your head and neck also helps.

Sometimes eating may help too, or you may feel better once you have been sick.

Medications for providing relief

Pain relievers: These over-the-counter or prescription pain relievers comprise of aspirin or ibuprofen (Advil, others).

Triptans: If standard painkillers are not able to alleviate your migraine symptoms, you should make an appointment to see a Physician. In addition to taking painkillers, they may suggest taking a drug known as triptan(sumatriptan).

Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide or prochlorperazine. These are usually taken along with pain medications.

Preventive therapy

 Your doctor might suggest preventive medications if you get frequent, long or severe headaches that did not respond well to therapy.

 Options include:

• Blood pressure-lowering medications. These consist of  beta-blockers like propranolol (Inderal, Innopran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers like verapamil (Veramil) may aid in intercepting migraines with aura.

• Antidepressants. A tricyclic antidepressant (amitriptyline) can prevent migraines. Because of the adverse effects of amitriptyline, like sleepiness and weight gain, other antidepressants might be prescribed instead.

• Anticonvulsants: Your doctor might suggest sodium valproate or topiramate.

Treatment for pregnant and breastfeeding women

In general, migraine treatment with medication ought to be restricted or avoided as much as possible when you’re pregnant or breastfeeding.

Instead, attempting to determine and avoid potential migraine triggers is usually suggested.

If the medicine is essential, your physician may prescribe you a low-dose painkiller, such as paracetamol or in some cases anti-inflammatory medicine or triptans may be prescribed.

1. Magnesium

 Magnesium is an essential mineral, useful in reducing the frequency of migraines in some individuals. The deficiency of this mineral may trigger migraine aura or a menstrual-migraine headache.

You can get magnesium from:-  magnesium supplements and from foods including

• almonds
• sesame seeds
• sunflower seeds
• cashews
• peanut butter
• oatmeal
• eggs
• milk

2. Ginger

It helps to ease nausea caused by migraines and decreases the migraine severity and duration almost as well as the prescription drug sumatriptan, but with fewer side effects.

3.  Essential oils

Essential oils are often used as natural remedies for many ailments. Most commonly used is Lavender oil, which is often recommended as a remedy for stress, anxiety, and headaches. A  study published in European Neurology found that lavender oil inhalation helps in the acute management of migraine headaches.

4. Massage

Massaging the muscles in the neck and shoulders may help relieve tension and alleviate migraine pain. Massage may also reduce stress.

People may choose to book a  professional masseuse for a massage. Alternatively, doing a self-massage along the head and neck will prove to be a  more cost-effective option.

5.Changes in diet

Making changes to your diet, such as eliminating foods and substances known to cause headaches, like alcohol and caffeine, could help in the prevention of migraines.

6.Stress management :

Taking steps to reduce stress by doing yoga, meditation and exercising regularly may also help prevent migraines.

7.Migraine Diary

Maintaining a migraine diary may also help in determining migraine triggers and thus, avoiding them as much as possible.

8. Staying hydrated

Not drinking enough water is a recognized migraine and headache trigger, and it only takes minor dehydration to induce a headache.

By drinking an ample amount of water every day, dehydration may be avoided. People with severe dehydration may require an oral rehydration solution to replace missing electrolytes.

9. Acupuncture

Studies have demonstrated acupuncture to be a potent treatment option for people with migraine headaches. People who are interested in using this technique should make sure to find a licensed practitioner for treatment.

10.B-complex vitamins

The B vitamins may help in reducing migraine frequency and severity as they play a role in regulating neurotransmitters in the brain.

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