Published in Panorama
There is increasing evidence that migraine is a genetically determined disorder affecting a sizeable proportion of any general population, irrespective of socio-economic backgrounds. According to Dr.Sasi Kumar, Neurologist, it is one of the commonest complaints suffered by individuals, particularly, women, the incidence being almost twice or more in them as compared to men. It is usually a condition of younger people and even children as young as four years of age, can be prone to the condition, opines the specialist.
How do you differentiate migraine from other forms of headache?
Headaches are basically of two types: Primary and Secondary – secondary to a general medical condition. Tension headache, cluster headache and migraine are forms of primary headache. If the headache occurs after the age of forty, is progressive, postural, that is, the patient has aggravation of pain while lying down or when woken up from sleep and is accompanied by rash, it is likely to be meningitis. The headache, when accompanied by weakness or numbness of the body is not likely to be migraine. Headache in the elderly and in an acute form could be on account of glaucoma or due to temporal arthritis which is a very dangerous condition.
What are the typical symptoms of migraine?
People may suffer from common or classic migraine, that is, migraine without or with aura. Most people with migraines suffer from common migraine which is characterized by a throbbing one-sided headache that is moderate to severe in intensity and is aggravated by normal physical activity. Occasionally, there may be pain all over the head. There may be associated symptoms as nausea, vomiting and sensitivity to light and sound. If left untreated, the bout may last between four hours to three days.
In migraine with aura or classic migraine, the patient may see flashes of light, stars, blind spots or distortion of objects followed by the headache. Other symptoms include tingling or a "pins-and-needles" sensation in the hands. A few people may have incoherent speech, experience confusion, have numbness in the hands, shoulders, or face and feel weak on one side of the body. Aura symptoms occur gradually within 20 minutes and seldom last beyond an hour. Patients may experience one or several symptoms of aura but only in succession and not all of them simultaneously
Children with migraine can present with vomiting and abdominal pain; hence they very often get wrongly diagnosed. Also, there is evidence to show that patients with nauseous sickness become future migraine patients.
What causes migraine? Are there identifiable triggers to the condition?
While it is not known what exactly causes migraine, there may be certain triggers which predispose individuals to it. These include certain food items, especially those containing tyramine – like banana, onion and tomato, or foods containing Monosodium glutamate) and other preservatives, red wine, white cheese, chocolates and citrus fruits. These foods may increase the neurotransmitter serotonin in the brain, thus triggering migraine attacks. However, this does not imply that all migraine sufferers have the attacks because of these triggers; in fact, in only 50% of individuals prone to migraine, the episodes may be triggered by these factors. Migraine could also be drug-induced, as in the case of drugs which cause vaso-dilatation or drugs meant to dilate the blood vessels.
Is it possible to identify the specific triggers?
It is difficult but it can be done with some degree of success by maintaining a migraine diary though which you look for some kind of pattern correlating food items and migraine episodes.
Many women who have migraines can relate their migraine headaches to their menstrual cycle, the headaches occurring a few days before, during or immediately after the cycle.
What are the diagnostic measures undertaken to identify and confirm migraine?
In most instances, symptoms described by the patient suffice to diagnose migraine. However, neurological examinations may be done to exclude all other causes of headache. Usually in migraine, no neurological findings may be observed and hence if symptoms clearly indicate migraine, CT scan of the brain is not required.
Once diagnosed, how is migraine treated?
Prevention is the cornerstone of treatment since there is no cure for migraine. But patients can modify the attacks - their frequency and intensity. This is best done by avoiding the triggers with proper diet, practicing relaxation techniques and changing pattern of life.
Patients are advised rest in a dark, quiet room when faced with a migraine attack. Treatment is begun with simple medication with an analgesic like panadol. Should the patient not find relief with this, aspirin or non-steroidal anti inflammatory drugs are prescribed. But overuse of these drugs may cause rebound effect or rebound headache due to drug abuse. Anti emetics may be given to address the nausea and vomiting caused by migraine.
Prophylactic medication may be given when there are indications. If a person has more than three attacks of migraine per month or if he has only one attack but it is so severe that it may last for days, then these prophylactic medications are indicated. These are either beta blockers or anti depressant medications or anti convulsants which are used for patients of epilepsy. However, these drugs should be taken strictly under medical supervision.
Can untreated migraine lead to complications?
Very rarely familial migraine can cause brain features like stroke. But this is usually reversible and migraine per se does not lead to stroke.