Migraine: Current concept for preventing annoying headache | By Dr Jahanzeb Durrani


Migraine: Current concept for preventing annoying headache

MIGRAINE is an annoying and severe headache of modern life, followed by nausea and vomiting, sensitivity to light and noise.

Globally, 29th June is remembered as “Chronic Awareness Day”. It is distinguishable from other headaches by a typical throbbing and pulsating pain sensation, sometimes signaled with aura.

Mostly, it lasts from a few hours to a few days, yet it differs from person to person. Commonly, one can get migraine every few days from 2-4 headaches per month. Doctors don’t know the exact cause of migraine, it could be genetic or hereditary.

Current scientific concept is that the migraine is likely to be triggered when overactive nerve cells send out signals to the trigeminal nerve which is responsible for sensation to our head, neck, face and eyes.

Our body releases chemicals like serotonin and calcitonin gene-related peptide (CGRP), which temporarily inflames the blood vessels of the brain causing pain.

People are likely to confuse Migraine with tension or Sinus headaches. In severe cases, people get isolated and withdraw from normal work, which negatively affects the psychology and mood changes in 10 to 20 % of the people in the long run.

According to the American Migraine Foundation more than 38 million people, currently, suffer from this scourge in the USA, which is increasing with the modern vagaries of life.

However, the incidence is profound in developing countries. If one parent has a history of migraine then their child has a 50% chance of getting migraine.

If both the parents suffer from migraine the risk jumps to 75%. Other reasons could be depression, anxiety, sleep disorders and epilepsy.

It has been observed thatwomen suffer three times more than men equally between the ages 10 and 40 years , but they experience better after the age of 50. However, some commonest migraine triggers include hormonal changes in them.

They have noticed migraine around their periods, during pregnancy, menopause, using hormonal replacement therapy or birth control medication.

Some foods and drinks, like frozen cheese, alcohol, and nitrates used as preservatives along with monosodium glutamate (MSG) salt used in our fast food and hotel dishes are very common triggers.

Skipping meals, overuse of caffeine containing drinks and tobacco may also be responsible for some people.

Other factors are changes in weather, strong winds, and change of altitude in hilly areas. Loud noises, bright lights, and strong smells, heavy physical activity in any exercise, and reduced sleep disorders can all trigger migraine.

Most common symptoms are sensitive to light, sound and smell. A few patients complain of dizziness, fatigue, muscle pain or weakness, numbness on one side of the body.

Some patients complain of food cravings, or lack of appetite with severe thirst, bloating and visual disturbance like flashes of light, hallucinations, verbal communication, strong smell and taste.

In chronic cases, patients may complain of constipation even diarrhea. According to scientific observation, there are several types of migraine-like Menstrual migraine, Vestibular migraine causing vertigo, nausea, and vomiting, mostly in younger age group. Hemiplegic migraine causes short period of weakness or numbness on one side of the body.

Status Migrainosus. a severe type of migraine which lasts more than 72 hours. The pain and nausea are so intense that the patient needs hospitalization.

Ocular migraine usually occur in young adults, with a dull ache behind or around the eyes, sometimes accompanied by paralysis of eye muscles, drooping of eyelids with double vision.

This is a hospital emergency to exclude some vascular or neurological condition. As far as the treatment is concerned, we must assure the patient that they can get back to normal life through medication or preventive therapies.

The secret is to adopt a stress-free life-style, good sleep, eat on time, avoid causative triggers or exacerbating factors.

Unfortunately, not all people have the same triggers, hence it is important to remember or to maintain a diary to keep a record of triggers.

In fact, it interrupts your normal life activities, but fortunately lifestyle changes do help to prevent migraine which include eating regularly, not to skip meals, limit excessive tea and caffeine containing foods, plenty of sleep and observing meditation.

In fact, there’s no definite cure for migraine as yet, but it never causes lasting harm. Your doctor may order some tests like MRI or CT scans, Electro-encephalogram (EEG) to rule out any other serious problems.

Common and simple treatment with medication over the counter in a pharmacy with a cup of tea often works well but using too much medicine one can get rebound headaches or become dependent on them.

Your doctor may suggest some preventive medicines to be taken regularly to make your headaches less severe or infrequent.

Some modern devices like single-pulse transcranial magnetic stimulation placed on the back of your head, activate the trigeminal nerve which works well in recurrent cases.

Some new devices like Cefaly, a head band used once a day for 20 minutes, produces a massaging sensation and sends electrical impulses to your brain.

Gamma Core is another stimulator, which sends mild electrical signals and helps in relaxing the pain It may also ease through acupuncture and home remedies like physical massage, yoga, resting with closed eyes in a dark and quiet room, putting a cold compress or ice pack on your forehead, regular moderate exercise and drinking plenty of liquids, lowers the frequency of migraine attacks.

Research has found that some vitamins, minerals and herbs can also treat migraines which include riboflavin, and melatonin, but always eat on a regular schedule with plenty of rest and fluids.

Amongst new medications, Atogepant (approved by Federal Drug Agency) for further investigation, is an oral drug taken once a day, for the prevention of migraine.

It is quite effective in reducing the migraine attacks, but it causes some adverse effects like constipation and nausea.

However, larger trials are under study to determine its safety. Other approved oral preventive medications include divalproex sodium, flunarizine, topiramate, propranolol and injectable timolol.

Monoclonal antibodies that target calcitonin gene–related peptide (CGRP) and botulintoxin-A are also being used. Too much coffee, tea, chocolate, artificial sweeteners, alcohol are common triggers (35%).

Monosodium glutamate (MSG)is an additive salt commonly used in fast foods by the youngsters along with fermented foods, frozen meat, certain drinks, ice cream containing nitrates as preservatives also act as triggers.

In recurrent attacks doctor may prescribe some anti-hypertensive and antidepressants which reduce migraine attacks.

Summarily, regular follow-ups with your family doctor will certainly help in managing migraine.

Moreover, limiting the time spent at bright lights from television and computers with frequent “screen breaks”will certainly help in mitigating the suffrage.

—The author is a practicing Eye Specialist at an international fame hospital in Islamabad


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