WHAT IS MIGRAINE?Sunflower Hospital Nagpur :- Migraine can cause severe headache either on one side on the forehead or temple area . Dr Jay Deshmukh says This can be throbbing or pulsating type. It is usually accompanied by nausea, vomiting and intolerance to bright light or sound. It is often accompanied by mood swings and irritability. The right medicine with self help techniques and life style changes may help. Sunflower Hospital Nagpur What are the warning symptoms of an impending episode of migraine ? Warning symptoms known as aura may occur before or with the headache.These can include flashes of light, blind spots or tingling on one side of the face or in your arm or leg.
What are the stages of a classical migraine ?
Sunflower Hospital Nagpur :- Migraine occurs during childhood early adolescence or in young people. It occur in 4 stages, prodrome, aura, headache and post drone. Though every person may not experience all the stages.In prodrome few days before upcoming migraine there could be few warning signals that include constipation, mood changes that includes depression, food cravings, neck stiffness, increased thirst and urination and frequent yawning. Few individuals may have an aura. This includes seeing zig zag lines, flashes of light and bright spots. Temporary vision loss. Pins and needles sensations in an arm of leg.Weakness or numbness in the face or one side of the body. Hearing noises or music.Uncontrollable movements or jerking.
What about the headache ?
The headache usually lasts from few hours to 3 days. The frequency and the pattern of symptoms differ in each individual. The pain is usually on one or both sides of head. It may be throbbing on most occasions. There is sensitivity to light, sounds and smell. There is accompanied nausea. In many vomiting brings in relief. There may be lightheadedness followed by fainting. After an attack of migraine you may feel drained out , exhausted and tired. Moodiness, confusion dizziness and sensitivity to light and sound may occur.
When to see a doctor ?
- You may see a doctor to plan your treatment.This includes life style changes, diet, exercises and preventive measures. Prevention of migraine is possible by certain medications. During an episode of migraine early initiation of treatment can prevent many hours of dysfunction.
What are the symptoms which are dangerous ?
Sunflower Hospital Nagpur :- An abrupt severe headache like thunder may occur in brain hemorrhage . Headache associated with fever, neck stiffness and double vision, weakness or difficulty in speaking may not be migraine. A chronic headache that is worse after coughing, exertion straining or a sudden movement needs further evaluation. A new headache that is persistent or if you are above 50 years needs extra attention.
What is the cause of migraine ?
- This occurs due to its occurrence in one of your family members.This is known as genetic. Certain environmental factors like sleep deprivation, excess of exercise, lack of food at proper times or exposure to sunlight, cold weather, mental stress or during menses are the common triggers. Migraine occurs due to imbalance in the chemical messengers of brain known as neurotransmitters and its interaction with the trigeminal nerve of the brain.
Besides hormonal changes what are the other triggers?
- Skipping meals or fasting triggers migraine. The artificial sweetener aspartame and the preservative MSG that is mono sodium glutamate can trigger migraine. Wine , excessive coffee, stress at home or workplace, bright lights, sun glares, loud sounds and strong smells can trigger migraine. Change in sleep wake pattern, intense physical exertion , sexual activity may provoke migraine. Oral contraceptives and nitroglycerin can precipitate migraine.
How can you prevent migraine ?
- Regular pattern of sleep, mild to moderate exercises, yoga and other relaxation therapy with regular timings for meals may prevent migraine. In recent time a learn to cope that is LTC therapy has been popular. In this you are gradually exposed to headache triggers that help desensitise you to them. Creating a consistent daily schedule, regular exercises and reducing the effects of oestrogen may help.
What are the investigations in migraine ?
- A detailed clinical examination and simple blood tests to exclude other medical conditions is necessary. In absence of relief with standard treatment against migraine or with atypical features a CT scan or MRI of the brain may be necessary to exclude other possibilities.
What is the treatment of migraine ?
Sunflower Hospital Nagpur Pain relieving medications and preventive medications are indicated. Preventive medicines are necessary if you have 4 or more debilitating attacks per month, headache that lasts for more than 12 hours, pain relieving medications are not helping and the migraine episode includes a prolonged aura or numbness or weakness. Preventive medications can reduce the frequency, duration and severity of migraine.The medications include propranolol, verapamil, lisinopril, amytryptiline, venlaflaxine and a few more. During an acute episode of migraine Naproxen, Aspirin, codeine steroids are useful. Sunflower Hospital Nagpur Ergot preparations are also useful and are in use since many decades.These need to be taken under doctors supervision to prevent side effects. Anti seizure drugs like topiramate, valproate can be used for prevention. Botox injections and the monthly self injectable Almovig are certain newer drugs.Migraine headache is a very common form of illness where there are no specific tests available in routine practice to confirm the diagnosis . The symptoms are classical and repetitive. The treatment is based on life style changes . Migraine triggers need to be avoided. Though it has no serious consequences in most individuals, it certainly affects the quality of good life.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.