Migraine: 7 things you must know
How is a migraine different from a simple headache? What are the phases a migraine sufferer goes through? What can you change about your lifestyle to help manage your symptoms? This month on MediScene, Dr. Thashi Chang, a Senior Lecturer and Neurologist at the Department of Clinical Medicine, University of Colombo walks us through 7 things you need to know about a migraine.
Migraine headaches are typically episodic:
Migraines are typically recurrent, severe and disabling episodes of headaches. During such an episode you might be severely incapacitated and unable to perform any of your usual activities but in between episodes you are free of symptoms and able to perform normally. The frequency of headaches can range from one in several months to one every other day. A person may experience migraines for many months to many years. A migraine headache usually lasts a few hours and sometimes up to one to three days.
Migraines often run in families:
Migraines affect about one in 10 people. The exact cause of migraines is unknown – researchers have identified triggers as diverse as drops in barometric pressure and high humidity to imbalances in brain chemicals and gluten intolerance. However, a genetic propensity has been widely recognised. The onset is usually in adolescence or early adult life and is about three times more common in women than in men. Women with a history of migraines often report headaches immediately before or during their menstrual periods.
A headache diary can help you identify your migraine triggers:
Migraines can be triggered by stress, worry, exposure to bright light (sunlight), menstrual periods, birth control pills, physical exertion, fatigue, lack of sleep, hunger, head trauma, and certain foods or drinks. Among known dietary triggers are monosodium glutamate, cheese, chocolates, alcohol and caffeine.
Exactly what triggers a migraine varies from individual to individual. Keeping a headache diary can be used to determine what triggers a migraine for you. Although it can be helpful to identify and avoid an individual’s own personal trigger factors it is important not to become too obsessive.
A host of symptoms can accompany a migraine headache:
Migraine headaches are often accompanied by nausea and vomiting, as well as increased sensitivity to light (photophobia), noise (phonophobia) and sometimes smells (osmophobia). The pain of a migraine headache usually begins gradually and intensifies over minutes to hours and is throbbing or pulsatile in nature. In two out of three people, the pain occurs on only one side of the head, although the side may alternate from headache to headache. Migraine headaches are worsened by movement and physical activity. Many sufferers experience relief when allowed to lie down in a darkened, quiet room. There are many varieties of migraines in addition to the common type described above and a neurological evaluation is necessary to differentiate between the many variants.
Migraines may progress through four stages:
The four stages of migraines are known as prodrome, aura, attack and postdrome but not everyone will experience all the stages. Some sufferers recognise a prodrome phase that kicks off two or three days before the attack. Symptoms like constipation, depression, diarrhoea, drowsiness, food cravings, or hyperactivity and irritability indicate the onset of an attack.
The second phase is known as a migraine aura. Auras are usually visual but can also be sensory, motor or verbal disturbances. Auras are not the same for everyone but about one in five people with migraines experience these symptoms before the headache. The aura may include flashing lights or bright spots, zigzag lines, changes in vision, or numbness or tingling in the fingers of one hand, lips, tongue, or lower face. An aura typically lasts five to 20 minutes. The headache occurs soon after the aura stops but for some patients can also occur during the attack. The attack is followed by a postdrome phase, where you might feel drained or washed out.
Treatment can help prevent migraines:
Migraine headache treatment depends upon the frequency, severity, and symptoms of the headache. There are basically two strategies of treatment: Acute (abortive) treatment – refers to medications taken to relieve the pain immediately. Preventive (prophylactic) treatment – refers to medications taken on a regular (usually daily) basis to prevent headaches from recurring and to reduce their severity when they do occur. These two strategies are often combined, unless the headaches are infrequent.
Lifestyle adjustments can help prevent migraines:
Start with getting regular sleep. This means going to bed and waking up at regular times each day. Do not change your pattern just because it’s the weekend or a heavy day at work. Most adults need 6 to 8 hours of sleep. As important as rest, is eating regular meals because low blood sugar can trigger a headache. While 3 meals a day are recommended, watch your sugar intake. (Too much sugar may lead to a rapid increase in blood sugar followed by a rapid decline in blood sugar, which can trigger a headache.) Drink plenty of water as part of your diet. Dehydration may cause headaches. Limit alcohol and other stimulant drugs. Caffeine is a stimulant and caffeine withdrawal may cause headaches as blood levels taper.
Moderate exercise three to five times each week will help reduce stress and keep you physically fit, however moderate is the key word here. Too much exercise or inconsistent patterns of exercise may trigger migraines. In general, reduce stress.
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