Learn how to treat migraine

Migraine is a neurological condition that affects many in Sri Lanka. It has multiple symptoms, but it is frequently characterised by intense, debilitating headaches  
In an interview with the Health Capsule Dr. Bimsara Senanayake, Consultant Neurologist of the National Hospital, elaborated more about the condition.   

What is migraine?
Migraine is a kind of primary headache disorder. That means it does not have any secondary cause, such as a brain tumour. Migraine by definition means ‘hemikrania’ derived from Greek origins, which means pain on one side of the head. Usually migraine headache sufferers have a headache on one side of the head. The sides in which the headache occurs can change. It is one of the most common causes of headache in the world. 10% of the people of our nation suffer from a migraine disorder. Hence it is one of the commonest neurological problems. Interestingly out of that 10% the majority are females. For every 1 male there will be 2 female suffering from migraine.   

Reasons for migraine 
It occurs because of a physiological process that takes place within our brains, between blood vessels and nerves, therefore it is neurovascular disease. There is swelling of these blood vessels due to various triggers, which thereby causes pain. It is important to note that the headache is only one symptom of migraine. Migraine has numerous other symptoms along with the headache, one common symptom is the blurring of vision which is knows as vision aura. Other symptoms are numbness, weakness of neck and arms, nausea, vomiting and feeling faintish. In some rare cases even brain fever can develop. This is why we call migraine a phenomenon or a syndrome in which case there it is collection of symptoms. In fact there are some cases where patients suffer from migraine sans headache. Further migraines occur because of a mixture of genetic and environmental factors.   

Though many feel that migraine is a benign  condition, migraine has a huge impact on the economic life of a country and the social life of the people. This is because of the large numbers that suffer from migraine. For instance around 1,000 people might not go to work because of a migraine attack. This is because it is such a common condition.  

Types of migraine  
There are two broadly different kinds of migraine; migraine with aura and migraine without aura. Aura is a kind of  warning, which means that before you get the headache you get a warning, such as blurring of vision, you start seeing zigzag lines or flashes of light. Some auras are called fortification spectrum. That is where you see something like a fortress. You even go totally blind for a period of time. In other instances you can start seeing large figures that are usually smaller (macropsia) or start seeing regular sized figures smaller ( micropsia). This particular aura is called the ‘Alice in Wonderland’ syndrome.   

Non vision associated auras are smells, numbness, a tingling sensation. Migraine with auras are also called classical migraines, but the common migraine does not have an aura. The majority of patients, around 80%, do not have an aura.   

Some patients can have hemiplegic migraine, this is similar to a stroke. The word hemiplegic simply means paralysis on one side of the body. A person with hemiplegic migraine will experience a temporary weakness on one side of the body as part of their migraine attack. This can involve the face, arm or leg and be accompanied by numbness, or pins and needles.Or your cranial nerves can get paralysed, where the eyelids cannot be lifted.  

Diagnosis and treatment 
First you must take a detailed history of the patient and see if there are any triggers that cause the migraine. Some such triggers are:  

• Bright flashes of light ( photo phobia)- this can occur when you go out in the sun  
• Loud noises (phonophobia)   (Hence a lot of migraine sufferers go into dark quiet rooms.)   
• Food- dairy products ( milk, butter,yoghurt), citrus food, chocolates, certain fruits that contain a chemical called serotonin, ( bananas, pineapples, tomatoes), peanuts  
• Women can suffer from migraine during menstruation- this is called menstrual migraine  

Treatment has two components: we try to cure the acute attack and secondly we try to prevent migraine recurring in the long-run. When a patient suffers an attack he will take a prescribed pain killer. Secondly he must take drugs to prevent attacks in the future. Such preventive drugs need to be taken for around 6-8 months, so that the patient can gradually space it out. In addition you must be aware of your triggers and hence avoid them.   

Need of scanning the brain  
A lot of migraine patients who come to us fear that they are suffering from a brain tumour. Not all migraine patients need to undergo a scan because the degree of the migraine can be clinically diagnosed. The diagnosis is hence done through a clinical history, not by a blood test or a scan. Some people have the wrong idea that a migraine can be diagnosed through a scan. 

 
When do you meet your physician?
These are the red flags of migraine where you must consult your physician; if you’re having episodic headaches ( headaches which come and go, for example where you get one attack now and then you get an attack in another 2 weeks time)   
If you are having a constant headache or if your usual headache pattern changes it is something to take seriously. 

 
When you get the worst possible headache that you have got in your entire life, where it feels like someone has hit you hard on the head, it might be migraine or/and there might be a certain bleeding in the brain. 

 
Further, if there are certain associated problems along with the headache such as a stroke, loss of consciousness, confusion, fits, this might not be migraine hence a brain scan may be needed.   

Therefore, you must seek treatment if you’re having such symptoms.   

Prevention mechanisms without medicine 
The first thing is that the triggers must be identified. You can use UV protective sunglasses to avoid harsh light. Food associated with migraine can be avoided and also noisy places. Mediation, acupuncture, botox, massages and relaxation activities can also help relieve migraine.   

Economic consequences  
Though many feel that migraine is a benign condition, migraine has a huge impact on the economic life of a country and the social life of the people. This is because of the large numbers that suffer from migraine. For instance around 1,000 people might not go to work because of a migraine attack. This is because it is such a common condition. In developed countries they have done a calculation of how many work days and school days are lost because of migraine and it runs into a billion dollar loss annually. Hence the WHO ( World Health Organization) takes the condition very seriously because of the large damage caused. Though it does not cause death it causes disability.