Headache is one of the commonest symptoms experienced and it is estimated that about 50% of the adult population would have suffered a headache at least once within the last year. WHO ranks migraine among one of the world’s most disabling medical illnesses

Approximately 90% of headaches are characterised by one of these three syndromes:

– Migraine headache
– Tension-type headache
– Cluster headache

SYMPTOMS OF MIGRAINE

It is estimated that about 10-15% of the population experiences migraine headaches and it is the second commonest cause of headache after tension headache.

Headache may be one-sided (about 60%), usually begins gradually, intensifies over minutes to hours and then resolves gradually. When mild it is usually dull and deep, becoming throbbing or pulsatile when severe. Headaches are more often accompanied by nausea with or without vomiting. The attack may end after vomiting in some occasions. In many instances headaches get worsened by light, noise, constant motion, straining and physical activity. Migraineurs get relief with rest in a quiet darkened atmosphere on many occasions.
Migraine headache usually lasts for a few hours but may extend to a couple of days on some occasions.

About 20% of migraineurs experience an aura (warning sensation) before the onset of headache in the form of flashing lights or bright spots, zigzag lines, changes in vision, or numbness or tingling in the fingers, lips, tongue or lower face. Aura typically lasts for about five minutes and is followed by the onset of headache.

Triggers for migraine may vary from person to person and include exposure to sunlight, stress, certain hormonal medicines including birth control pills, menstrual periods, lack of sleep, hunger, physical exertion, perfumes and certain foods/chocolates that contain nitrites, glutamate, aspartate and tyramine.

DIAGNOSIS OF MIGRAINE

Migraine is mainly a clinical diagnosis and tests may be done in some instances to rule out other causes of headache. Treatment for migraine will depend on frequency, severity and duration of symptoms. Consult your doctor to establish the diagnosis of migraine. Take medications only when prescribed by your doctor. Do not self-medicate.

TREATMENT OF MIGRAINE

Pharmacological therapy would consist of acute treatment (to abort a headache) and prophylactic treatment. Acute treatment refers to medicines one needs to take when he/she suffers an acute headache to relieve the pain immediately. Prophylactic (preventive) treatment refers to medicines one needs to take on a regular (usually daily) basis for a finite period to prevent headaches/reduce frequency/intensity of headaches.

NON-DRUG THERAPIES

For acute headache management

– Try to relax and try deep breathing.

– Stop excessive exertion, if any.

– Eliminate triggering factors like sunlight/loud noise immediately, Catch up with skipped meal, if any.

– Rest or sleep for two-three hours, preferably in a quiet, dark surrounding

PREVENTIVE MEASURES

– Change your lifestyle.

– Identify triggers and avoid them.

– Restrict physical exertion on a hot day.

– Exercise: Strenuous exercise may precipitate migraine in some patients but gradual increase in exercise is usually beneficial.

– Eat on time and do not miss meals.

– Limit consumption of tea, coffee and analgesics as they may cause rebound headache.

PSYCHOLOGICAL MANAGEMENT

Open discussions of patients’ problems between patient and doctor helps the doctor to guide the patient to deal effectively with stress and inevitable fluctuations in life.

– Relaxation and biofeedback technique are beneficial.

– Meditation and yoga may help.

– Avoid/eliminate items which may trigger attack like alcohol, particularly red wine.

– Avoid sleeping (later than your normal hours of working) during weekends, as this often causes a ‘let-down’ headache.

STRESS AND MIGRAINE

Address stress effectively as there is an increase in frequency of migraine headaches in stressed individuals. Spread workload evenly to avoid peaks and troughs of stress as it can trigger migraine.

HEADACHE DIARY

People who have frequent or severe headaches may benefit from keeping a headache diary over the course of one month. This can be used to determine what triggers the migraines and what makes them better.