Understanding this disabling headache called migraine » Manila Bulletin Lifestyle

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By Eduardo Gonzales, MD

Every few months, I get an attack of severe migraine headache that is preceded by about half an hour with blurring of vision. My headache is so severe that I am completely bedridden and I often want to bang my head on the wall. What causes this headache? Please discuss this condition in your column. —luisa_psg@gmail.com

Migraine is a primary headache disorder, which means, in migraine, the headache is not the symptom of an underlying disease but is the disease itself. Migraine headache varies in location, character, intensity, and duration from person to person and from one migraine attack to another in the same person, but typically, it is characterized by a moderate to severe throbbing or pulsating pain on one-side of the head that is aggravated by physical activity, coughing, straining, sounds, odors, and light.

A migraine attack, as you can attest to, is often very disabling and is usually accompanied by an assortment of other signs and symptoms including loss of appetite, nausea, vomiting, numbness, tingling, weakness, dislike for sound, light and certain smells, temporary paralysis of a limb, ringing of the ear, speech difficulty, temporary blindness, confusion, and disorientation.

Migraine where the headache is heralded by an aura, as in your case, is referred to as classical migraine. The aura often consists of a visual disturbance like blurring of vision, or perception of flashes of lights, halos, stars, blind spots, etc. Most migraines however have no aura. Ironically, there is also such a thing as headache-free migraine, where there is an aura but noheadache.

What causes migraine?

Migraine is a poorly understood condition that is characterized by a series of complex changes in the blood flow to certain areas of the brain. These changes include initial narrowing followed by widening of some blood vessel, which is believed to activate nearby pain receptors and give rise to headache.

The cause of the neurovascular changes in migraine is unknown, but geneticand environmental factors appear to play a role in their development. Migraine, which is three times more common in women than in men, runs in families.

Clinical course of migraine

The onset of migraine can be at any age, but the attacks usually start during adolescence or early adulthood. The attacks peak when the person is in his/her 30s, and gradually become less severe and less frequent in the following decades.

A migraine attack is generally triggered by any of a variety of conditions including emotional or physical stress, lack or excess sleep, hunger, intake of certain foods (e.g., MSG, chocolate, cheese), alcoholic beverages, and coffee, certain smells such as perfume, smoke, and paint thinner, intake of certain medications such as oral contraceptives and vasodilators, exposure to intense light or glare as well as loud sounds; changes in weather, altitude or time zone, and, in women, the drop in the blood level of the female hormone estrogen that occurs before menstruation.Most migraine sufferers know their trigger/s.

During an attack of migraine, the headache and other symptoms typically increase in intensity over a period of one to two hours before gradually and spontaneously subsiding within a few hours. Occasionally, however, the headache persists up to 24 hours or even days.

The frequency of migraine attacks vary from once every several months or years to several times a month. Rarely, migraine becomes chronic, i.e., the attacks last for 15 or more days a month for more than three months.

Treatment for migraine

There is no cure for migraine but attacks can be relieved and prevented. Mild migraine headache can usually be relieved by over the counter pain relievers such as acetaminophen and ibuprofen. Severe attacks, however, may require prescription medications such astriptans and antidepressants known as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).

Other measures that help ease the symptoms of migraine include resting in bed in a dark and quiet room and applying cold compress over the affected area. Incidentally, a modality that many find effective in relieving migraine is acupuncture.

The best way to prevent migraine is by avoiding its trigger/s. Adopting certain lifestyle changes may also help prevent the disorder—regular sleep patterns, regular meals, regular exercise, and maintenance of a healthy body weight.

A variety of drugs to prevent migraine are also available, but these drugs are recommended only for people with frequent attacks (three or more a month) and should only be taken with doctor’s supervision.

Email inquiries on health matters to: medical_notes@yahoo.com

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