How do you Identify Migraine Headache?

Migraine is a complex genetic disorder. Exact cause of headache is not known.

The type of headache patients feel is:

1.      It is a sudden attack of headache. Pulsating type and of moderate to severe intensity.

2.      In most of the cases only one side of head is affected.

3.      The attack lasts for 4 hours to 24 hours.

4.      Migraine Pain increases by routine physical activity (eg, walking or climbing stairs).

5.      During headache, patient feels vomiting sensation. They also try to avoid light and sound.

6.      In between two headache attack episodes, patient is pain-free in most of the cases.  

Other symptoms that may be associated with Migraine (Aura symptoms)

1.      Among all Aura symptoms, visual aura is the most common. One side of the vision is usually affected and gradually gets bigger over 5-20 minutes. Examples include- a temporary loss of part of vision or experiencing a bright flashing light (often in a C-shaped pattern) or zig-zag lines. Some people may feel that objects or letters on a page has started to rotate, shake, or boil.

2.      Second most common type of migraine aura is experiencing numbness and pins and needles of upper part of the body. Numbness usually starts from the hand. It then travels up the arm and then involves the face, lips and tongue. The leg is rarely involved.

3.      Speech Problem is the third most common type of migraine aura. Other associated symptoms may be vertigo, tinnitus, or slurred speech (brainstem aura). It is specifically named as basilar migraine.

4.      Some other types of migraine aura symptoms include an odd smell, food cravings, a feeling of well-being, and other odd sensations.

 You may experience one or more of the migraine auras listed above. They typically last for a few minutes but can go on for up to an hour. The aura usually fades before the headache starts. The headache can come on anytime within an hour of the aura ending, and sometimes right after it. In some cases, you may only have the aura without the headache (silent migraine). If you have migraine with aura, you may also get migraine without aura at other times.

Prevention of attack by avoiding triggers

Some people have migraine attacks without any clear cause. However, certain things may set off migraine attacks in others. These triggers can vary widely. For example:

Diet: Rapid weight loss by extreme dieting, skipping meals, or consuming cheese, chocolate, red wine, citrus fruits, foods with a food additive called tyramine and not drinking enough water (dehydration) can trigger migraine attack.

Environmental. Tobacco smoke, bright light, computer screens or flashing TV sets, loud noises, strong odours etc. can also serve as trigger factor.

Psychological. Depression, anxiety, anger, fatigue, stress, etc. Some people with migraine handle stress well but have attacks when they unwind, resulting in weekend migraine.

Medicines. Hormone replacement therapy (HRT), some sleeping pills, and the birth control pill can act as precipitating factors.

Other causes. Starting of Menstrual cycle every month, shift duties, changes in sleep patterns, and menopause.

Treatment:

Treatment protocol is influenced by the severity of the symptoms, how frequently they occur, and whether the patient has nausea and vomiting. Oral medicines are usually prescribed under two headings. One is daily treatment, and the other is for the attacks only. Commonly used drugs are Paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS), Triptans, Anti epileptics etc.

Botulinum Toxin injections

This option is chosen when medicines do not work anymore. Patient is experiencing headache for more than 15 days a month.

Other interventions that may be useful in individual cases

Sphenopalatine ganglion block

Dr. Chinmoy Roy is a well-known pain expert and author of multiple medical books who is available at Rajarhat Pain Clinic, Newtown, Kolkata. He has an extensive experience of using Botulinum Toxin for Migraine treatment.