Migraine Headache

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What is Migraine?

Migraine is a form of throbbing, debilitating headache, the worst a person could have. It may last from four to 72 hours, affecting one or both sides of the head, moderate to severe in intensity, associated with nausea or vomiting, and with increased sensitivity to smell, light, loud music or noise, and aggravated by exertion. While migraine affect both genders, even during infancy, it is more common in adult women and most frequently starts between 5 and 35.

What causes Migraine?

The cause is not known. What seems clear is that there are blood flow changes in the brain cortex during an attack of migraine: vasodilation (opening up) of tiny blood vessels in the brain, followed by inflammation and irritation of the tiny nerves around the small blood vessels. Some theorize the opposite: vaso-constriction (clamping down) of the vessels in the brain leading to reduced blood flow and diminished oxygen supply to the cortex of the brain. A cascade of events then ensue in either scenario that ignite the severely disabling headache into a full blown migraine.

What triggers migraine?

The mechanism in the development of migraine is not clear, but there are triggers known to the clinician. Cycling estrogen is one, and this probably explains why women are affected 3 times greater than men, and why estrogen replacement therapy for postmenopausal women usually makes migraine worse. The other triggers are smoking, barometric pressure (altitude) changes, hypoglycemia (hunger), insomnia, stress, fatigue, flickering or glaring light, certain foods or the weather.

What foods can trigger an attack?

This depends on individual reaction to certain foods. Some people develop migraine after Yogurt, lima beans, nuts, dishes with MSG (taste enhancer), others sufferers do not. Some scientists postulate that migraine could be precipitated by foods that contain tyramine and by some cold medications, both of which can constrict arteries, or it could be an allergic reaction to these foods and medications.

What are the symptoms of migraine?

There are two types of migraine: classic and common. The classic form is the one preceded by a prodrome or an "aura" ten to 30 minutes before it strikes. The prodromal symptoms may include temporary blindness, vision of flashing lights or zigzag lines, weakness of an arm or a leg, tingling in the hands or face, speech difficulty, and confusion. The pain is intense, pounding or throbbing, affecting the forehead, temple, around the eye, ear or jaw, and starting on one side but may spread to the other side, lasting for 1 to 2 days. The common migraine is labeled as such because it occurs more commonly in the general population. It has no "aura" although some people have a some vague symptoms before it sets in, like mood changes, mental fuzziness, fatigue, and even fluid retention and swelling. Nausea and vomiting, diarrhea and increased urination may be present during the actual headache phase. Common migraine may last 3 to 4 days.

Can migraine cause paralysis?

Yes, among patients who have what is termed as Hemiplegic Migraine, where a temporary form of paralysis of one side of the body occurs during the attack. Some may have vertigo, and or double vision. In the Status Migrainosus type, which is rare, the very intense headache can last up to 72 hours or longer, requiring hospitalization. Many of these patients were depressed and anxious before the event occurs. The Headache-Free Migraine does not cause any pain but patients have dizziness, nausea, vomiting, fever, constipation, or diarrhea.

How is Migraine diagnosed?

The history, clinical presentation (symptom pattern), and the absence of any evidence of intra cranial pathology (diseases in the brain), are the most important information needed to make the diagnosis of migraine, especially when a family history of migraine is present. No tests will clinch the diagnosis, except exclusion of other causes of headaches. This is why consultation with a physician is important. In the United States there are now Headache Clinics and Headache Specialists, who treat nothing but headaches.

Why do bright lights or noise aggravate migraine?

The over sensitivity of the patient to external stimuli brought on by migraine makes bright lights, noise, loud music (or even some odor or aroma of food) irritating to persons having an attack of migraine. The perception of all these are so magnified out of proportion that they make the sufferer hurt more.

Is it true some migraine patients have committed suicide?

Yes, there are reports to this effect. The very severe excruciating and intolerable pain in the head has led some patients to bang their head against concrete walls, leading to serious, even fatal, head injuries. And some people have committed suicide because they could no longer take the torture from the recurrent exquisite migrainous headaches. Luckily for us, nowadays, there are more effective treatment regimen to help migraine patients.

What is the modern regimen?

One of the drastic forms of therapy for migraine during the Stone Age was cutting with flint instruments pieces of the skull of the patient for relief of pains. In the 19th century in the British Isles, the patients were given a vinegar cocktail of cow's brain, juice of elderseed and goat's dung (manure). Compared to those, suicide might seem to be a more pleasant alternative. Fortunately today we have drug therapy, stress management, biofeedback training and activity/diet control (keeping a migraine diary to keep track of what activity or food to avoid to prevent migraine attacks). Prevention of hypoglycemia (low blood sugar from hunger) among migraine patients helps control the occurrence of an attack. Abstinence from cigarettes also minimize migraine attacks. Regular exercises (ballroom dancing, vigorous walking, swimming, aerobics) can also minimize the severity and frequency of attacks. Once the migraine sets in, those same activities will aggravate the pains. Yoga or whirlpool baths, other relaxing activities also help prevent attacks. During the attack, the patient should be alone in a dimlit and quite room, with just the right temperature. Cold compress over the painful throbbing part of the head, or pressure on the pulsating artery by the temple helps. There are two strategies in the use of drug therapy for migraine: one set for prevention and the other for relief. The drugs to prevent attacks should be taken at the first sign of a headache. Even simple aspirin or acetaminophen may help at the onset (as a first step) to minimize the pain, and antidepressants have been prescribed for prevention. Personal discipline plays a major role in preventing, or minimizing the attacks of migraine. For the actual relief, a variety of medications are now available also, starting from the different formulations of Ergotamine Tartrate. Since treatment has to be individualized, migraine sufferers should consult with their physician for a personalized and comprehensive management. Outlook for migraine victims today is much more hopeful, much better and more pleasant than it was decades ago.

©2003Raoul R. Diez, M.A.O.D.