Headaches and Migraines
Headaches are one of the most common symptoms that can be experienced. Most people will experience a headache at some point of their lives. They can affect anyone regardless of age and gender. Headache is a broad term that comprises of many different things. Headaches are pains that occur in any region of the head; they can occur on both sides of the head or be isolated to a certain location.
Headaches are basically of two types-
1. Primary headache (Common)- migraines, tension-headaches and cluster headaches
2. Secondary headache (Bit rare) – These are caused due to underlying disease or occurrences such as dehydration, concussion, stroke, overuse of pain medication ( rebound headache)
Among all these headaches, migraine headache is widespread and one of the most troublesome.
What is Migraine?
A migraine headache is a condition of the nervous system, which is complex in nature. It is often described as an intense pulsing or throbbing pain at one side of the head. Migraine attackes amy cause severe unbearable pain for hours to days, hampering the daily activities.
This sort of headache is often accompanied by nausea, vomiting and sensitivity to light and sound. In some cases, patients may predict the start of a migraine, because they experience warning signs ( called aura). These warning signs include blind spots, zig-zag line, flashes of light, temporary loss of vision or tingling sensation in arms or legs. Migraine headaches result from a combination of blood vessel enlargement and release of chemicals from nerve fibers that coul aroung these blood vessels.
Migraines are more common in women than in men. It is a chronic condition and can occur frequently, multiple times in a week. These headaches, may begin at any time of the day, but its usual in the early hours. The onset of migraine usually occurs between the age group 8-35 years. It is a treatable disease but not curable.
Risk Factors for Migraine-
Though it is still unclear, but migraines may have a genetic cause. It is noticed that if your immediate family member suffers from migraine, you are at risk too. But, there are also other triggering factors. Such as-
! Menstruation or oral contraceptives
! Irregular sleep pattern, too much or too little sleep
! Hunger ( missed meals)
! Stress in personal and professional life
! Weather changes, high altitudes
! Alcohol or Red wine consumption
! Bright light, Loud noise or Strong odours.
! Foods containing tyramine ( aged cheese), preserved meats, excessive caffaine, etc.
Way of Diagnosis
You may be unsure, if you are experiencing migraines or some other headache. Hence, the International Headache Society has recommended a criteria to distinguish Migraine from others. It is known as '5,4,3,2,1 criteria'-
! 5 or more attacks
! 4 hours to 3 days in duration
! At least 2 unilateral(one-sided) location
! At least 1 additional symptom such as, nausea, vomiting, sensitivity to light, sensitivity to sound.
Treatment
There is actually no cure for migraine. But there are certain treatments. There are two ways to approach migraine through medications. Medicines taken during attacks to get relieved (acute treatment) or Medicines taken daily to reduce or lighten the pain intensity (preventive treatment)
Acute medications-
! Aspirin, Ibuprofen, naproxen or there combinations with aspirin and caffeine.
! NSAIDS or Narcotics ( Opoids )
! Vasoconstrictors such as egotamine ( Migranal )
! Preventive medications-
! Beta-blockers- Propranolol
! Anti-depressents- Amitriptyline
! Anticonvulsants- Neurotonin, Gabapentin
! Horomone therapy- for menstrual migraine in women
! Behavioural measures can also be option, if one doesn't ones to take drugs-
! Avoiding triggering foods
! Regular exercise
! Cognitive-Behavioural Therapy/ Stress management.
When to Seek a Doctor
Usually you don't need a doctors for the treatment of migraine unless it is hampering your lifestyle. But in some situations, immediate visit to doctor is a must, as signs and symptoms of migraine can sometimes be confused with those of a stroke. In any of the below mentioned situations, do visit a doctor-
! Headache is very severe
! Headache leading to fever
! Headache with stiff neck
! Sudden headache with high intensity of pain
! Trouble with movement, vision, speech or balance.
Rebound Headaches
This is also known as medication overuse headache. If one uses over the counter drugs or prescription drugs too often for headaches, it can worsen the scenario. Acute migraine can slowly progress to chronic migraine due to over use of drugs. It can create a headache-worsening pattern that results in more headaches and you need to take more medications. The only way to stop this pattern is consulting a doctor before starting medications and avoiding taking medications on wish.
The writer is Research Physician, Centre for Child and Adolescent Health (CCAH), ICDDR,B.
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