Everything you want to know about a migraine
Although it’s one of the leading disabling disease of mankind, migraine is still largely underdiagnosed and under treated. It is not surprising when patients are told they have migraine, and they tend to say “I have been living with this headache my whole life!” It is imperative therefore, that we understand that migraine is more common than perceived.
Migraine is a condition that causes severe throbbing pain or a pulsing sensation, generally on just one side of the head. It is accompanied by nausea, vomiting, extreme sensitivity to light and sound, and sometimes to strong odour.
This pain which is usually moderate to severe could last for days and can be so severe that the pain is incapacitating.
About a fifth of individuals will have warning symptoms known as aura but most people experience migraines without aura. Aura may occur before or with the headache. It can include flashes of light, blind spots, or tingling on one side of the face or in your arm or leg. In some individuals their maybe one sided body weakness that may be mistaken for a stroke.
Symptoms
Migraines may progress through four stages: prodrome, aura, headache and post-drome, though all stages may not occur.
Stage 1-Prodrome
This stage (one or two days before a migraine) is characterised by, subtle changes that warn of an upcoming migraine attack. The symptoms at this period include constipation, mood changes, food cravings, neck stiffness, increased thirst and urination, frequent yawning.
Stage 2-Aura
Auras originate from the brain and could happen before or during the headache. They are usually visual disturbances, such as flashes of light or wavy, zigzag vision. Occasionally, they manifest as pins and needles sensations in an arm or leg (ganzi), or as weakness or numbness in the face or one side of the body.
Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes.
Stage 3 -Headache
A migraine usually lasts from 4 to 72 hours if untreated. The frequency of headache attacks vary between individuals. Frequency can range from 1 in years, to several times a month. The pain of migraine headache starts form one side of the head and could involve both sides, while been made worse by movements and activities. The headache is pulsatile and could be very severe. This may be accompanied by nausea, vomiting, sensitivity to light or sound and lightheadedness, sometimes followed by fainting.
Stage 4- Post-drome
The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. During this period, which may last up to 24 hours, you may feel confused, moody, dizzy or generally weak.
Causes
Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.
Triggers
Migraine triggers include but are not limited to:
1. Hormonal changes in women: This is related to pregnancy, menstruation, menopause or use of hormonal medications.
2. Foods and drinks: Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks. Food additives such as sweetener (aspartame) and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines. including red wine and caffeine.
3. Stress at work or home can cause migraines.
4. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people.
5. Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
There are medications that can help prevent some migraines and make them less painful. The choice of the medication that best suites you will be made based on several factors such as your age. The right medicines, combined with self-help remedies and lifestyle changes, may help. You can be pain free!
The author is a Consultant Neurologist based at The Aga Khan Hospital, Dar es Salaam.
