Beating the migraine

Migraine is the most common disabling headache disorder, which presents itself with recurrent attacks of headaches. During attacks, patients suffer from headaches which are moderate to severe in intensity, along with nausea and sensitivity to light and sound. Because of these, they are unable to carry on their routine work. Also, in between attacks, there is an enduring predisposition to future attacks and anticipatory anxiety.

Migraine is seventh in the list of causes of years of life lived with disability as per the data from Global Burden of Disease Study 2010. Migraine surprisingly appears ahead of many chronic disorders in the list of disabling diseases. It is actually a chronic disorder with episodic attacks usually beginning at the age of 20-30 years in majority and producing maximum disability during the peak productive years of life. Not only is it more prevalent in women, but also associated with greater symptomatology, higher disability and impact, and poorer quality of life than in men.

Treatment of migraine consists of treating an acute attack of headache which has already started and preventing the recurrence of attacks. Majority of patients do not require brain scans with CT or MRI, unless the treating doctor strongly suspects another disease which may mimic migraine. Unfortunately, not many people know that migraine is a treatable condition and that they need not suffer in silence and darkness. With the right medical support and slight modification in lifestyle, a migraineur can live easily with prolonged migraine-free days.

Ways to treat an attack

The method of treatment depends on the severity of the attack of headache, the time it takes to peak and expectations of patients. We have choice of agents which can be taken as tablets, injections, nasal or oral sprays or patches which can be applied on the body part. Usually, simple analgesics like Diclofenac, Ibuprofen, Naproxen and Paracetamol will help majority of patients and are tried at first. If a patient’s headache is severe and s/he requires instant relief, a specific class of agents called as triptans can be used. These can be administered orally, by injection or by nasal/oral sprays. They are a little expensive and the treating physician will decide whether it is safe to administer them to a given patient.

Prevention

Whenever a patient gets three to four attacks of headache per month with severe or frightening symptoms associated with them (weakness of limbs/visual blurring), prophylactic medications to prevent the recurrence of attacks are used. They are helpful in 50-80% of patients in reducing the attacks of headaches, severity and associated symptoms. Depending on the patient’s demographic profile and associated co-morbid diseases, the doctor will choose an agent with least side effects, best suited for a given patient.

These medicines are started in low doses and gradually increased to get desired effects. Other general methods when used which will help in reducing the attack frequency aren Avoiding known triggers: This one is probably the best known remedy for migraine. Every individual migraine sufferer has their own set of specific triggers that can initiate a migraine headache. By accurately knowing these triggers and avoiding them, one can prevent the attacks of migraine.

Staying hydrated: Dehydration is one of the major reasons for a headache along with migraine headache. Drinking ample amount of fluids, especially water, is beneficial in avoiding a migraine headache due to dehydration.

Stop popping headache pills: The first thing people do when they get a headache is pop a pill without medical supervisions. Medication overuse is one of the reasons for headache and limiting the intake of pills to cure headache can in fact help in reducing the frequency of migraine headache.

Limit stress and get enough rest: Stress is the number one cause of most of the modern day disorders and is also considered one of the strong triggers for migraine. If you are a migraineur and often suffer from a headache due to stress and overwork, then try techniques that will help you cope with stress, such as yoga, breathing exercises, meditation etc. Getting adequate and good quality sleep, eating nutrient-rich food on time and limiting stress will go a long way in treating migraine headaches.

(The author is additional professor, neurology, NIMHANS, Bengaluru)