Migrained Headache

Migrained Headache

Migraine is an ailment that affects millions worldwide. It affects people of all races and gender, and the social and economic implications are tremendous. It has been estimated that in the USA, US$5 to $17 billion is lost in productivity per year due to migraine alone. The healthcare costs for treatment of migraine alone runs to millions in the USA.

Just how common is migraine? It is estimated that countries such as Norway and the US have estimated a prevalence of between 11-18%. Migraine is more common in women - in almost every community-based survey of migraine prevalence, the ratio of females to males suffering from migraine is about 1.5 to 1. We have come a long way from the time when headache and migraine were thought to be due to "evil spirits" trapped within the head. Exorcism of the spirits was then believed to be achieved by drilling a hole in the skull to let the spirits out. Naturally, this drastic treatment proved to be rather unpopular!

We know that migraine is more complicated than that. There are certain individuals who are more prone to migraine - it is believe that these individuals have an altered migrainous threshold that makes them more susceptible to migraine headache. Genetics may play a role in the migraine threshold. Persons with a lower threshold may be more prone to environmental triggers that may set off an attack, such as certain food types, stress or menstruation in women.

Symptoms of Migraine

The International Headache society divides migraine into 2 main groups - migraine with aura and migraine without aura. Common to both is the presence of headache, which is often one-sided and of a pulsating quality. Bilateral headaches, however, are certainly not unknown in migraine. The headache is usually of moderate to severe intensity, and may be associated with nausea and vomiting. The headache usually lasts between 4-72 hours.

Aversion to light and sound is also a feature of a migraine headache. The patient often has to lie down and rest for relief. Other features such as irritability, a sensation of light-headedness and nasal congestion may also be present. Some migraine patients have migraine with aura. The aura precedes the headache, and this often lasts 10-20 minutes. The most common type of aura is the visual aura, which can be varied.

Some people report seeing flashes or sparks of light, while some others report a scotoma, or a "hole" in their vision, which may be surrounded by a shimmering rim or light. Still others report visual hallucinations shaped like the jagged walls of a fortress, termed "fortification spectra". Besides the visual aura, other rarer types of aura exist. Some migraine sufferers report tingling or numbness over one side of their body, while others report weakness of one side. Speech disturbances are rare but have been reported. Regardless of the type of aura, the symptoms almost always resolve completely with time, though in very rare instances, the neurological abnormality may remain. After 4-72 hours, the headache gradually resolves. During this resolution phase, patients often feel tired and may have little appetite.

Can other diseases simulate migraine ?

Generally, the most important factor in the diagnosis of migraine is taking a good history from the patient. There are of course other more serious conditions, such as bleeding into the brain, brain tumors or infections of the brain that may superficially resemble migraine. However a closer examination of the patients symptoms will often yield clues that will tell the physician that it may not be migraine after all. Some of these clues are:

a) Sudden severe headache

b) Headaches associated with persistent fever

c) Headaches accompanied by drowsiness or confusion

d) Progressively worsening headaches

e) Headaches associated with persistent neurological signs such as double vision, weakness of limbs, or fits.

These clues are known as "red flags" as they tell us that there may be a more sinister and dangerous diseases lurking behind the seemingly innocent facade of headaches. To put things in perspective however, such sinister conditions are uncommon. By and large, most patients with headache have either migraine or tension headaches, and less than 1% have sinister conditions.

Treatment of Migraine

However, if "red flags" are causing the physician to be concerned, then a CT scan of the head may be done to exclude such potentially dangerous conditions. It is not feasible nor cost-effective to do a CT scan for every patient with a headache, as the majority of CT scans will not reveal any major abnormality. The treatment of migraine does not just depend on drugs alone. Besides medication, a wellness program should also be concurrently initiated.

It is important to modify one's lifestyle to avoid migraine triggers such as stress, lack of sleep and smoking. Relaxation techniques and biofeedback may also help to reduce migraine. Food triggers such as alcohol, chocolate or food containing high levels of MSG may have to be avoided. However, as each person's trigger varies, this has to be individualized. Restrictive diets are rarely necessary, and the modifications in food should not be too drastic.

Migraine is a common disease that affects a significant percentage of the population. We are indeed fortunate to have medical insights and new drugs that are able to treat migraine more effectively. New research is ongoing to hopefully help us in unlocking the mysteries of migraine, so that we are better able to lessen the socio-economic and healthcare burden of this common disease.

How to treat Migraine ?

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