World Brain Day 2019: Headache is the most common region for medical attention. Life-threatening headache is relatively uncommon but needs urgent treatment. Migraine is more common in adults than children and women than man. Migraine is not life-threatening but significantly interferes with the patient’s daily routine. In migraine, headache is episodic, recurrent and starts with half of the head, throbbing character and may be associated with nausea and vomiting. The patient is sensitive to bright light and loud sound. In some patient, migraine is activated by specific triggers. The brain of migraine patients is particularly sensitive to environmental and sensory stimuli. A family history of migraine is the potent and consistent risk factor for migraine, with a two – to – three-fold greater chances of migraine among relatives of people with migraine.
There are several migraine triggers
- Stress at work or home.
- Lake of sleep, jet lag
- Physical exertion
- Hormonal changes in women
- Alcohol especially wine
- Strong odors – perfumes
- Medications – OCP, vasodilators.
Change of weather
Food containing tyramine may provoke migraine – cheeses, yogurt, banana, vinegar, beans and peanuts. Among all the triggers of migraine stress – mental tension is the most common and potent risk factor for migraine. The stress may be of different kinds like- tension at work, marriage or relationship problems, financial problems, switching jobs or struggling to balance work and life.
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Tips to manage stress-induced migraine
- Try to identify the types of stressful situation triggering your headache and take steps to avoid them.
- Get adequate night sleep.
- Do regular exercise for at least 30 mints.
- Do relaxations techniques like meditation.
- Eat healthy food.
- Do time management.
- Make good social and family relations.
- Sharing your stressful condition with your near and dear.
- How to differentiate between a headache and a Migraine
The patient who presents with new-onset, severe headache has quite different causes than the headache which is recurrent and occurring for many years. In new-onset - severe headache, the underlying cause may be serious or even life-threatening. Whereas recurrent chronic headaches are usually not life-threatening but maybe quite disabling, affecting day to day functioning and may hamper the quality of life.
Migraine is a very common disorder in which the patient is having an episodic, recurrent and usually unilateral headache, often a pulsatile character may be associated with nausea and vomiting. It may begin in childhood but usually begins in adolescence or early adult life in 80% of the patients. Its frequency decrease with advancing age but it may worsen in some postmenopausal women. Activation of the trigeminovascular system, leading to an inflammatory response that is generated by local neural mechanisms have been assigned a role in migraine headache. In migraine patients, it has been found in PET scan that there is activation of an area in pons during the attack.
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Mainly migraine is of two types
- Migraine with aura (classic migraine): Patients may have an aura before the onset of headache. An aura may be in the form of visual disturbances with flashes of light or zigzag lines or other neurologic symptoms. Migraine with aura, frequently occur after awakening but may occur at any time of the day
- Migraine without aura (common migraine): In these patients, there’s no aura before the onset of headache. It is five times more common than the classic Migraine
Common Features of Classic & Common Migraine
- Either type of migraine may be preceded by vague premonitory changes in mood and appetite
- Sensitivity to bright light, loud sounds or smell and headache increases with head movement, are seen in both types of migraine
- Family history is seen more commonly in classic migraine than common migraine
- One-third of migraine patients have more than three attacks in a month, if untreated the frequency increases so need medicines
There are several migraine triggers, including:
- Drinks - alcohol, especially wine, and too much of coffee
- Sensory stimuli - Bright lights and sun glare, loud sounds. Strong smells - perfume, paint thinner
- Sleep changes - Lack of sleep, jet lag can trigger migraines in some people
- Weather changes - Change of weather or barometric pressure can prompt a migraine
- Foods - Cheeses, chocolates, and coffee might trigger migraines. So might skipping meals or fasting
- Food additive- a sweetener and the preservative
How To Differenciate between Migraine & Normal Headache?
- In migraine, headache is usually episodic, starts with half of the head, throbbing type of headache and associated with nausea and vomiting. Whereas common headache is generally because of stress & it affects both sides of the head and it is usually dull, stretching type of headache. This is not associated with nausea /vomiting/ photophobic/ Sensitive to light and sound
- A family history of migraine is the most potent and consistent risk factor for migraine, with a two-to-three-fold greater chance of migraine among relatives of people with migraine whereas in common headache family history is not relevant
- In some of the patient’s migraine is activated by specific triggers whereas in common headache there’s no such trigger
- Migraine needs specific treatment and management whereas in common headache may be managed by lifestyle modifications & some painkillers.
(About the author: Dr. Jaideep Bansal, Director, Dept of Neurology, Fortis Hospital, Shalimar Bagh.)
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