Migraine headaches

Introduction
Of all the painful states that afflict humans, headache is undoubtedly is the most frequent and rivals backache as the most common reason for seeking medical help. In fact, there are so many cases of headache that special headache clinics have been established in many medical centers. For an intelligent person, there is greater concern about what happens to the head than to other parts of the body, since the head houses the brain and headache frequently raises the question of brain tumor or other brain disease.

What do you mean by migraine?
Migraine is a familial disorder characterized by periodic, commonly unilateral (one side of the head) headache, which begin in the childhood or early adult life and with diminishing frequency during old age. The French word migraine is said to derived from megrim.

What are the types of migraine?
There are two types of migraine:

1. Classic migraine-migraine with aura (aura is the warning symptom that the patient gets before headache)
2. Common migraine-migraine without aura.

Common migraine is the one, which occurs most frequently, and the ratio to its classic counterpart is 5:1. Migraine is remarkably a common condition. It is present in 4-6 percent among men and 13-18 percent among women. Usually it starts before the age of 30 years.

Is there any provoking cause for migraine?
Some patients suffer from migraine while taking some particular foods like chocolate, cheese, fatty foods, oranges, tomatoes and onions. Alcohol, particularly red wine regularly provokes attacks in some patients. Noise and sudden movements of the head also causes headache. Stress and tension also triggers the attack.

What are the common symptoms of migraine?
Classic migraine patients frequently have mood changes, hunger or loss of appetite, drowsiness and frequent yawning. Then they have sudden flashes of light while seeing (photopsia) formations of dazzling zigzag lines (arranged like the battlements of a castle, hence the term fortification spectra). Some patient may have blurred or cloudy vision. Some may have tingling sensation or numbness over the face lips and hands; weakness of limbs, dizziness or drowsiness. Nausea and vomiting may occur. The headache lasts for hours and sometimes even for a day. Between the attacks the migraine patients are normal.

Many variations of migraine can occur:

• The headache may be exceptionally severe and sudden in onset. It is called crash migraine.
• A less common form of migraine with predominant brain symptoms is called basilar migraine. Patient is usually a young woman with giddiness, vertigo, weakness of all the limbs and difficulty in speaking and bilateral blindness.
• Opthalmoplegic migraine is the one with unilateral headache and weakness of the muscles of the eye. Here the patient has difficulty in moving the eyeballs normally.
• A trouble some migraine can occur in the childhood following head injury.
• Hemiplegic migraine occurs in child or adult and there is weakness of one side of the body with headache and it recovers by itself after the episode of headache.
• Sometimes stroke may occur with headache.
• True menstrual headache is the one, which women get during their attacks in the perimenstrual period.

What are the available treatments for migraine?
Treatment of migraine maybe subdivided into two parts- one to control the individual attack and the other to prevent the attacks. Treatment should be started immediately at the onset of headache. In mild cases acetaminophen is sufficient. In treating acute severe attacks of migraine, the ergot alkaloids like dihydroergotamine and sumatriptan is used. Newer drugs like zolmitriptan and rizatriptan can also be used. Elderly patients should be cautious while taking there drugs and pregnant women should not be given these drugs.

How to prevent migraine?
For prevention, drugs like propronolol,clonidine are useful. Amitriptyline can also be used. Flunarizine is the most effective among all the drugs. If the patient has hypertension it should be controlled, oral contraceptives should be discontinued and dietary modification (for example red wine can be avoided if it precipitates attack) will help in preventing migraine attacks. Yoga and meditation may be helpful.

Did you know?
Of all the painful states that afflict humans, headache is undoubtedly is the most frequent and rivals backache as the most common reason for seeking medical help. In fact, there are so many cases of headache that special headache clinics have been established in many medical centers. For an intelligent person, there is greater concern about what happens to the head than to other parts of the body, since the head houses the brain and headache frequently raises the question of brain tumor or other brain disease.