Migraine
Migraine is a type of severe headache that often affects one side of the head. It may be accompanied by nausea, vomiting or increased sensitivity to light. They are one of the most common types of headache.
Who gets migraines?
Migraines affect about 15 percent of adults. They tend to run in families, and are about twice as common in women than men. Migraines also affect around four percent of children, but they are most common in adults aged between 20 and 50.
Migraine symptoms
A severe migraine attack can cause a persistent throbbing or pounding pain, with sensitivity to light, sound and movement. The pain may be on just one side of the head, though there may be pressure on both. Attacks last between four and 72 hours. You may also feel nauseous, be sick, have diarrhoea, or feel exhausted.
Some migraines can cause other neurological (to do with the brain) symptoms - called aura. These are usually visual disturbances that start before or accompany the headache, including flashing lights, black spots, zig-zag patterns or distorted vision. You might also get a stiff neck, have tingling or stiff limbs, or have difficulty speaking.
For many, the symptoms are so severe that they are forced to lie down in a quiet dark room and wait until the migraine stops.
What causes a migraine?
Although the cause of a migraine is not fully understood, most sufferers probably have a genetic predisposition to them. About 80 percent of people who have migraine headaches have a family history of migraines.
It used to be thought that the aura and then headaches in migraines were caused by blood vessels at first contracting and then expanding (dilating) in the brain. However, recent research suggests that migraine symptoms are caused by changes in the activity of neurones (nerve cells in the brain), and that changes in blood vessels happen as a result of this. A chemical messenger in the brain - serotonin - is also thought to be involved in migraine.
In women who suffer from migraines, hormonal changes may also play a part. Some women get menstrual migraines - migraines that only happen in the days before, during, or immediately after a period. Many women have their first migraine in the same year as their first menstrual period.
Migraine triggers
Some people find that their migraines are triggered by something. Some example triggers include:
- certain foods such as chocolate, cheese, citrus fruits, coffee, tea
- alcohol
- too much or too little sleep
- changes in hormone balance in women - such as periods, the pill, menopause and hormone replacement therapy
- emotional stress, or relaxation after a period of stress
- irregular meals
- physical activity
- smoking
- bright or flashing lights
- loud noise
- weather - high pressure conditions, changes in pressure, hot dry winds, change of season and exposure to sun and glare
- intense smells such as paint, fumes from cars or perfume
Unfortunately, avoiding triggers is not always possible, and even then this may not prevent an attack - most migraines have no obvious identifiable trigger.
Migraine types
There are two main types of migraines.
Migraines without aura (common migraine)
The headache comes on quite suddenly, without any warning at all. There are the usual migraine symptoms - headache, sickness, sensitivity to light, sound and smell - but there are no aura symptoms. Movement makes the pain worse.
Migraines with aura (classic migraine)
According to the Migraine Action Association, about 1 in 10 sufferers experience aura with migraines. People who get migraines with aura sense when an attack is coming on. They may feel tired, thirsty, hungry, euphoric or excited. Nervous system symptoms - called an aura - usually develop before the migraine symptoms.
These may include:
- visual disturbances such as seeing flashing or flickering lights, zig-zag lines and even temporary blindness
- numbness
- dizziness
Occasionally, symptoms can be more severe - including partial paralysis, difficulty in speaking, confusion, or fainting. Aura symptoms usually settle down within an hour. Some people get the aura without the subsequent headache.
When to see a doctor
It is possible that migraine symptoms are caused by something more serious. See a doctor if you experience any of the symptoms below.
- Aura symptoms that are always on the same side of the body, or last less than five minutes or more than an hour.
- Aura symptoms without a headache.
- A sudden change in the character of your migraine such as attacks coming more often, or treatment not working.
- Headache after you exercise.
- Your first ever attack when you're over 50.
- Stomach pains with the headache.
- Nervous system problems - difficulty in walking, or disturbance of vision between attacks.
- A high temperature with the headache.
Treatment
Over-the-counter medicines
Mild migraine attacks tend to clear up in a few hours. It's best to rest in a quiet, darkened room, and use the painkiller that you would normally take for a non-migrainous headache. Soluble versions of these painkillers may work better than tablets. Take it as soon as you can - treatments for migraine are more effective when you take them early on in an attack.
You might also find that over-the-counter preparations containing the anti-sickness drug buclizine (eg Migraleve) help reduce nausea and sickness. This means that the painkillers can be better absorbed by the body. Ask your pharmacist for more advice.
If these treatments don't help it is worth seeing your GP. You should also contact your GP if you find that your attacks suddenly change in nature, become more frequent, or if any symptoms carry on between attacks.
Prescription-only medicines
There are other treatments for migraine that your doctor can prescribe. The medicines metoclopramide and domperidone can be used to treat nausea and vomiting. They are often combined with over-the-counter painkillers.
Non-steroidal anti-inflammatory drugs (eg ibuprofen or tolfenamic) are sometimes used to treat the headache, and they can also be combined with drugs which reduce sickness.
If standard painkillers don't stop the pain, your doctor may prescribe you triptans such as sumatriptan, fovatriptan or zolmitriptan. These work by correcting the serotonin imbalances in the brain. Response to triptans varies between individuals - you may need to try out different types before finding the most effective one for you.
Triptans are available as tablets, injections, nasal sprays or dissolvable wafers. They shouldn't be used by people who have had a heart attack or stroke, who have high blood pressure, or who are taking certain medications - your GP will be able to give you more information. Some people get side-effects from these drugs, such as dizziness, a feeling of pressure in the neck or chest area, nausea and vomiting.
Other treatments
Some people find that non-drug treatments help, although there's little evidence that they work. Some examples are listed below.
- Keep a diary. It can help to try and identify, track and avoid triggers.
- Specially tinted glasses. Evidence is lacking but some find that wearing these reduces or prevents migraine attacks.
- Dental splints. Teeth grinding and clenching your jaw may trigger attacks. A dental splint can be worn overnight to try and reduce this.
- Physiotherapy helps some but, again, there is little evidence.
- Relaxation therapy. By being less stressed some find that fewer attacks are triggered.
- Temperature change. For some, pressing an ice pack or hotwater bottle where it hurts, helps.
- Acupuncture. Some research suggests that acupuncture may be helpful for migraines, but the evidence is not conclusive.
Recent evidence also indicates that migraines are more common in people with depression, and that depression is more common in people that suffer from migraines. Researchers are investigating whether treating depression can help relieve migraines and vice versa.
Preventive drugs
If avoiding triggers doesn't help, and you continue to get severe migraines, you may want to discuss with your doctor taking a daily preventive treatment.
These include:
- beta-blockers, such as propanolol
- tricyclic antidepressants, such as amitriptyline
- some anti-convulsants, such as topiramate or valproate
- the antihistamine pizotifen
Many women find that migraines get worse as they reach the menopause. Some find that hormone replacement therapy helps, but for others it makes it worse.
Whatever the approach, it will take some time, and support from a doctor, for each individual to find a treatment that best helps manage their migraines.
Some of you may ask why is this important. Some of you might say that it is just like having another headache. It is true that you will not be able to distinguish between migraine and the 'normal' headache when you have it, and in most cases, you might just choose not to care. Makan panadol saja bah, you thought. Indeed. However, it is good to know where its coming from. If it recurs, then you know what to do.
Oh ada lagi!
What is the difference between a headache and a migraine?
It is not always easy to distinguish between the two, as there may be an element of both muscle tension and a vascular component in both headaches and migraine. In many cases, migraines are more severe than headaches, and are often accompanied by visual disturbances or nausea. Normal headaches will often respond to over-the-counter medications, whereas migraine is often severe enough to require prescription medication.
Ok? I hope these informations can help you in the future. :D
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