What is migraine, signs, symptoms and management of migraine ?

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Migraine is an ill- health condition which affects people differently with presentation of severe headache felt as throbbing pain at the front or on one side of the head; and usually gets worse with movement. Migraine attack can cause significant pain for days; and the attack can be so severe that all that the sufferer thinks about is finding a dark and quiet place to lie down.

Migraine is a disorder that can negatively affect quality of life, economic status and productivity. It can increase the risk of mental health problems and death sequel to ischemic stroke or heart disease if not controlled early.

There are five distinct stages to a migraine attack, although not everyone goes through all the stages. The headache occasioned by migraine is mostly unilateral (affecting one half of the head) and pulsating in nature, lasting for 2 to 72 hours. Migraine pain is generally aggravated by physical activities. More than 60% of people with migraine headache experience forewarning of migraine attack (aura), manifesting as transient visual, sensory, language or motor disturbance which signals imminent attack of headache. Occasionally there may be little or no headache following an aura.

WHAT IS MIGRAINE

Migraine is a chronic neurological disorder characterized by recurrent moderate to severe headache and debilitating pain often in association with a number of autonomic nervous system symptoms. It is a state of abnormal health caused by spasm and subsequent over dilatation of some arteries of the brain, producing recurrent throbbing headache on one side of the head with some symptoms which clear as the headache develops. Migraine headache is a major health complex that is commonly accompanied by nausea, vomiting and extreme sensitivity to light and sound. Most times, migraine is preceded or associated with sensory warning symptoms (aura) such as flashes of light, blind spots or tingling in the arm or leg.

The frequency of migraine attack is variable. Specifically, it can be greater than 15 days or a month.  For an attack which is longer than 3 months and/or auras that are unusually long or unusually frequent, there may be an outcome of seizure or brain lesion. The exact mechanisms of action of migraine are not clearly defined; however, it is believed to be a neurovascular disorder. Also migraine is believed to be due to a mixture of imbalances in brain chemistry, environmental and genetic factors.

MIGRAINE PREVALENCE

Globally, approximately 15% or one billion of the population is affected by migraine at some point in their life span.  In women, migraine without aura is more common than migraine with aura, but in men the two types do occur at the same frequency.

Migraine headache often begins in childhood, adolescence or early adulthood.  Migraine affects more boys than girls before puberty  (15 – 24 years); and happens most frequently in women than men of 35 to 45 years of age. During adolescence, migraine is more common among women and this continues for the rest of their life span; and more elderly females than males are affected. The propensity for migraine attack usually decreases during pregnancy.

SIGNS AND SYMPTOMS OF MIGRAINE

There are four phases and seven subclasses of migraine with a wide variety of signs and symptoms. Not everyone experiences these signs and symptoms when they have a migraine, and all do not usually occur at once. Signs and symptoms commonly associated with migraine manifest as a combination of pulsating and throbbing pain on the neck, extending to the back or top of the head or one side of the head (usually lasting for 4 to 72 hours in adults and less than 1 hour in children). There are presentations of prostration- crave for rest in a quiet and dark room, stiff muscles or a tingling sensation like pins or needles in the neck, shoulders, limbs or the nose-mouth area of the same side of the body; and weakness of limbs.

Other signs and symptoms of migraine are nausea which makes one feel queasy and this may be followed by vomiting, photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound) and osmophobia (increased sensitivity to smell). Poor concentration or feelings of disorientation or off balance, very hot feeling (sweating) or very cold feeling and abdominal pain which can cause constipation or diarrhea are sometimes observed. There may be frequent urination, altered mood, depression or mild euphoria and fatigue or feeling of weakness or “hung over” which often lasts longer than one hour. Also noticed are, signs and symptoms of unusual craving for certain food, severe headache like a thunderclap, mental confusion for a few days after the headache has passed, seizures, ringing in ears and cyclical vomiting (occasional intense periods of vomiting).  Benign paroxysmal vertigo of childhood (occasional attacks of vertigo) and vision disturbances such as seeing various shapes, bright spots or flashes of light; even temporary blindness in one eye can occur. Migraine may present signs and symptoms that include numbness and speech or language disturbances, feeling of earth spinning, nasal stuffiness, swelling or tenderness of the scalp, sore feeling in the area of the body where the migraine occurred, lightheadedness, occasional fainting and feeling of been drained or washed out.

AVOIDABLE TRIGGERS OF MIGRAINE

It is very necessary for people prone to migraine attack to avoid workplace or home emotional triggers of stress, anxiety, tension, shock, depression and excitement. Physical triggers of poor quality sleep (missing sleep or sleeping too much), shift work, poor posture, neck or shoulder trauma, travelling for a long period of time, excessive exercise including sexual activity and low blood sugar should be avoided.

Migraine sufferers should avoid dietary triggers of lack of food (dieting), delayed or irregular meals, dehydration and excessive alcohol use especially beer and red wine. Also the food additive (tyramine), caffeine products such as tea and coffee, foods such as chocolate, citrus fruit and aged cheese should be consumed with caution.

There is need for migraine victims to avoid environmental triggers of bright lights especially fluorescent,  flickering screens such as television or computer screen, smoking (or smoky rooms) and loud noise.  Changes in climate such as very cold temperatures, strong smells including pleasant scents such as perfume and unpleasant odors such as paint thinner and stuffy atmosphere should be avoided.

The people who do experience migraine should avoid medication triggers of drugs such as certain sleeping tablets, contraceptive pills, hormone replacement therapy and vasodilators. So take only prescribed and proven drugs for relevant ill-health conditions.

 PRECAUTIONARY MEASURES AGAINST MIGRAINE ATTACK

Migraine sufferers should carefully observe these measures. Recognize and promptly report signs and symptoms of migraine attack. Keep a record of your attacks and how you treated them. Make an appointment with your doctor to discuss your experiences of headaches and pains, and partner effectively on the decision of your treatment plan. If you are above 50 years; and one or both of your parents have migraine, then be careful with your lifestyle and watch out for migraine signs and symptoms. Take certain migraine pain and headache relievers such as ibuprofen that may cause abdominal pain, bleeding, ulcers and rebound headaches under proper medical supervision.

As much as possible, study your system; and stop whatever you are doing (at workplace or home) before the attack starts and go to sleep in a dark room as soon as the aura presents. Wear polarized sunglasses to cut off direct contact with bright light glare.  Do not be too busy to drink plenty water regularly. Agree with your doctor and engage in regular aerobic exercise like walking, swimming and cycling to reduce or prevent migraine tension. Keep your weight down to prevent obesity that causes migraine headache.

MIGRAINE MANAGEMENT GOALS

There are three main management goals for migraine attack which are: trigger avoidance, acute symptomatic control and pharmacological prevention. Medications are more effective if used earlier before an attack. The frequent use of medications may result to medication-overuse-headache, where the headache becomes more intense and frequent. This is a common problem which can result to chronic daily headache.

 Early identification of signs and symptoms of migraine and prompt reporting for treatment/management protocol, do interrupt migraine progression. Therefore, partner in your migraine medical intervention measures by paying careful attention to the advice of expert healthcare professionals.

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