12 Helpful Facts About Dealing With Migraines From A Neurologist

Having migraines can be troublesome and can lead to missing days of school or work, being less productive at school or work, being unable to perform household responsibilities, and missing out on family, social, and leisure activities. Migraine attacks may come on suddenly without warning, or they may be preceded by certain known triggers, such as skipping a meal, being exposed to smoke or air pollution, or experiencing a change in hormone levels as part of the menstrual cycle. Most migraine attacks last from 4 to 72 hours, although effective treatment can shorten them to a matter of hours. On the other hand, some migraine attacks can last even longer than 72 hours. Read further to know more about migraines.

TC46 connected with Dr Pawan Ojha, Senior Consultant – Neurology, Hiranandani Hospital, to help shed some light on this very common yet painful ailment. Here he shares the symptoms, causes and remedies for migraine. 

1. Migraine is a neurological disease

Migraine is a neurological disease that involves nerve pathways and chemicals. Most people associate migraines with severe headaches. But headaches are only one symptom of migraines, and they can range in severity and duration. Migraines are usually one-sided, often associated with nausea, have specific triggers, and can run in families. More importantly, migraines require a specific treatment that is different from other headaches. 

The changes in brain activity affect blood vessels in the brain and the surrounding tissues, causing a range of symptoms such as:

• Nausea
• Increased sensitivity to light, sound, or certain smells
• Dizziness
• Extreme fatigue and tiredness 

2.  Migraines seem to affect women more

Migraine can affect people of all ages, but it seems to afflict women more. As per some studies, nearly 75% of all persons who experience migraines are women, the common reasons being hormonal changes and stressful lifestyles. Women taking Oral Contraceptives and those having irregular menses are particularly susceptible to Migraines. 

Migraine is common in all age groups. Women in their 30’s are particularly susceptible. This is probably because of changing hormonal levels of Estrogen, Progesterone, sleep deprivation and a stressful lifestyle.

3. Migraine attacks can last for hours to days

Migraine usually presents with a one-sided throbbing headache and is often worsened with stress, loud noise, and bright lights. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be severe enough to interfere with one’s daily activities.

4. Migraine is caused due to abnormal modulation

Migraine is a primary headache caused due to abnormal modulation of normal sensory stimuli, and dysfunction of a part of the brain called Trigeminal Nucleus. Triggers of migraines include bright lights, loud sounds, sleep deprivation, excess sleep, hormonal disturbances, red wine, stress and certain foods.

5. There are many types of migraines

There are many types of migraines. Commonly they occur as headaches with or without aura. An aura is a phenomenon like a certain smell or sound that heralds the onset of a headache. Other types of migraines include migraines associated with dizziness, paralysis and vision disturbances. 

The most frequent and common migraine is an episodic headache affecting one half of the head, associated with nausea, and worsened by movement, excessive light & sound. Occasionally, before the onset of headache, the patient feels an aura for 5-10 minutes, i.e., sees visual patterns (zigzag lines or blindness on one side), perceives a particular smell or sensation on one side of the body. Migraines can present with symptoms besides headaches, giddiness (vertiginous migraine, altered consciousness (brainstem migraine), paralysis (hemiplegic migraine) or atypical aura.

6. Migraines can be diagnosed by a Neurologist

Migraines can be diagnosed easily by a Neurologist after careful history taking and clinical examination. A typical history is that of an episodic one-sided headache with nausea occurring for over a year. Certain features like family history and response to medication also aid in clinching the diagnosis, tests such as Brain MRIs help to rule out serious causes of headaches.

7. Treatment for migraine is divided into three parts

The first is lifestyle modification such as avoiding triggers, sleeping well, doing regular exercise, and eating healthy. Secondly, an acute treatment that needs to be taken during attacks of headache such as NSAIDs (ibuprofen, Diclofenac, Naproxen, Ergots, and Triptans). Finally, there is a role for preventive medications that must be taken regularly for a long time to reduce the severity and number of headache attacks.

• Broadly, migraine therapy involves treating migraines during the acute attack with pain medication, they include Triptans, NSAIDs (such as Naprosyn or brufen), and Ergot derivatives. They are ideally taken immediately after the onset of headache. It is better to avoid using too much NSAIDs as it can harm the Kidneys, and also lead to Chronic Migraines. 
• The second group of medications are preventive. These are taken regularly to prevent headaches from occurring, including Beta-blockers, Tricyclic Antidepressants, some Epilepsy medicines and Flunarizine. Vitamins, food supplements, Magnesium, Melatonin might be useful in some. Treatment options for severe Chronic Migraine include nerve blocks and Botulinum injections, TMS (Transcranial Magnetic Stimulation). Besides this a healthy lifestyle and sound sleep are of paramount importance.

8. Specific foods can trigger migraines

Any food can trigger migraines, and this is unique to different individuals. Common foods that trigger migraines are caffeine in coffee and tea. Chocolates, aged cheeses, smoked fish, certain meats, artificial sweeteners, and foodstuffs containing excessive MSG can also trigger migraines.

9. Stress relief and adequate sleep can help

Home remedies can only alleviate the pain superficially but will not nip the problem in the bud. The most important thing a migraine sufferer needs to do at home is to take measures to reduce stress and get adequate sleep. 

10. Take measures to prevent migraines

To prevent migraines, one must adhere to the prescribed medicines. Try to lead a stress-free life. Get adequate sleep, and the adoption of healthy eating habits are of paramount importance. Avoid any substances that cause headaches. Apart from this, you do the following:

1. Avoid loud noises and bright lights in the room.
2. Pay attention to food choices, eat healthy and oil-free food.
3. Keep a headache diary.
4. Beware of hormonal changes and report them to your clinician.
5. Take supplements prescribed by your doctor.
6. Pay attention to the weather changes.
7. Eat and sleep on a regular schedule.
8. Avoid stress.
9. Educate family members and friends about the disease.
10. Partake in relaxation and meditation like Yoga.

11. Yoga poses or exercises can help manage migraines

Aerobic exercise done on a regular basis for 30-45 minutes a day for at least 5 days a week can help in preventing headaches. However, heavy workouts and neck bending should be avoided. Yoga and meditation can be of much use in the prevention of stress and migraine.

Some yoga poses that might help:

• Hastapadasana (Standing Forward Bend)
• Setu Bandhasana (Bridge Pose)
• Shishuasana (Child Pose)
• Adho Mukha Svanasana (Downward Facing Dog Pose)
• Shavasana (Corpse Pose)
• Padmasana (Lotus Pose)

12. Pregnancy is safe for migraineurs

Pregnancy is generally safe for migraineurs. Migraine usually gets better in the first and second trimesters of pregnancy, but in some cases, it may become very troublesome. Close working between the Neurologist and Gynaecologist is required for a seamless pregnancy.