Fitness and health 10.8.2016 10:57 am

Migraines: the most debilitating pain

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

You can fight these headaches with medication, remedies and lifestyle changes.

A migraine is a severe, painful headache that can be preceded or accompanied by sensory warning signs such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting, and increased sensitivity to light and sound. The excruciating pain that migraines bring can last for hours or even days. Migraine attacks can cause significant pain for hours or days and can be so severe that the pain is disabling.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, may help. Migraines are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches. See your doctor if the pattern changes or your headaches suddenly feel different.

Several factors make you more prone to having migraines, including family history or age – it is commonly seen in adolescence. Women are three times more likely to get them.

SYMPTOMS

Migraines can start in childhood, adolescence or early adulthood. They usually progress through four stages: prodrome, aura, headache and post-drome, though you may not experience all stages.

  • Prodrome: One or two days before a migraine, you may notice signs that warn of an upcoming migraine. These include constipation, mood changes – from depression to euphoria – cravings, usually for sugars, neck stiffness, increased thirst and urination, frequent yawning.
  • Aura: Auras are symptoms of the nervous system. They are usually visual disturbances, such as flashes of light or wavy, zigzag vision. Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Your muscles may get weak, or you may feel as though someone is touching you. Each of these symptoms usually begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine aura include: seeing various shapes, bright spots or flashes of light, loss of vision, pins and needles sensations in an arm or leg, weakness or numbness in the face or one side of the body, difficulty speaking, hearing noises or music, uncontrollable jerking or other movements.
  • Attack: The headache usually lasts from four to 72 hours if untreated. The frequency with which headaches occur varies from person to person. Migraines may be rare, or strike several times a month. During a migraine, you may experience pain on one or both sides of your head, pain that feels throbbing or pulsing, sensitivity to light, sounds, and sometimes smells and touch, nausea and vomiting, blurred vision, light headedness, sometimes followed by fainting.
  • Post-drome: The final phase, known as post-drome, occurs after a migraine attack. You may feel drained and washed out, while some people feel elated. For about 24 hours, you may also experience confusion, moodiness, dizziness, weakness, sensitivity to light and sound.

DIAGNOSIS

If you have migraines or a family history of migraines, or symptoms suggestive of a migraine see your doctor, who will be able to diagnose you based on your medical history, symptoms, and a physical and neurological examination. Your doctor may also recommend more tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe.

CAUSES

Imbalances in brain chemicals, including serotonin, which helps regulate pain in your nervous system are said to be involved. Researchers are still studying the role of serotonin in migraines. Serotonin levels drop during migraine attacks.

Migraine triggers

Hormonal changes in women. Fluctuations in oestrogen seem to trigger headaches in many women. Women with a history of migraines often report headaches immediately before or during their periods, when they have a major drop in oestrogen. Others have an increased tendency to develop migraines during pregnancy or menopause.

Hormonal medications, such as oral contraceptives and hormone replacement therapy, also may worsen migraines. Some women, however, find their migraines occur less often when taking these medications.

  • Foods: Aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting also can trigger attacks.
  • Food additives: The sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods, may trigger migraines.
  • Drinks: Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.
  • Stress: Stress at work or home can cause migraines.
  • Sensory stimuli: Bright lights, loud sounds and sun glare can induce migraines. Strong smells – including perfume, paint thinner, secondhand smoke and others – can trigger migraines in some people.
  • Changes in wake-sleep pattern: Missing sleep or getting too much sleep may trigger migraines in some people, as can jet lag.
  • Physical factors: Intense physical exertion, including sexual activity, may provoke migraines.
  • Changes in the environment: A change of weather or barometric pressure can prompt a migraine.
  • Medications: Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

Treatment

Migraine treatments can help stop symptoms and prevent future attacks. Many medications have been designed to treat migraines. Some drugs often used to treat other conditions also may help relieve or prevent migraines. Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions. Medications used to combat migraines fall into two broad categories:

1. Pain-relieving medications: Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms. Take pain-relieving drugs as soon as you experience signs or symptoms of a migraine for the best results. It may help if you rest or sleep in a dark room after taking them. Examples are aspirin, ibuprofen, painamol.

Some combination drugs are marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine) also may ease moderate migraine pain. They aren’t effective alone for severe migraines. Please take them as directed by your doctor because if taken too often or for long periods of time, these medications can lead to ulcers, gastrointestinal bleeding and medication-overuse headaches.

The prescription pain reliever indomethacin may help treat a migraine and is available in suppository form, which may be helpful if you’re nauseated. If no relief is received do go back to your doctor to get more treatment options, such as Triptans, glucorticoids, etc.

2. Preventive medications: These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines. You may be a candidate for preventive therapy if: You have four or more debilitating attacks a month, if attacks last more than 12 hours, if pain-relieving medications aren’t helping or if your migraine signs and symptoms include a prolonged aura or numbness and weakness.

Preventive medications can reduce the frequency, severity and length of migraines and may increase the effectiveness of symptom-relieving medicines used during migraine attacks. It may take several weeks to see improvements in your symptoms. Your doctor may recommend daily preventive medications, or only when a predictable trigger, such as menstruation, is approaching.

Preventive medications don’t always stop headaches completely, and some drugs cause serious side effects. If you have had good results from preventive medicine and your migraines are well-controlled, your doctor may recommend tapering off the medication to see if your migraines return without it. The most common medications for migraine prevention include: cardiovascular drugs such as beta blockers, ACE inhibitors and calcium channel blockers. Antidepressants, especially tricyclic antidepressants, may be effective in preventing migraines, even in people without depression.

These medications can cause sleepiness, dry mouth, constipation, weight gain and other side effects. Some anti-seizure drugs seem to reduce the frequency of migraines. In high doses, however, these anti-seizure drugs may cause side effects. Nonsteroidal anti-inflammatory drugs, especially naproxen (Naprosyn), can also help prevent migraines.

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