Migraine and its management

Migraine is a type of throbbing or pulsating headache accompanied by nausea, vomiting, sensitivity to sound or light.

The above symptoms may all occur in one person or just some but the bottomline is that the pain must be throbbing or pulsating for the headache to qualify as a migraine.

Migraine attacks can last for hours to days(status migrainosus).

 

Types of migraine

There are several types of migraines and some are listed below;

Migraine with aura

In this type of migraine, the patient has a feeling(aura) 20-30 minutes before the headache.

  • The patient may see blind sports,
  • flashing lights,
  • funny smells, 
  • pins and needles(paraesthesia)
  • confusion
  • loss of coordination
  • muscular weakness.

After the aura, an intense throbbing headache follows.

Migraine without aura.

This type of migraine does not elicit any type of aura before the headache.

The pain comes without a warning.

The headche is worsened by movement and may present with the following symptoms;

  • nausea and vomiting,
  • Photophobia(sensitivity to light)
  • Phonophobia(sensitivity to sound)
  • Stiff neck and shoulders,
  • blurred vision.

Migraine aura without a headache.

The warning feelings (aura) mentioned in the migraine with aura may occur and no headache follows.

this is migraine aura without headache.

Hemiplegic migraine.

This type of migraine is rare and causes reversible paralysis of one side of the body.

This  type of migraine may last for day or weeks.

It begins in childhood and has a familial history.

Diagnosis requires intense examination of the the nerves to rule out other disease that cause paralysis like stroke.

Basilar migraine

This is a rare migraine and is accompanied by lack of balance,

  • double vision
  • blured vision
  • loss of conciousness and fainting

The migraine occurs when blood circulation at the back of the brain is interrupted due to narrowed basilar artery.

It occurs mostly in women but can also occur in children.

Ophthalmoplegic Migraine

This is a rare type of migraine that occurs in young people and cause weakness of one or more of the muscles that move the eyes.

The patient may have dilated pupils or unable to move the eyes, or drooping upper eyelids, 

Triggers of migraine

The triggers do not cause migraine but may bring about the attack.

  • Travelling
  • Changes in work routines
  • Foods and Beverages – Cheese, chocolate, products containing MSG(monosodium glutamate) (e.g. hot dogs, Chinese food),
  • citrus fruits, dairy products, nuts, wheat, fatty foods, nitrates and marinated or pickled foods
  • Alcohol especially redwine
  • caffeine and nicotine or withdrawal from coffee and tea
  • hormonal changes in women during adolescence and menopause
  • Meteorological Triggers – change of seasons, high atmospheric pressure, heat or cold
  • Environmental Triggers – smoke, strong smells, high altitude, loud noise, bright, irregular or flickering lights, glare (e.g. from sunlight, from wet surface while driving)
  • Exercise – too much exercise may act as a trigger, although lack of exercise can also be a trigger
  • Smoking or passive smoking
  • Over-exertion / dehydration
  • Long periods in front of a computer screen
  • Head, neck or back injury, High Blood Pressure and other physiological irregularities.

 

Management of migraine

management depends on the stage of the migraine and may be preventive or abortive treatment or pain managing treatment.

The most commonly used migraine preventives in kenya include:

acute migraine is treated using painkillers and a class of drugs called triptans.

Ergotamin plus caffeine has also proved to be effective.

When having a migraine, always stay in a dark quiet room. Placing ice pad on the forehead may also alleviate the pain.

 

 

 

 

 

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Dr Mathu

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