Headache

12 February 2007

More on migraine

The cause of migraine is unknown but there is evidence that suggests that it is caused by a genetically transmitted disturbance of the blood flow to the brain and the scalp.

Not all severe headaches are migraines. Classic migrainous headache is a one sided throbbing headache that occurs episodically following its onset in adolescence or early adulthood. In many cases the headaches do not conform to this pattern but their response to antimigranous treatment is similar.What follows is a discussion of typical migraine and if your headaches fit the description, there is a good chance that it might be migraine.

The cause of migraine is unknown but there is evidence that suggests that it is caused by a genetically transmitted disturbance of the blood flow to the brain and the scalp. Certain trigger factors have been identified and include the following:

  • Certain foods, especially coffee, chocolate, nuts, dairy products, red wine, fried foods, shellfish, citrus fruits, spicy foods, cured or processed meats, peanuts and yeast.

  • Emotional and physical stress. This includes anger, anxiety, depression, and excitement.

  • Lack or excess of sleep.

  • Missed meals.

  • Loud noises.

  • Bright or flashing lights.

  • Alcohol.

  • Oral contraceptives.

  • Menstruation.

The symptoms may vary in frequency and intensity from person to person. The headaches may be lateralised or generalized, dull or throbbing, and may be associated with loss of appetite, nausea, vomiting, blurred vision and increased sensitivity to light and sound.

Sometimes patients see flashing lights or shimmering zig-zag lines around an area of lost vision, from one or both eyes. Pins and needles in the hands and difficulty of speech may also occur. These symptoms can last 4 to 72 hours.

So, what do you do? Lie down in a dark and quiet room (alone!). Take something for the pain and nausea and try to remain calm. If this doesn't work, the best drug to take is sumatripan (Imigran®) (or any of the other "triptans" like Naramig(tm), Maxalt(tm), etc) if there are no contra-indications (you can find this out from your friendly neighbourhood GP).

The triptans are serotonin agonists and the wonderful thing about these drug are that if they are taken in the early stages of a migraine attack, they can abort it. It can also be taken as treatment but not as prophylaxis.

It used to be available only in injectable form, but these days it is also available as a pill and nasal spray. If this doesn't work, ergotamine and caffeine preparations like Cafergot® or Migril® may be used. If this doesn't work it is time for a visit to your friendly neighbourhood GP.

The important thing about migraine is to try and prevent the thing from happening. Try to identify the triggering factors (see above) which cause your migraine by studying the pattern of events before an attack.

By keeping a dairy in which you note changes in routine, food and drink etc. and eliminating the triggering factor, you can prevent a migraine attack or at least eliminate the need for prophylactic treatment.

Try to eat regular meals, as low blood sugar can also trigger an attack. If you don't have the time, drink a Coca-Cola (wonderful stuff, tastes great and has medicinal value)

If you suffer from two or more attacks per month, your friendly neighbourhood GP should prescribe a preventative medicine to be taken daily for a period of time. Methysergide (Deseril®) is effective but can cause eye, lung and heart damage if taken for longer than three months.

Clonidine (Dixarit®) and Pizotifen (Sandomigran®) have also been used with success.All three of them are not safe to be taken during pregnancy and breast feeding. Propranolol 20 to 40mg, three to four times a day, offers long-term relief in half of patients.

Unfortunately the whole prophylaxis thing is a matter or trial and error.This applies to the elimination of trigger factors as well as the prophylactic drug of choice. The good news though, is that migraine is not dangerous, just very unpleasant. You just have to be sure that it is migraine, otherwise a visit to the GP should be on the cards.

And for all the lovers out there, next time the love of your life says "not tonight honey, I have a migraine", you can use this article to double check them.

 

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Headache expert

Dr Elliot Shevel - Founder and Medical Director - The Headache Clinic, (Johannesburg, Durban, Cape Town) South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon.

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