MIGRAINES

Migraines are the second most common type of headaches, after Tension headaches.   They tend to be hereditary, commonly running in families.  Age of onset may vary, but most commonly begin in the 20s and 30s.  Migraines rarely, however, commence in middle age or older.

Types of Migraine:

• Migraine without aura, also known as "common migraine".
• Migraine with aura
• Others: basilar artery migraine, hemiplegic migraine, ophthalmoplegic migraine, retinal migraine, abdominal migraine etc.

Symptoms:

The signs and symptoms of migraine attacks vary greatly among individuals.   There are 4 phases of a migraine attack commonly described, but not all phases are experienced by all individuals.

Prodrome Phase:
Prodromal symptoms occurs in about 40 - 60% of migraine sufferers.  Symptoms include altered mood, irritability, fatigue, yawning, craving for certain foods etc, and may precede the actual headaches by several hours or days.

Aura Phase:
These migraine auras may be visual, sensory or motor disturbances, with the visual auras being, by far, the most common.  Visual disturbances may include flashes of light, zigzag lines, cloudy vision etc. These auras usually do not last more than an hour.

Headache Phase:
Migraine headaches are typically severe, throbbing/pulsating, one-sided headaches, lasting from several hours to as long as 3 days.  The headaches are usually accompanied by nausea, with or without vomiting.  Typically, migraine sufferers in this phase, get comfort by sleeping in a darkened and quiet room.

Postdrome Phase:
This is the "hangover" phase, where one feels tired and weak.

Triggers:

Many factors can potentially trigger a migraine attack. These factors include:

• Emotional, mental or physical stress
• Changes in sleep pattern
• Bright lights, loud noises, certain odours
• Weather changes
• Alcohol
• Smoking or exposure to smoke
• Alcohol
• Hormone related eg. menstrual cycle fluctuations, taking oral contraceptive pills
• Certain foods eg. foods containing tyramine (eg. red wine, aged cheeze), monosodium glutamate (MSG), nitrates (in bacon, salami, sausages), chocolates, nuts, banana, citrus, diary products, onions etc.

Management:

The management of migraine headaches involves treating the acute attacks and preventing future attacks by taking of prophylactic medication and avoiding triggers.

Treatment of acute attacks:
1.  Simple pain-killers such as paracetamol (with or without a muscle relaxant) and the NSAID (non-steroidal anti-inflammatory drugs) group of medication, may be used for pain relief.  An anti-emetic (anti-vomiting) may be added to control nausea.

2.  Ergot derivatives eg. Ergotamine are also useful as abortive rescue medication for acute attacks.

3.  Triptans eg. Sumatriptan, Zolmitriptan, Naratriptan, Eletriptan, are also effective in aborting acute attacks.

Prophylactic treatment:
Prophylaxis (preventive) treatment should be considered with your doctor if your headaches are very frequent.  A whole range of medication can be used for prophylaxis and they may include beta blockers, calcium channel blockers, antidepressants, anticonvulsants, NSAIDS, angiotensin blockers etc.

Trigger Avoidance:
A "migraine diary" is useful in helping to identify possible triggers.  Unless one knows what triggers one's migraine, it would be impossible to avoid them.

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The article above is meant to provide general information and does not replace a doctor's consultation. 
Please see your doctor for professional advice.