Migraine Headache
“Doctor, I could not sleep well last night and now I am having severe right sided headache, with nausea, vomiting and flashes of light. I took a paracetamol but it had no effect, which medicine is safe for me?”
It’s a very common neurologic headache called migraine, which commonly affects young women with a strong family history. It is characterized by typical history and clinical features.
This will guide you about it’s cause, management, and treatment.
What is a migraine?
It is a common reoccurring, mild to moderate, throbbing, or pulsating headache usually affecting one side of head and can also gradually shift to other side. If not treated timely severity can increase from moderate to severe, involving whole head.
Why it occurs?
It starts due to dilatation of blood vessels by release of chemicals (prostaglandins).
Who are affected most?
Women are affected three times more as compared to men.
How long it lasts?
It can last from few hours to 3 to 4 days.
What are triggering factors?
All these cause biochemical disturbances which can trigger an attack:
- Stress and anxiety
- Hormone disturbance (less estrogen)
- Excessive Caffeine intake
- Foods like cheese, chocolate, fermented pickles
- Missing meals, crash dieting and less water intake
- Changes in sleep pattern
- Weather
- Exposure to bright lights, loud noises, smoke, and strong fragrances
What are the early warning signs days before migraine?
It usually starts with a PRODROME:
- Neck stiffness
- Extreme tiredness and fatigue
- Irritability and anxiety
- Depression or hyperactivity
- Increased thirst or food cravings
- Rarely Fever or diarrhea
What is an AURA?
These occur just before or during an attack of migraine these are due to altered sense of vision, hearing, taste, smell, touch, nerve, and muscle function disturbances. These are:
- Flashes or dots of light
- Decreased eyesight
- Ringing in ears
- Tingling
- Inability to balance
- Weakness of one side of body
How pregnancy affects migraine?
High estrogen levels during pregnancy lower chances of migraine, but any trigger can start migraine.
What are risks associated with migraine during pregnancy?
It does not harm the baby, but there is a slightly more risk of having high blood pressure and pre-eclampsia during pregnancy.
How to avoid migraine?
If you have a history of migraine then:
- Avoid the triggering factors
- Reduce stress by relaxation techniques of exercise, yoga, meditation
- Take adequate rest
- Have small frequent meals
- Increase fluid intake
Are there any home remedies during an attack?
Yes, you can try mild pain killers along with icy cold fomentation, head, and neck massage, excessive fluid intake, taking rest in a comfortable dark place.
What are the preventive medicines?
- Low dose aspirin
- Paracetamol
- Beta blockers
When to start migraine preventive medicines?
If you are having three or more attacks of migraine in a week then consult your doctor for starting preventive medicines. These are safe for use during pregnancy and breast feeding.
What is the treatment of migraine?
All medicines should be taken after consulting a doctor. Painkillers, sickness medicines, triptans and vomiting suppressing medicines can safely be used alone or in combination. They are also safe during pregnancy and nursing.
What medicines for migraine should not be taken during pregnancy?
- Ergot derivates (can start uterine contractions)
- High doses of aspirin (can increase bleeding tendency)
- Ibuprofen after 24 weeks (can cause heart defects in baby)
- Anti-epilepsy drugs (as they cause birth defects, cleft lip, and cleft palate)
- Narcotic pain killers (can cause dependence or withdrawal issues)
Remember… if you are having headache that is not going away with simple remedies then consult your doctor for a proper evaluation and treatment as there could be some other serious issues. Migraine is a common treatable problem if medical help is timely sought.
Dr. Ayesha Azam Khan