Migraine Headaches

Dear Dr. B: I was wondering if you could write your next column on the topic of migraine headaches. What causes them? How can you deal with them?

Migraine is a severe headache. It is often associated with severe pain on one or both sides of the head, nausea, vomiting and visual disturbance. It is the most common type of vascular headache.

Migraine headache affects 28 million Americans, 75 percent of whom are women. The first attack occurs between the ages of five and 35 years. It is rare to have first attack after the age of 40. The frequency of attacks varies a lot. But the frequency becomes less as the person gets older.

There are many types of migraine headaches. The two most common types are – the classic migraine and the common migraine.

The classic migraine is preceded by an aura – a person may see flashing lights, zigzag lines, or temporarily lose vision. There may be speech difficulty, weakness of an arm or leg, tingling of the face or hands, and confusion.

Common migraine is more common in general population. There is no preceding aura. There may be vague symptoms of mood changes and fatigue. There may be nausea, vomiting, diarrhea and increased urination.

What causes migraine headaches?

There is no known precise cause of migraine headaches. The theory is individuals have blood vessels that overreact to various triggers. This results in chemical changes in the blood and in the caliber of the blood vessels in the brain. First the blood vessels narrow and then after a while they rapidly widen and severe headache develops.

Stress and certain foods (like chocolates and cheese) can trigger an attack. Some people are affected by fatigue, glaring or flickering lights, and changes in the weather and at the time of menstruation. This list is by no means complete.

Although many sufferers have a family history of migraine, the exact hereditary nature of this condition is still unknown.


Do I need any tests?

Most of the time migraine headache can be diagnosed by your physician from your symptoms. A physical examination shows no detectable abnormalities during an acute migraine attack. Rarely CT scan or MRI of the brain is done to rule out serious causes like a brain tumor.


What is the treatment?

The object of the treatment will be:

-Drugs to reduce the duration of acute attacks
-Drugs to help treat symptoms
-Drugs to prevent future attacks

There are several drugs in each category. It will be futile to name them here. The best thing is to discuss with your family doctor. He will find an appropriate medication which suits your needs.


Can it be prevented?

You need to identify the factors which trigger your migraine. Keep a diary for few weeks to identify the triggers and then avoid them. Eat regularly and follow a regular sleep pattern. If life is stressful then learn to do some relaxation exercises. Laughter and meditation may help.

You can also visit Migraine Association of Canada’s website: www.migraine.ca (under construction but has some links) or contact them by e-mail: support@migraine.ca.


Thought for the week:

“What good is perfect eyesight when you are inwardly blind?” – From Images and Reflections by Dennis van Westerborg, a local artist and writer.

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