Migraines are severe painful headaches that are recurrent, usually affecting one half of the head, pulsating in nature, and usually lasting 2 (two) to 72 (seventy two) hours. They are often preceded or accompanied by sensory warning such as flashes of light, blind spots, tingling in the arms and legs, nausea, vomiting and increased sensitivity to light and sound and the pain is generally aggravated by physical activity.

A migraine headache causes the sympathetic nervous system to respond with feelings of nausea diarrhea and vomiting. This response also delays the emptying of the stomach into the small intestine (affecting food absorption), decreases blood circulation (leading to cold hands and feet) and increases sensitivity to light and sound.

Some people who suffer from migraines can clearly identify triggers or factors that cause the headaches, but many cannot. Potential migraine triggers include;

• Allergies and allergic reaction
• Bright lights, loud noises and certain odors or perfumes
• Physical or emotional stress
• Changes in sleep patterns or irregular sleep
• Smoking or exposure to smoke
• Skipping meals or fasting
• Alcohol
• Menstrual cycle fluctuations, birth control pills, hormone fluctuations during menopause onset
• Tension headaches
• Foods containing tyramine (red wine, aged cheese, smoked fish, chicken livers, figs and some beans), monosodium glutamate (MSG) e.g Ajinomoto or nitrates (like bacon, hot dogs and salami).
• Other foods such as chocolate, nuts, peanut butter, avocado, banana, citrus, onions, dairy products and fermented or pickled foods (foods preserved in brine).

Triggers do not always cause migraines and avoiding triggers does not always prevent migraines.

Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families, fluctuating hormone levels may also play a role; migraine affects slightly more boys than girls before puberty, but about two to three times more women than men. Propensity for migraines usually decreases during pregnancy. The exact mechanisms of migraine are not known. It is however believed to be a neurovascular disorder.

Preventive treatments of migraines are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. They include; medications, nutritional supplements, lifestyle alterations, and surgery.

Prevention is recommended in those who have headaches more than two days a week, those who cannot tolerate the medication used to treat acute attacks, those with severe attacks that are not easily controlled or to avoid medication overuse headache ( a common problem and can result in chronic daily headache).

There is some tentative evidence of benefit for Magnesium, Coenzyme Q (10), Vitamin B-2, Riboflavin, Vitamin B(12), Feverfew and Butterbur supplements. Butterbur has the best evidence for its use.

Management

There are three main aspects of treatment; trigger avoidance, acute symptomatic control and pharmacological prevention.

Medications are more effective if used earlier in an attack. The frequent use of medications may result in medication overuse headaches in which the headaches become more severe and more frequent. This may occur with Triptans, Ergotamine and analgesics especially narcotic analgesics.

• Recommended analgesics include; simple analgesics e.g Non-Steroidal Anti-Inflammatory Drugs (NSAIDs); Aspirin, Ibuprofen, Diclofenac etc. or the combination of Paracetamol, Aspirin and Caffeine.

Paracetamol either alone or in combination with Metoclopramide is another effective treatment with low risk of adverse effects. In pregnancy, Paracetamol and Metoclopramide are deemed safe as are NSAIDs until the third trimester.

• Triptans e.g Sumatriptan are effective for both pain and nausea in up to 75% of people. Initially recommended for those with moderate to severe pain or those with milder symptoms who do not respond to simple analgesics. They are not addictive, but may cause medication overuse headaches if used for more than 10 days per month.
• Ergotamines; Ergotamine and Dihydroergotamine. In the most debilitating cases, they appear to be the most effective treatment option e.g Cafergot.

REFERENCES

1. http://en.wikipedia.org/wiki/Migraine
2. http://www.medicalnewstoday.com/articles/148373.php
3. http://www.mayoclinic.com/health/migraine-headache/DS00120

MEGACARE…… A HEALTHIER YOU