Health

H

Dr Rod Pearce

HEALTH The pain of migraine

Amigraine is a headache which can cause severe throbbing or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Migraine attacks can last for hours or even days, and the pain can be so severe that it interferes with your daily activities.

Migraine is a vascular headache caused by the blood-flow changes and certain chemical changes in the brain leading to a cascade of events. These include constriction of arteries supplying blood to the brain and the release of certain brain chemicals.

Vascular headache is one of the four major types of headaches alongside muscle contraction (tension), traction, and inflammatory headache. Migraine is the most common type of vascular headache and is more likely to affect women than men.

For some people, a warning symptom known as an aura occurs before or with the headache.

An aura can include visual disturbances, such as flashes of light, blind spots, or other disturbances such as tingling on one side of the face or in an arm or leg and difficulty speaking.

With tingling on the side of the face, or arms or legs, the concern is that the migraine is in the “motor cortex” and is going to lead to a stroke or permanent damage.

Some people’s experience begins with a premonition phase, with mood or behaviour changes in the period before the main symptoms begin.

The throbbing pain of the migraine then occurs, often accompanied by additional symptoms such as nausea and sensitivity to light. As the pain resolves, the resolution phase often involves considerable fatigue, lack of concentration and irritability.

The treatment of vascular headaches depends on the specific characteristics of the condition and several factors should be considered. These might include: • Medical and family history. • Frequency and severity of symptoms. • Tolerance for medications. • Therapies. • Expected treatment outcomes. • Personal preferences. • Lifestyle alterations, particularly in reducing activities with a high level of stress.

Prioritizing a healthy diet can make a significant difference in the frequency and severity of vascular headaches.

Other treatment options for vascular headache might include: • Biofeedback training. • Stress reduction. • Nutritional modifications. • Physical therapy. • Pressure therapy. • Cold packs.

Sometimes resorting to medication is necessary and there is a range of medications used as prevention.

Hydration remains an important physical intervention and sometimes medical treatment with several litres of fluid and analgesia is successful.

The first-line treatment options for vascular headaches include analgesic medications, such as paracetamol, ibuprofen and aspirin.

Many people will be able to avert a migraine with an early taking of basic medication and withdrawing from the world in a dark, quiet room. History and medical review are the best ways to make a diagnosis and, if changes in lifestyle and rapid hydration do not work, there is an array of usually successful medication that can be used.

But, because this is often not possible, medication can be taken every day to prevent the frequency, and anyone who gets two to three migraines a month should be looking at preventive treatment.

Some medications which seem to have benefit are the anti-epileptics such as topiramate (Topamax).

The beta blockers metoprolol, propranolol, and timolol have been shown to be relatively safe prevention drugs.

If the migraines appear to be resistant, consideration can be given to two antidepressants, amitriptyline and venlafaxine, or other medication for treatment (triptans).

The triptans were a major advance in migraine treatment because they specifically seemed able to abort a migraine episode.

One of the difficulties has been to manage the vomiting associated with migraines because it exaggerates the dehydration and prolongs the migraine, and any oral medications can’t be used. They work directly on serotonin which causes narrowing of blood vessels in the brain.

Triptans have now become available in tablet form but also for use intra-nasally and as injections as well as a wafer which can be dissolved under the tongue.

Pizotifen can be taken to prevent migraine and recurrent throbbing headaches. It is also used to treat cluster headaches. These are headaches which occur in close succession at certain times of the year, usually lasting six to 12 weeks.

Pizotifen is a potent serotonin and tryptamine antagonist which has been used for migraine prevention for many years.

Migraines that occur because of oestrogen need to be dealt with according to the usual methods but also sometimes changing oral contraceptives.

History and medical review are the best ways to make a diagnosis and, if changes in lifestyle and rapid hydration do not work, there is an array of usually successful medication that can be used.