Migraine is a type of headache, usually affecting one side of the head. It is usually pulsating in nature, lasting 2 to 72 hours.
Other than head ache, migraine suffers may have nausea and vomiting. Photophobia ( increased sensitivity to light), phonophobia ( increased sensitivity to sound) can occur. About ¼th of migraine suffers have an “Aura” which precedes the headache. Patients feel more comfortable in a quiet, dark room during the headache.
Migraine is more common in ladies than gents. Familiar history of migraine is common. It can occur in children as well. Fluctuating hormones may play a role in migraine.
Many migraine attacks are triggered by external factors. Finding out and avoiding migraine triggers can improve quality of life significantly. The triggering factors are
- Disturbed / Lack of sleep
- Skipping meals
- Menstral cycles, birth control pills
- Caffeine intake – coffee, tea, aerated drinks.
- Alcoholic beverages, food additives
- Changing weather
- Emotions stress
- Cheese, tyramine, etc.
A pain physician or neuro physician should be consulted to diagnose migraine. Clinical history suggestive of unilateral / bilateral pulsating headache associated with vomiting, photophobia, phonophobia may suggest a migraine. Sinus infections, tension / cluster headaches, strokes, etchave to be ruled out after careful evaluation. Your pain physician may suggest investigations like CT, MRI, EEG, spinal tap to confirm the diagnosis.
Through initial evaluation and patient education is essential. Migraine trigger avoidance improves quality of life significantly.
- Simple OTC medicines like paracetamol will help in mild attacks.
- Medication like beta blockers, anti-depressants, gabapentin may be used to prevent migraine attack
- Medications like Triptans, ergotamines, valproates are used to treat the migraine attack itself.
Other than trigger avoidance and migraine medications, minimally invasive pain interventions can be used.
a) BOTOX INJECTIONS:
In severe and refractory migraine sufferers, botox injections are given around the head. They are US FDA approved treatment for migraine. Botox injections are highly effective in treating migraine. This is a safe pain procedure done on a day care basis.
b) Other procedures like sphenopalatine ganglion block, neuromodulation, bio-feedback can be used in selective patients.
Your pain physician will be able to help you decide which treatment suits you best.