I am a 45-year-old lady, working as a receptionist. I always get severe throbbing headache especially on my forehead which lasts for a long time. I also feel to vomit. This problem has been with me for a long time. I have consulted many doctors, taken different medications, but they provide only temporary relief. CT scan of the head was done and reported as normal. This problem is really affecting my work and forcing me to take leave often. Why do I have this problem and what can I do to get rid of this problem?
Reena Sebastian, Bangalore
You seem to be suffering from migraine which is a very common neurological problem. Migraine is a chronic neurological disorder characterised by recurrent moderate to severe headaches often in association with a number of associated symptoms. Globally, approximately 15% of the population is affected by migraines at some point in life. Typically the headache affects one half of the head, is pulsating in nature, and lasting from 2 to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people with migraine headaches perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur.
Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families. Changing hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty, but about two to three times more women than men. The risk of migraines usually decreases during pregnancy. The exact mechanisms of migraine are not known but believed to be a neurovascular disorder related to increased excitability of the cerebral cortex and abnormal control of pain neurons.
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. Initial management is with simple analgesics such as ibuprofen and paracetamol (also known as acetaminophen) for the headache, an antiemetic for the nausea, and the avoidance of triggers. Common triggers are stress, hunger, fatigue, menstruation. menarche, perimenopause, menopause, oral contraceptive use, pregnancy, and certain dietary factors.. Environmental aspects include indoor air quality and lighting, sunlight, certain smell and sound. Specific agents such as triptans or ergotamines may be used by those for whom simple analgesics are not effective.
Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe attacks that are not easily controlled.
Preventive treatments of migraines include medications and lifestyle alterations.
The goal of preventive migraine medications is to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. Another reason for prevention is to avoid medication overuse headache. This is a common problem and can result in chronic daily headache. The frequent use of medications may result in medication overuse headache, in which the headaches become more severe and more frequent. This may occur with triptans, ergotamines, and analgesics, especially narcotic analgesics. Due to these concerns simple analgesics are recommended to be used less than three days per week at most.
Topiramate, divalproex sodium valproate, propranolol, and metoprolol are first line drugs used. Frovatriptan is effective for prevention of menstrual migraine.. duration of prophylaxis is usually 3-6 months started at small dose and increased gradually. Acupuncture Chiropractic manipulation, physiotherapy, massage and relaxation might be as effective as propranolol or topiramate in the prevention of migraine headaches; Medical devices, such as biofeedback and neurostimulators, have some advantages in migraine prevention, mainly when common anti-migraine medications are contraindicated or in case of medication overuse.
Dr Arun Oommen
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