Yes, I have a Migraine

By Dr.(Prof) Sekar Michael and Dr. J. Gnanaraj

Many belonging to the younger generations will casually claim they have a migraine. The question that immediately arises is that: are migraines so common these days as they claim? Or is it a fancy name they give to a common headache? Of course, a headache is more common among the youngsters as they are pressurized with many things in this competitive world. But the fact is that the incidence of migraines is not that high among the headaches. Although WHO estimates that 47% of people have headaches within the last year the incidence of migraines is only about 2% [1] while the incidence of classical migraine is less than 0.066%. Since the management is different between a migraine and headache, it is important to diagnosis and differentiate between a migraine from the regular tension type chronic headache.

How do I confirm?

It is not your job to diagnose the exact type of headache! Your Physician will do that for you swiftly. As long as you give the exact history and express the symptoms you are experiencing, your Physician will be able to come to a conclusion. To help express your symptoms to your physician, we need to know the basic characteristics of migraine.

Characteristic features:

Though there are seven different types of migraines identified so far, only two among them are common.

1. Migraine with aura
2. Migraine without aura

We can divide the course of the headache into four phases:

a. Premonitory
b. Aura
c. Headache
d. Resolution

Premonitory Phase:

Patients with established chronic migraine headache will be able to sense that they are going to get the headache soon. Many will not come out of home and sensible individuals cancel their programme and remain at home. The symptoms that they get are varying from excitation to depression to irritation and so on. This premonitory phase may last for a few hours and slips in to the phase of aura.

Aura:

Changes in visual field with black and white spots called scotoma appear and symptoms of neurological deficit like hemianopia [partial blindness] also can occur. Though it starts in a small focal area, it gradually increases and extends to the entire visual field. Tingling sensation which is called sensory aura may be experienced in severe form of aura. Severe form of neurological symptoms like sensory loss over the face and even hemiparesis can occur. Usually it persists on one half of the body. This aura persists for almost one to two hours prior to the headache. The visual disturbances are more severe during stress and bright light.

Headache Phase:

Usually migraine headaches are unilateral or one sided. Occasionally symptom may starts on both sides but ultimately persists unilaterally. The visual disturbances slowly disappear as headache starts. A severe pulsatile headache with nausea and vomiting is the characteristic features of migraine. Very few individuals may experience photophobia (extreme sensitivity to light) and phonophobia (fear of loud sounds) and prefer to be alone.

Resolution Phase:

One or two bouts of vomiting precede the resolution phase. Though they are relieved from the severe headache, a mild form of depression may affect them in the aftermath. Some individuals may be hyperactive in contrary. The resolution phase may last anywhere from a few hours to days.

Mechanism:

The mechanism of aura and headache is explained with animal models. A transient state of decreased blood flow followed by the dilatation of blood vessels and decreased blood pressure has been proven in experimental animals. This explains the wave of excitation followed by a wave of inhibition over the cortical area during the attacks. But certainly there are some triggers which precede the attack.

Can I find out the trigger factors myself?

It is easy for you to find as long as you know the probable trigger factors. Look at the list below and try to find out the possible trigger, but unfortunately the list is much more than what you are seeing below and sometimes you may not be able to find the real factor at all.

How do I manage?

It is very important to confirm that you have migraine. You may not have migraine at all. Many of my patients walk into my clinic and claim to have migraine. Surprisingly many of them may not have the symptoms of migraine. Since many varieties, especially secondary headaches like cervicogenic, occipital neuralgia and sinusitis have better outcome we should rule out all probabilities. However, the management of migraine could be:

1. Lifestyle changes
2. Avoiding trigger factors
3. Medications

Relaxation techniques like yoga, walking and socialisation helps a lot in preventing migraine. If you are able to avoid the trigger factors that affect you comfortably. Medications are tailored to prevent attacks and relieve headache. It is difficult to get rid of migraine completely. In general, as you become older the frequency and severity of attacks might reduce.

What is available at SEESHA and Coimbatore Pain Clinic?

SEESHA or Coimbatore Pain Clinic can give you the correct diagnosis and medical treatment. The other causes of headache could be evaluated and corrected treatment could be initiated.

Dr. Sekar Michael, underwent post-graduate training in anaesthesiology and pain services at Christian Medical College, Vellore. His passion for chronic pain management led him to specialise in pain services and start a comprehensive interventional pain clinic at Coimbatore. Besides being active Instructor in Essential Pain Management, he is also the Editor in chief of the Tamil Nadu Journal of Anaesthesia, and has many international and national publications to his credit.

Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore currently working as Director of Medical Services of the charitable organization SEESHA and Adjunct Professor in Karunya University. He has special interest in rural surgery and during the last three decades of service in rural areas helped 23 rural hospitals start minimally invasive surgeries. Karunya is now recognized as center for excellence in innovation for rural surgery by Lancet Commission on Global Surgery. He has over 200 publications. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. Recently, he was awarded the Lockheed Martin innovations award by the Department of Science and Technology of Indian Government and the Lockheed Martin Group (USA)