Dr.Souvik Banerjee, MD.

 

Migraine

Migraine is a type of headache. It comes with severe throbbing pain or a pulsing sensation, usually on just one side of the head and is often accompanied by nausea, vomiting and extreme sensitivity to light and sound. Migraine attacks can cause significant pain lasting for hours, sometimes even days. The pain can be so severe that it can adversely affect a person’s day-to-day functioning and quality of life. Usually, some warning symptoms, also known as aura, occur before the start of the actual pain attack. Auras can occur before or during the migraine attack. Typically, these include seeing flashes of light or blind spots or tingling on one side of the face or in either of the arms or legs. The symptoms vary from person to person, with different symptoms for each time. Migraine attacks may differ in length and frequency too, usually lasting from 4 to 72 hours. Most people are free from symptoms between the attacks.

There are different types of migraine. In 1988, the International Headache Society produced a classification system for migraines and headaches, which has been adopted by the World Health Organization. The two most common types of migraine are migraine with aura and migraine without aura. Medications can cure some migraines and make them less painful

Types of Migraine

·        Migraine with aura: Patients with this type of migraine experience various disturbing symptoms that occur before the actual headache begins, usually lasting about 20 to 60 minutes. About 20% of people with migraine experience ‘aura’ in addition to some or all of the symptoms of migraine without aura. The other symptoms of migraine are usually followed by the migraine aura.

·        Migraine without aura: The majority of migraine patients have migraines without the aura. Instead, they experience symptoms of migraine that occur during the main headache attack, but none before the onset of the migraine attack, making them experience a sudden severe pain.

·        Migraine aura without headache: About 1% of migraine sufferers experience only the migraine aura without the actual headache. However, the symptoms of their auras may be of any type, varying from person to person.

·        Basilar migraine: Basilar migraine is a rare form of migraine that includes symptoms such as loss of balance, double vision, blurred vision, difficulty in speaking and in some patients even fainting. These sensations are often frightening because they mimic the feeling of a stroke. This type of migraine occurs when the blood circulation in the back of the brain or neck is affected.

·        Hemiplegic migraine: Hemiplegic migraine is a rare but severe form of migraine that causes temporary paralysis, usually on one side of the body. This type of migraine often begins in childhood, and often, there is a strong family history.

·        Ophthalmoplegic migraine: Ophthalmoplegic migraine is a very rare type of migraine that occurs mainly in young people that weakens one or more of the muscles that move the eye. In addition to usual migraine headaches, symptoms of ophthalmoplegic migraines include dilation of the pupils, inability to move the eye upward, downward or across and sometimes causing drooping of the upper eyelid.

Migraine Causes

It is observed that genetics and environmental factors play a role in causing migraines. Functions of certain chemicals in the brain may also be responsible. With the levels of a chemical known as serotonin decreasing during migraine attacks, the trigeminal nerve releases a chemical substance called neuropeptides, which travels to the brain's outer covering. The result is migraine pain.

Several factors make you more prone to having migraines, namely:

·        Family history - If the patient has a family member with migraines, then they have increased chances of developing a migraine.

·        Age - Migraines can begin at any age, but the attack usually starts in adolescence. They may become intense during the age of 30 and above, and gradually becoming less severe and less frequent in the 40s.

·        Sex - Women are three times more likely to have migraines. Although headaches tend to affect boys more than girls during childhood, at the time of puberty and beyond, more girls are affected.

·        Pregnancy - Some women report that migraine attacks begin during pregnancy, or their attacks have increased during pregnancy.

 

What causes migraines

·        Hormonal changes in women - Fluctuations in the estrogen hormone may trigger headaches in many women. That could be the reason why many women experience migraine attack before or during their periods.

·        Foods - Certain foods like aged cheeses, salty foods and processed foods may trigger migraines. Skipping meals or fasting can also trigger attacks.

·        Food additives - Sweeteners and certain preservatives used in many foods may trigger migraines.

·        Drinks - Alcohol, especially wine, and highly caffeinated beverages may trigger migraines.

·        Stress - Emotional stress of any type may trigger migraines.

·        Changes in the wake–sleep pattern - Missing sleep, and conversely, sleeping too much may trigger migraines in some people. Jet lag is also a common migraine trigger.

·        Physical factors - Intense physical exertion, including sexual activity, may trigger migraines.

·        Changes in the environment - A change of weather can trigger migraine.

·        Medications - Some medicines, such as oral contraceptive pills, can trigger migraines.

·        Other factors - Bright lights and bright sun glare can cause migraines. Loud sounds, strong smells such as perfume and paints, secondhand smoking among others are all common migraine triggers.

 

Migraine - Symptoms

In most cases, migraines progress through four stages:

1.      Pro-drome - One or two days before a migraine attack, a patient experiences mild changes that warn them of an upcoming migraine. The changes include the following:

o   constipation;

o   mood changes, from depression to euphoria (a feeling of intense excitement);

o   food cravings;

o   neck stiffness;

o   increased thirst and urination; and

o   frequent yawning.

Aura - An aura may occur before or during migraines, though many people experience migraine pains without the aura. Auras are symptoms of the nervous system. They are usually disturbances related to the vision, such as flashes of light or wavy, zigzag vision. Sometimes auras can also be related to disturbances in the sense of touch, movement or speech. The patient’s muscles may get weak or they may feel as though someone is touching them. Each of these symptoms begins gradually, builds up over several minutes and lasts for 20 to 60 minutes. Examples of migraine auras are as follows:

o   disturbances of vision such as seeing various shapes, bright spots or flashes of light;

o   vision loss;

o   pins and needles sensations in either of the arms or legs;

o   weakness or numbness in the face or on one side of the body;

o   difficulty in speech;

o   hearing noises or music;

o   uncontrollable jerking or other bodily movements; and

o   sometimes associated limb weakness.

2.      Main headache attack - A migraine usually lasts for 4 to 72 hours if untreated. The frequency with which headaches occur vary from person to person. During a migraine, one may experience the following:

o   pain on either or both sides of the head;

o   throbbing and pulsing pain;

o   sensitivity to light, sounds and sometimes even smells and touch;

o   nausea and vomiting;

o   blurred vision; and

o   lightheadedness, sometimes followed by fainting.

3.      Post-drome - The final phase, known as post-drome, occurs after a migraine attack. Some patients feel drained and washed out, while some feel elated. For the next 24 hours, the patient may also experience the following:

o   confusion;

o   moodiness;

o   dizziness;

o   weakness; and

o   sensitivity to light and sound.

Diagnosis

A diagnosis of migraine is usually arrived from a careful study of the patient’s medical history, migraine symptoms, the patient’s family history of migraines as well as a number of physical and other advanced examinations. The doctor usually rules out other common possibilities of headache before arriving at diagnosing migraine.

The doctor will ask the patient the exact manner in which they experience the headache, the region where they experience the headaches, time when the headaches start as well as the frequency and duration of the headaches. Other useful information would include knowing how long the patient has been having these headaches and whether the related migraine symptoms are experienced before, during or after the attacks.

Headaches caused by poor eyesight, cervical spondylosis and sinusitis will all be ruled out after the medical tests.

What are the symptoms of a migraine headache

Status migrainosus: This rare and severe migraine with aura lasts for longer than 72 hours.

Migrainous infarction: This is when a migraine is associated with brain stroke. Typically, this is a migraine headache with an aura that lasts more than an hour. An aura that lasts longer than an hour can be a sign of bleeding in the brain.

Persistent aura without infarction: This complication arises if an aura lasts for more than a week after a migraine has ended. This complication has similar symptoms to migrainous infarction, but there is no bleeding in the brain.

Migralepsy: This is a condition where an attack of fits is triggered by a migraine.

Stroke: A brain stroke occurs when blood supply to the brain is cut off or blocked by a blood clot or fatty material in the arteries.

Mental health issues: According to the Anxiety and Depression Association of America, migraines have been associated with a small increased risk of depression and anxiety.

Other complications: Migraines can also bring on symptoms like motion sickness, sleepwalking, sleep talking, night terrors and teeth grinding. Additionally, migraines can bring on abdominal pain, cyclical vomiting and vertigo.

Complications due to medications: It is frequently observed that because migraines recur, people frequently overuse pain medications. Frequent and unguided use of pain medicines lead to abdominal complaints such as gas and acidity to more severe conditions like bleeding.

Medication overuse headache (rebound headache): Continual, long-term use of medications used to treat migraines can cause a rebound headache also known as a medication overuse headache. This can lead to a cycle where taking too much medication causes a rebound headache, which then necessitates taking more medication, which causes worse headaches and so on.

Homeopathic Treatment for Migraine

According to the homeopathic system of medicine, migraine is a chronic disease occurring periodically. The patient may experience it as an acute problem, but because it is periodic and recurrent it needs continuous homeopathic treatment during the attack, and homeopathic medicines need to be taken even when there is no attack. All this is to reduce the frequency and intensity of subsequent attacks and eventually stop them.

In all types of acute and chronic illnesses, homeopathy applies the concept of individualisation, which means that even if two people are suffering from the same type of migraine, a homeopathic doctor will study the whole case history of each of the patients — their exact nature of symptoms, temperament, feelings, likes and dislikes — and then suggest a remedy suitable for each of them to ascertain deep-rooted and permanent cures.