Migraine isn't simply a headache

Q:
I suffer from migraine about once every several months, usually when I sleep late for several nights in a row. I know when I’m going to have a migraine because I have blurring of vision about 30 minutes before I experience severe right sided headache. What causes migraine? What can be taken to lessen the pain of, or prevent, an attack of migraine? ---Myrna L., Makati City


A:
The type of migraine you suffer from is called classical migraine, a condition that presents as throbbing or pulsating headache, usually one sided, that is preceded (by 20 to 60 minutes) by an aura that often consists of a visual disturbance like blurring of vision, or perception of flashes of lights, halos, stars, blind spots, etc.

Aside from classical migraine, there are many other types of migraine and in most the headache is not heralded by an aura. There is also such a thing as headache-free migraine, where there is an aura but without a headache. Thus, contrary to common perception, migraine is not simply a headache because there may in fact be none. Rather, it is a poorly understood condition that is characterized by a series of changes among the cells of, followed by complex changes in blood flow to, certain areas of the brain. The blood flow changes include initial narrowing followed by widening of certain blood vessels of the brain. The widening of the blood vessels is believed to activate nearby pain receptors and give rise to headache.

Migraine headache varies in location, character, intensity and duration from person to person and from one migraine attack to another in the same person. Typically, though, an attack usually starts as pain on one side of the head that is aggravated by physical activity, coughing, straining, sounds, odors and light. An assortment of other signs and symptoms often accompany migraine headache including loss of appetite, nausea, vomiting, numbness, tingling, weakness, dislike for sound, light and certain smells, temporary paralysis of a limb, ringing of the ear, speech difficulty, temporary blindness, confusion and disorientation.

The course of a migraine attack also varies, but usually, over a period of one to two hours, the pain spreads and increases in intensity before gradually and spontaneously subsiding usually within a few hours. Occasionally, however, the headache persists up to 24 hours or even days.

A migraine attack is triggered by one or a combination of a variety of conditions: emotional or physical stress; lack or excess sleep; hunger; intake of certain foods (e.g., MSG, chocolate, cheese), alcoholic beverages or medications; certain smells (perfume, for example); exposure to intense light or glare; changes in weather, altitude or time zone; and, in women, the drop in the blood level of the female hormone estrogen that occurs before menstruation.

There is no cure for migraine but attacks can be relieved and prevented.

In migraines with aura, ergotamine when taken at the start of the aura prevents or at least alleviates the headache. Unfortunately, ergotamine preparations have been withdrawn from the Philippine market. Mild migraine, on the other hand, is usually relieved by over the counter pain relievers such as acetaminophen and ibuprofen. Severe attacks, however, may require prescription medications such as sumatriptan. Incidentally, a modality that many find effective is acupuncture.

Other measures that often help ease the symptoms of migraine include resting in bed in a dark and quiet room and applying cold compress over the affected area.

The best way to prevent migraine is by avoiding its trigger and most people with the condition know what their trigger is. A variety of prescription drugs to prevent migraine are also available, but these drugs are recommended only for people with frequent attacks (three or more a month) and should only be taken with doctor’s supervision.