By Dr, Goke Akinrogunde

Headache comes in different forms and intensities; it can come throbbing, sometimes it is felt as a tension wrapped around the head and more commonly it is felt as a dull but disturbing ache. A special type of headache that is highlighted in the passages below is migraine.

Migraine is a condition that causes recurrent episodes of severe headaches; it is commonly, though not always, a one-sided headache that is typically described by the victim as throbbing or pulsating.

Available epidemiological studies reveal that headache is one of the most common symptoms experienced by adults and migraine is the most common cause of headache in the general population. Migraines occur equally frequently in all countries and all races. They are slightly more common in male disabling children, but after puberty, are 2-3 times more common in women.

Causes of illness and types of migraine
Migraine causes attacks of headaches, often with feeling sick or vomiting. One “good’ thing however is that between migraine attacks, the symptoms go completely.
Migraine attacks come in two forms:

Migraine without aura – sometimes called common migraine.

Migraine with aura – sometimes called classic migraine.
Migraine is not an uncommon illness in the population common. World-wide, it is estimated that about 25% (i.e. 1 in 4 women) and about 1 in 12 men, develop migraine at some point in their life. It most commonly first starts in childhood or as a young adult.

Some individuals who suffer from migraine can have frequent attacks – sometimes several in a week. While others have attacks infrequently, that is only now and then. Some people may go for years between attacks. In some cases, the migraine attacks stop in later adult life. However, in some cases the attacks persist throughout life.
Migraine without aura
It is the more common type of migraine (about 75 per cent of all patients). Symptoms include the following.

The headache is usually on one side of the head, typically at the front or side. Sometimes it is on both sides of the head. Sometimes it starts on one side, and then spreads all over the head. The pain is moderate or severe and is often described as ‘throbbing’ or ‘pulsating’. Movements of the head may make it worse. It often begins in the morning, but may begin at any time of day or night. Typically, it gradually gets worse and peaks after 2-12 hours, then gradually eases off.

Other symptoms that are common include: feeling sick (nausea), vomiting, the victim may be provoked or get worse by bright lights or loud noises, and as such conditioned the individual to want to lie in a dark room.
Other symptoms that sometimes occur include: being off food, blurred vision, stuffy nose, hunger, diarrhea, abdominal pain, passing lots of urine, going pale, sweating, scalp tenderness, and sensations of heat or cold.

Migraine with aura
About 25 per cent (i.e.1 in 4) of people with migraine have “migraine with aura”. The symptoms are the same as those described above for “migraine without aura”, but also include an aura i.e. a warning sign before the headache commences.

Visual Aura: this is the most common type of aura. Examples of visual aura are: a temporary loss of part of vision, flashes of light, objects may seem to rotate, shake, or ‘boil’.

Numbness Feeling: numbness and ‘pins and needles’ are the second most common type of aura. Numbness usually starts in the hand, travels up the arm, then involves the face, lips, and tongue. The leg is sometimes involved.
Speech problems: problems with speech are the third most common type of aura.

Other types of aura include: an odd smell, food cravings, a feeling of well-being and other odd sensations.
It is worthy of note that one of the above auras may develop, or several may occur one after each other. Each aura usually lasts just a few minutes before going, but can last up to 60 minutes. The headache usually develops within 60 minutes of the end of the aura, but it may develop while the aura is still present. Sometimes, just the aura occurs and no headache follows.

Similarly worthy of note is that a number of people who have migraine with aura also have episodes of migraine without aura.

Tests for migraine
Ordinarily no laboratory or radiological investigation is required before a diagnosis of migraine is made. This is because there is no test to confirm migraine.
The physician can be confident that an individual has migraine if he/she has the typical symptoms. However, some people with migraine have non-typical headaches. Sometimes tests are done to rule out other causes of headaches.

Tension headaches
A point to also note is on the more common tension headaches that are sometimes confused with migraine. These are the common headaches that most people have from time too time. Although if an individual has migraine, he/she can also have tension headaches at different times to migraine attacks.

Causes of Nausea
The causes of migraine are not yet so clear, although there are some theories being postulated. One of the theories says that blood vessels in parts of the brain go into spasm and suddenly become narrower which may account for the aura. The blood vessels may then open wide (i.e. dilates) soon after, which may account for the headache. The blood vessels then gradually return to normal.

However, the above do not explain all that occur during migraine attack. It is now thought that some chemicals in the brain increase in activity in addition to any blood vessel changes. It is not clear why people with migraine should develop these changes. However, something may ‘trigger’ a change in the brain to set off a migraine attack.

Is migraine inherited?
Migraine is not a strictly inherited condition. However, it often occurs in several members of the same family. So, there may be some genetic factor involved, which makes one individual to be more prone to developing migraine.

I Need Help on my Duodenal Ulcer
Sir,
I have been a victim of duodenal ulcer since 2001, I went to my doctor recently who sent me for endoscopy and the result confirmed that I am still having duodenal ulcer.

I went back to my doctor, he only recommended Gestid for me which I have been taking till now without cure.
I need your help, please send me the names of the medications that could be of help to cure the ulcer.

Thanks

Dear Wale,
In the light of your letter above, I should quickly note that your doctor acted well by sending you for endoscopy, which incidentally is the gold standard in the diagnosis of peptic ulcer and related disease conditions.

The is more so the case since the endoscope makes it possible to directly visualise any problem in the stomach and the intestinal tract; with this, the type of ulcer or otherwise can be seen and better described. This is unlike the result with the use of contrast X-ray of the stomach that is also use in the diagnosis of peptic ulcer.

However, I wish to make it clear that I am not in position to question the judgement of your doctor as per why he decided to limit your treatment to antacid medication like the Gestid you mentioned. Although, it is save to add that the mainstream in the treatment of duodenal ulcer these days involve using the combination of antacids and other related drugs with antibiotics.

It should however be noted that the use of antibiotics in ulcer treatment is informed by the fact that most of the ulcers in the duodenum is thought to be related/caused by a bacteria (Helibacter pylori) infection in the duodenum. Hence, by eradicating this organism, most of the ulcers soon get healed and their reoccurrence become very limited.

So, it may be assumed that even if the use of antacids lead to the healing of the ulcer in the first instance, a permanent cure may not be achieved since the primary cause, which may be due to the presence of H. pylori in the upper intestine, is not eradicated with the use of potent antibiotics combination. I should also add that there are many of such combinations of antibiotics and not just limited to two types of antibiotics as you mentioned in your letter.

On the other hand, the converse can also be the case in medical settings where related tests can be carried out to confirm the absence or otherwise of H. pylori; antibiotics usage may not be compulsory, if the test for the presence of the bacteria in the duodenum is negative.

In the light of the foregoing, my impression is that you should go back to inform your doctor of the unimpressive outcome of the initial treatment for your duodenal ulcer and I want to trust that he will act on the scientific line of the discussion above.

Meanwhile, it is unprofessional and unethical to prescribe ethical drugs like antibiotics by correspondence on a medium like this, more so the idea is not to overstretch the essence of this column as a alternative to interacting with the health professionals on a one-on- one basis in a clinical environment.

Accept my best wishes. (Dr. Goke)