That Stubborn Headache could be Migraine (2)

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Dr. Goke Akinrogunde

Going forward from the last discourse on ‘Migraine’ on this page, migraine is said to be the most common cause of disabling headache in the general population. Migraines occur equally frequently in all countries and all races. They are slightly more common in male children, but after puberty and are more common in women.

There are two main types of migraine: migraine without aura – sometimes called common migraine and migraine with aura (e.g. nausea and vomiting, mal-sensation etc) – sometimes called classic migraine.

Migraine is not an uncommon illness in the population. It is estimated that about 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.

Although migraine is not a strictly an inherited condition; it often occurs in several members of the same family. So, there may be some genetic factor involved, not fully understood now, which makes one individual to be more prone to developing migraine.

Triggering factors of migraine
Majority of migraine attacks occur for no obvious reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:
•Diet. Dieting too fast, irregular meals, cheese, chocolate, red wines, citrus fruits, and foods containing tyramine (a food additive).
•Environmental. Smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
•Psychological. Depression, anxiety, anger, tiredness, etc.
•Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
•Menstruation. In some women, it is not unusual to have more attacks of migraines during their monthly periods (menstruation).
•Pregnancy. Some women have more attacks of migraine during pregnancy than when not pregnant.
•Other provoking factors are shift work, different sleep patterns, the menopause.

It may help to keep a migraine diary. Note when and where each migraine attack started, what you were doing, and what you had eaten that day. A pattern may emerge, and it may be possible to avoid one or more things that may trigger your migraine attacks.

Treatments for Migraine
Painkillers Paracetamol or aspirin (as do other non-steroidal anti-inflammatory drugs) work well for many migraine attacks. However children under 12 should not take aspirin. A normal dose of the analgesic should be taken as early as possible after symptoms begin.

If the painkillers are taken early enough, they often reduce the severity of the headache, or stop it completely. A lot of people do not take a painkiller until a headache becomes really bad. This is often too late for the painkiller to work well. The only solution may then be to find a quiet, dark room to ‘sleep it off’.

Take the full dose of painkiller. For an adult this means 600mg – 900 mg aspirin (usually two to three tablets taking with food) or 1000 mg of Paracetamol (usually two 500 mg tablets). Repeat the dose in four hours if necessary. Soluble tablets are probably best as they are absorbed more quickly than solid tablets.

Anti-inflammatory painkillers Anti-inflammatory painkillers other than aspirin probably work better than paracetamol or aspirin to ease a migraine. They include ibuprofen which can be obtained at pharmacies or get on prescription. Other anti-inflammatory non-steroidal medications include diclofenac, naproxen, or tolfenamic acid need a prescription.
Sometimes, ergotamine-based drugs (e.g. Cafegot) are prescribed in stubborn cases.

Dealing with nausea and sickness As noted above migraine attacks may cause nausea (feeling sick and feeling like vomiting) or actual vomiting. The nausea causes poor absorption of tablets into the body. If one takes painkillers, they may remain in the stomach, not getting absorbed, and not work well if one feels sick. You may even vomit the tablets back.

Tips that may help include:
•Use soluble (dissolvable) painkillers. These are absorbed more quickly from your stomach and are likely to work better.
•An anti-nausea/anti-vomiting medicine e.g. Phenegan or Avomine may be taken with painkillers. A doctor may prescribe one. Like painkillers, they work best if one takes them as soon as possible after symptoms begin.

Combinations of medicines, Some tablets contain both a painkiller and an anti-vomiting medicine. They may be convenient. However, the dose of each constituent may not suit everyone, or be strong enough. It may be preferable to take painkillers and anti-sickness medicines separately so that you can control the dose of each.

Triptan medicines. A triptan is an alternative if painkillers do not help. These include: almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. They are not painkillers. They work by interfering with a brain chemical called 5HT. An alteration in this chemical is thought to be involved in migraine.
Preventing a migraine attack

A medicine to prevent migraine attacks is an option if one has frequent or severe attacks. It may not stop all attacks, but the number and severity are often reduced. Medicines to prevent migraine are not painkillers, and are different to those used to treat each migraine attack. The doctor knows better and can advise on the various medicines available.

Better still, keep a migraine diary of the time, frequency of attacks and remotely linked events and causes that occur around the time of the migraine episodes