Migraine is a recurrent,severe complicated one sided headache associated by sickness, sensitivity to light or noise, nausea and vomiting and often preceded by warning symptoms. Some migraines have aura (associated symptom) like abnormal visual sensations, numbness in parts of the body, speech problems or even change of smell and food cravings. Migraine affects 8% of men and 25% of women, 15% of females have their migraines around their period. Migraines cost the Australian state billions of dollars due to lost working days, reduced productivity and cost in medication and treatment sought. To keep migraine apart from other forms of headache it is often sufficient to take a good history and pass a basic physical examination with your GP. Important is to recognize a recurrent pattern and show complete recovery between headaches, which can occur weekly to twice a lifetime. Different theories are used to explain migraines and effectiveness of medication. These might be vascular models showing association to tightening and dilatation of brain blood vessels, or changed discharge / excitability of brain cells, there often is a familial pattern for migraines.
Triggers for migraines can be
- dietary certain foods, fodd chemicals
- environmental smoking , computer screens , smells, shift work
- psychological depression , anxiety anger tiredness..
- medicines Hormone replacement, sleeping tablets , contraceptives
- hormonal Menopause , periods
Treatment aims at recognition and avoidance of triggers, non medical measures like lying or sitting down in the dark, cold cloth on forehead , relaxation techniques. Where possible anti sickness and simple pain killers should be used early in the course of the migraine. Stronger combined or migraine specific medications are used in the in the more gusty face of a migraine. These can be combination of above with codeine, or newer medications like triptans. Strong opioids should be avoided where possible. Some severe migraines require short transient admission, fluid infusions and injections of antiepileptics, neuroleptics and anti sickness medications.
Drugs used to prevent migraines are used if migraines are frequent and disabling and poorely controlled by above measures. These can be Beta blockers, anti epileptics, certain antidepressives. The aim being to reduce frequency and severity of attacks. Important is to avoid the over- or regular use of even simple analgesics like paracetamol , Ibuprofen and migraine medication , as this can lead to chronic headache (medication headache) which is a very difficult to treat catch 22 condition. While Migraines can be severe and recurrent complaints, they usually not indicate severe disease. Beware worsening migraines while on the pill!, especially if they also show odd nerve symptoms (weakness, pins and needles , speech disturbance). Beware also the worsening migraine, in smokers, overweight or not , with or without the history of other risk factors for stroke and vessel disease.
Helko Schenk
25 5 2009
Sources
- Migraine Diagnosis and treatment, Australian Family physician 8 2005
- Migraine, John Murtaghs Patient Education, McGraw-Hill , Australia
- Migraine, www.patient.co.uk
- Migraine , www.gpnotebook.co.uk
Triggers for migraines can be
- dietary certain foods, fodd chemicals
- environmental smoking , computer screens , smells, shift work
- psychological depression , anxiety anger tiredness..
- medicines Hormone replacement, sleeping tablets , contraceptives
- hormonal Menopause , periods
Treatment aims at recognition and avoidance of triggers, non medical measures like lying or sitting down in the dark, cold cloth on forehead , relaxation techniques. Where possible anti sickness and simple pain killers should be used early in the course of the migraine. Stronger combined or migraine specific medications are used in the in the more gusty face of a migraine. These can be combination of above with codeine, or newer medications like triptans. Strong opioids should be avoided where possible. Some severe migraines require short transient admission, fluid infusions and injections of antiepileptics, neuroleptics and anti sickness medications.
Drugs used to prevent migraines are used if migraines are frequent and disabling and poorely controlled by above measures. These can be Beta blockers, anti epileptics, certain antidepressives. The aim being to reduce frequency and severity of attacks. Important is to avoid the over- or regular use of even simple analgesics like paracetamol , Ibuprofen and migraine medication , as this can lead to chronic headache (medication headache) which is a very difficult to treat catch 22 condition. While Migraines can be severe and recurrent complaints, they usually not indicate severe disease. Beware worsening migraines while on the pill!, especially if they also show odd nerve symptoms (weakness, pins and needles , speech disturbance). Beware also the worsening migraine, in smokers, overweight or not , with or without the history of other risk factors for stroke and vessel disease.
Helko Schenk
25 5 2009
Sources
- Migraine Diagnosis and treatment, Australian Family physician 8 2005
- Migraine, John Murtaghs Patient Education, McGraw-Hill , Australia
- Migraine, www.patient.co.uk
- Migraine , www.gpnotebook.co.uk
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