Today Consultant ENT Surgeon Dr. Ms. Chandra Jayasuriya (MBBS (Colombo), D.L.O.M.S (Otolaryngology), FRCS (Edin) and one of the three senior Consultants attached to the ENT Unit of the Colombo National Hospital speaks about Migraine, one of the common diseases report from the people.
Q – What is Migraine ?
A – Very severe episodic headache. To diagnose Migraine, there should be five attacks of similar episodic of throbbing nature.
Q – How we can diagnose Migraine and what are the main symptoms ?
A – There are warning signs before headache. They are called aura. Patterns of lights in visual fields, back dots, flashes of light, distorted field of vision are the common symptoms of aura. They last for five to 30 minutes. Only 25 percent of affected people get aura.
During a typical attack of headache, it is felt in one half of the head. It lasts approximately two to 70 hours. These are associated with vertigo, vomiting, sensitivity to light and sound or smell. Pain is worsen by physical activity. About 60 percent can have a family history. Females are affected more than men (3:1). Among affected children, boys are affected more than girls. Exact causes for Migraine are not known. It is believed to be a neuro-vascular disorder.
Q – What are the trigger factors for Migraine ?
Dr.Ms.Chandra
Jayasuriya
A – Loud sound, sunlight and other powerful sources of light(watching television and playing video games), stress, fatigue, inadequate sleep, contraceptive pills or injections, food (these may vary from person to person. Can be identified by keeping a headache diary), junk food, alcohol and alcoholic beverages, trauma to the head, changes in temperature etc.
Q – What are the treatment available for Migraine ?
A – The patients need an explanation about the nature of the disease. It is not a life threatening condition. Treatment can be divided into four sections. They are the treatment during aura, treatment during the attack, treatment for preventing the attack and lifestyle modifications.
The warning signs of aura are vertigo, pallor, inability to talk, sensitivity to light, slurring of speech, chills and numbness. The treatment during aura are massaging and hot fermentation of head and neck, relaxation therapy and Pranayama yoga exercises for better breathing techniques, taking analgesics and anti-emetics before headache and vomiting appear.
The signs of an attack are severe throbbing pain, hyperemia of skin, sweating with pallor, confusion and loss of memory, irritability, sensitivity to sound, sensitivity to light and slow speech due to pain. The treatment during attack are analgesics for pain, tablets of Triptan give immediate relief. These should be kept in the handbag all the time. With the first sign of headache, a tablet can be taken.
There are treatment to prevent attack. If the attacks are prolonged, prevalence medication is recommended. If regularly taken for three to six months, it prevents the frequency and severity of headache.
There are lifestyle modifications. The persons who suffer from Migraine should avoid bright light, oral contraceptives etc. they should get away from bright lights and noises. When such a person missed a meal, they should take a snack without delay to avoid hypoglycemia which could trigger Migraine. Massaging the head could be helpful as it increases blood circulation of the head. Hot fermentation helps to increase blood floor. having a good night sleep and waking up and going to bed at the same time every day could be help. The room should be arranged with fewer lights. The analgesics should be taken only when necessary and not regularly.
The patients need to maintain a `Headache Diary’. About 10 percent of sufferers have food triggers. Keeping notes regarding the food and the affect could be helpful to avoid attacks. Acupressure can be used to relieve pain. Tap on three areas : temple, shoulders and inner aspect of the wrist and repeat. Regular exercises for 30 minutes per day would improve the mood due to endorphins. Certain food such as eggplant, potato, sugar, spinach, cheese, red wine, fried food, bananas, tomatoes, artificial additives, soy food etc should be avoided.
Q – What is a `Headache Diary ‘ ?
A – The Headache Diary has information on three things. they are headache, triggers and treatment. The information on headache includes date and time of the start of the headache, the time of the end of the headache, frequency, severity, warning signs (prodrome or aura), site, character (throbbing,pounding) and severity of the pain (scale 1 to 10) and accompanying symptoms (nausea, vomiting or any other symptom that occurred during or after the attack).
The information on triggers includes records of all meals and liquids taken on the day of headache and on the day before, records on all activities on the day of the headache and on the day before. Remarks on any unusual activities. Records on the time went to bed and woke up including whether there were any disturbances. Records on all medications or nutritional supplements taken before the headache. Records on any stressful event that occurred before the headache. Records on the feelings such as excitement, anxiety, happiness, depression, and anger.
The information on treatment includes effectiveness of therapy for each attack, list of prophylactic medications : Propanolol, list of analgesics : NSAIDS, list of abortive medication : Triptans, records on any other steps taken to relieve pain.
The patient need to fill the diary each time when he/she experience even a mild headache. When he/she has enough entries, he/she will be able to find the pattern of headache, its triggers and effectiveness of treatment. Then he/she can inform it to the doctor.
