The present topic is vast hence it may take multiple posts to explain this common but most misdiagnosed and most mistreated medical condition.
WHAT CAUSES MIGRAINE..?
Migraine is a condition causing recurrent headaches, dizziness, lightheadedness, blurring of vision, weakness, fatigue, and even blackouts & loss of consciousness triggered by many known and unknown factors.
Accordingly, migraine is commonly known by many types -
a) Migraine causing recurrent headaches (Common Migraine),
b) Migraine causing visual disturbances (Migraine with Visual Aura),
c) Migraine causing dizziness (Vestibular Migraine),
d) Migraine headache during menstrual periods (Menstrual Migraine)
e) Migraine causing weakness of limbs (Hemiplegic Migraine), and even
f) Migraine causing transient loss of consciousness (Syncopal Migraine)
WHAT ARE THE REAL CHALLENGES IN DIAGNOSING MIGRAINE?
Migraine is not just headaches but it can present in various clinical forms and may mimic most of the clinical diagnosis. Moreover, there is no specific investigational tool or specific examination findings to prove a diagnosis of migraine. Rather migraine is diagnosed based on certain criteria defined by the International headache society based on illness history. Hence it poses a significant challenge to the clinician to reach the diagnosis based on extracting exact illness history which will be time-consuming.
In our clinics, we routinely face many such difficult clinical situations,
1) A patient in the emergency dept. or Outpatient clinic having severe headache with nausea, multiple episodes of vomiting and she is just irritable doesn't want to talk much and, wants a pain-killer to get rid of this nagging irritating pain in the head and doesn't want to get interrogated with a hundred questions. She would rather choose investigations MRI, CT, or blood to be taken for reaching a diagnosis but not many questions. But poor clinician doesn't have anything right to be suggested but would tell, "Initially we can treat your acute problem, rule out major causes of headaches for which I need your cooperation then if needed we can go for investigations just to rule out other possibilities".
2) A patient coming to the 'expert clinician' referred by her contacts or by a family physician with a history of chronic recurrent headaches and she wants to know what is happening to her head these days and want to reach a specific diagnosis with most appropriate clinical investigations that I suggest. Then with the utmost difficulty, I have to convince her that investigations are done just to rule out other possibilities and we need to reach a diagnosis based on her illness history.
3) A patient coming with dizziness, fatigue or blackouts, visual disturbances and she eagerly explaining her varying experiences regarding the situations of imbalance, giddiness, fall risks, depressions, anxiety regarding the problem and her dreaded new life, while I go on asking about her headaches, it's triggers, specific features and finally patient interrupting me and telling, "doctor sorry to interrupt, my real problem is dizziness and not my headaches. I only have the 'usual headaches' which get relieved with sleep or rest or even with a Paracetamol". Then I have to explain to her about all different varieties of migraines and make her convince that your dizziness could also be a migraine and we need to assess it.
These are few situations in the routine where we have to listen patiently to all, educate them, asking their cooperation in managing the problem, the need for regular follows up and be compliant on the long term treatment. And to my experience, these patients will be your hardcore fans later.
WHAT ARE THE KNOWN MIGRAINE TRIGGERS?
Now it has been proven scientifically that 'alteration in homeostasis' is that resulting in migraines.
Homeostasis is the 'tendency to maintain internal physiological stability to compensate for external or internal environmental changes'. So many external and internal triggering factors are found to cause migraines. This condition is influenced by genetic factors, hormonal factors, and gender factors.
The factors which are found to trigger or increase the tendency to get a migraine are called migraine triggers. Among the following described triggers some are avoidable, some are unavoidable while some are correctable.
MIGRAINE TRIGGERING FACTORS:
1) Bright Sunlight exposure, Change in temperature (Unavoidable)
2) Long journey or Travel with curves and speed alterations (Unavoidable)
3) Skipping meals or late meals (Avoidable)
4) Sleep disturbance or inadequacy (Avoidable)
5) Menstrual periods (Unavoidable)
6) Job stress/Family stress/Learning stress (Unavoidable)
7) Excessive physical activity (Avoidable)
8) Specific food items (Avoidable) – Chocolate, Aged cheese, Red wine, MSG(Ajinomoto), Excessive coffee
9) Specific drugs (Avoidable) - containing caffeine, Birth controlling pills
10) Head & neck factors (Correctable) – Eye strain, Sinusitis, Toothache, Jaw bone joint pain, Cervical neck pain
IS THERE ANY MIGRAINE RELIEVING FACTORS?
MIGRAINE RELIEVING FACTORS:-
1) Avoidance of Migraine triggers
2) Adequate sleep/rest, oral fluids & food, stress relievers
3) Any symptomatic drugs for headache, dizziness
DOES A MIGRAINEUR GET ALL THOSE FEATURES EXPLAINED ABOVE?
No, those who have chronic recurrent migraines do get many of the above features but rest may have some features alone, like constellations of symptoms.
So there can be mild, moderate, or severe migraineurs. Even each attack or episode can differ between mild, moderate, or severe grade.
WHEN DO WE NEED MIGRAINE TO GET TREATED?
Migraine needs to get treated if it is,
- affecting our daily activities,
- affecting our job,
- affecting our studies,
- affecting our quality of life
and if it has resulted in certain complications like
- Chronic headache
- Chronic persistent dizziness
- Depression and Anxiety.