Dear Doctor,

I suffer from migraine headaches and I wish to know how to reduce the pain and prevent attacks.

Gerald

Dear Gerald,

Migraine is severe throbbing headache usually affecting one side of the head. The headache is often severe enough to be debilitating, compelling one to take rest. There may be associated nausea, vomiting, photophobia and visual auras of seeing bright lights, one or more of these symptoms. Migraine is more common in young women and can start as early as in teens.

The exact cause of migraine is not known. But it is postulated to be caused  by neurochemical, vascular changes in the brain. Many trigger factors have been identified, which precipitate an attack of migraine. These can be hormonal. Many women experience migraine about 2 days before menses and it may continue till 2 to 3 days after. Some women get relief from migraine attacks after menopause, whereas in some women it may become worse. This occurs due to change in level of  estrogen and progesterone. Migraine can occur due to combined contraceptive pill or hormone replacement therapy in some women.

Emotional factors play a very important role in inducing migraine attacks in those prone to it. Agitation, anxiety, depression, excitement, any sudden emotional change can trigger an attack.

Lack of sleep, jet lag, physical or mental exertion, shoulder or neck pain, low blood sugar levels, dehydration, poor working postures are some of the physical factors responsible for an attack of migraine. Bright lights, flickering lights, loud noise, change in climate or very cold climate can bring an attack of migraine in susceptible people.

Some people are prone to develop migraine due to some kinds of foods like chocolate, cheese, tea, coffee, etc. One can have an attack due to missed meals or irregular meals or eating binge of food.

Migraine is diagnosed on the basis of clinical history of type of headache. There is no specific test for it. Prevention lies in avoiding trigger factors. Regular meals taken in time avoiding to eat much quantity  is useful.  Healthy life style factors like  sleeping and getting up in time, balanced diet and regular physical exercise, are also  useful in preventing attacks.

One should  learn to be relaxed physically as well as mentally.  Meditation and yoga are beneficial in preventing migraine.  Treatment of an attack involves bed rest in a quiet, dark room. Drugs like propranolol, anxiolytic drugs, etc. are used for treatment.