Aarti Aneja Pathak, a homemaker in Noida, often skipped breakfast as a child. The result: gastric problems and “high-intensity headaches that last(ed) for days”. It took her years to figure out that these were migraines. At 35, she now has her condition under control. “That’s because I know my migraine triggers,” she says, “and I have warning signs such as a craving for something sweet, water retention and incontinence. Minutes after that, my migraine hits hard.”
Illustration: Jayachandran / Mint
For 32-year-old Milanka Chaudhury, a practising lawyer in Delhi, a migraine means he must stop work midway, even if in court. “I get a sudden throbbing pain that keeps increasing every minute. If I don’t have medication on hand, the only way to get relief is to get home, take the painkillers and lie down in a dark room for hours together. There’s a tendency to vomit and I cannot eat. All I can think of is the searing pain. Each time is just as unbearable as the last.”
Most sufferers know there is no cure; but many are unaware that migraines can be managed effectively.
Migraine or simple headache?
• Do you get pounding one-sided headaches that threaten to turn your insides out?
• Does it make it impossible for you to carry out your daily chores?
• Do you feel like lying down in a darkened room until the pain subsides?
If you answered yes to any of the above, chances are that you have migraines. Take that headache to the doctor for diagnosis, please.
Most people learn it’s a migraine from symptoms they become familiar with over the years.
• Severity: That throbbing one-sided pain is a classic, a result of physiological changes that dilate or inflame blood vessels. In other headaches, the pain is usually from constricted vessels or tight head or neck muscles. “(Migraine is) much more severe,” says A. Panneer, neurologist, Apollo Hospitals, Chennai, “It can affect normal day-to-day functioning,” and worsens with physical exertion. “Even walking aggravates the pain,” he adds.
• Gastric symptoms: Migraines often come with nausea or vomiting.
• Sensitivity: “There is an aversion to light, noise and smell,” says Dr Panneer.
• Onset: “Its onset is sudden and it may be mild to begin with, but then becomes very severe over time,” says Ish Anand, senior consultant and vice-chairman, department of neurology, Sir Ganga Ram Hospital, New Delhi. Migraines may occur at any age, but “it starts most of the times in the teens,” he adds.
• Genes: “Most of the patients have family members with similar headaches,” says Dr Anand. Approximately 75% of the sufferers are women.
• Location: It typically starts from one side or sometimes from the front or the back of the head.
• Duration: “It may last from 4-48 hours,” says Dr Anand (this differs from cluster headaches, frequent attacks over weeks or months, followed by remission periods of months, even years).
• Aura: “A person may have certain sensory symptoms (termed aura) 10-30 minutes before an attack,” says Dr Panneer. “Flashing lights, blind spots, numbness, disturbed sense of smell, taste or touch, feeling mentally incoherent, etc.” Some see shadowy patterns. Others get a pins and needles sensation in their hands or face. However, studies show that only one in five people experience an aura and women have this form of migraine (called a classical migraine) less often than men.
Being prepared is the key to managing a migraine, experts say. Not everyone has the same triggers (see Triggers), so keeping a migraine diary over the years helps. It’s important to avoid the triggers for your migraine and treat immediately (see a basic plan in Treatment) with a drug that suits you.
• For mild or occasional attacks: Individuals with occasional mild migraines that do not interfere with daily activities can usually find relief with over-the-counter (OTC) pain relievers. There are two major classes: acetaminophen (Crocin) and non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs include aspirin (Disprin), as well as ibuprofen (Brufen) and naproxen (Napra).
• For acute attacks: Dr Anand says, “Two types of medicines are useful, and you must carry them at all times: (1) a tablet containing anti-inflammatory medicines with antiemetics with or without caffeine (Napra D, Naxdome, Meftal Forte) and (2) triptans such as sumatriptan (Suminet in tablet, nasal spray or injectable form), rizatriptan (Rizact) or zolmitriptan (Zomig).”
Earlier, triptans were prescribed for moderate to severe migraines after OTC analgesics or other simple measures failed. Newer studies suggest they can be the first treatment for debilitating migraines. Triptans should be taken early before the pain sets in or while it is still mild. This increases their effectiveness (at least 80% of attacks are aborted within 2 hours), reduces side effects and decreases chances of recurrence in the next 24 hours.
• Only under medical supervision: Another set of drugs—ergotamines (Ergomar, Wigraine, Cafergot, Migranal, DHE-45)—work like triptans by constricting blood vessels, but ergots constrict the cardiac vessels more and so are deemed less safe.
Sometimes headaches can signal other critical, even fatal problems. Any severe, persistent headache with neck pain and stiffness, vomiting or visual disturbance should be reported to the doctor at once.
WHEN A MIGRAINE HITS
Stop, pop and sleep: Experts advise that as a first line of treatment, sufferers must stop whatever they are doing and rest, taking perhaps even a simple analgesic (see main story) with or without an anti-nausea agent (to prevent vomiting). If you take your medication right at the beginning of the migraine and rest immediately, chances are you will recover much faster. Find a place where you will not be disturbed, preferably a darkened room where you can lie down, and stay there until the attack passes.
WARDING OFF ANOTHER ATTACK
Regulate: Once you know your migraine triggers, try and avoid those foods or activities. Do not upset your biological clock if you can help it.
Relax: Stress activates migraines. Relaxation techniques such as nature walks, yoga and pranayama can help in stressful times or situations where you cannot avoid triggers such as menstruation (for many female sufferers, attacks seem hormonally triggered, occurring just before or at the onset of their periods).
Forestall: “If the frequency is more than four-six episodes per month, then preventive medicine may be used, such as riboflavin (vitamin B2) and magnesium compound,” says Dr Panneer. Prophylactics are also offered when the migraine attacks are prolonged or disrupt daily life.
Anything disturbing the biological clock: Missed meals, too much or too little sleep, travel (hence hunger, weekend or holiday migraines)
Menstrual migraines occur just before or at the onset of periods due to normal hormonal changes or due to birth control pills. Also, stress and anxiety
Bright lights (sun glare), loud noises or strong smells (even perfumes)
Aged cheese, fermented or pickled food, dairy products, chocolate, bananas and avocados, citrus fruits, papaya, passion fruit, plums, dried fruits, lentils and nuts, peas and beans, onions, alcohol (including beer and red wine), foods containing monosodium glutamate (ajinomoto), nitrites (used in processing meats), yeast, sulphites, saccharine or aspartame
Don’t let your heart miss a beat!
Symptoms of heart disease vary with the exact problem and severity—it’s not all chest pain and palpitations. Some symptoms are often overlooked:
• Acidity, heartburn, excessive burping: If nausea, sweating, squeezing pain or shortness of breath are also felt, avoid coffee or other caffeinated foods, and call the doctor.
Breathlessness (in women): The most common early warning of heart disease. It may be accompanied by a dry, unproductive cough.
• Severe leg pain: Crippling peripheral artery disease (PAD) mainly affects the legs, as arteries get lined by fat and cholesterol deposits. Doppler ultrasonography and arteriography can aid diagnosis.
• Frequent fainting: Abnormal heartbeat is just one problem that can cause this, especially during exercise or exertion. Get a check-up.
Expert: Dr Ashok Seth, chairman, cardiac sciences and chief cardiologist, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi
— Kavita Devgan
Beware of antiviral drugs
Given expert warnings against indiscriminate use of antiviral drugs such as Tamiflu, it is worth asking: When do I see a doctor?
• Hard to breathe? Chest pain or pressure? Confusion? Seizures? Persistent vomiting? Bluish lips? It’s an emergency
• Those at high risk (pregnant, or with heart disease, asthma, diabetes or other chronic illness, or aged under two or over 65) must see a doctor. Antivirals work best in the first 48 hours.
• Not everyone gets a fever. But generally, people without fever don’t get as sick. Most otherwise healthy people should stay home and rest, getting plenty of fluids
• If the fever goes away but returns days later, seek help. It can be a sign of the bacterial infections that sometimes follow.
Prickly heat—blame the sun or the monsoons?
Contrary to what ad spots suggest, prickly heat isn’t actually caused by the sun. Many find it’s more problematic in the monsoons.
Why: “Prickly heat begins with excessive perspiration, usually in a hot, humid environment,” says Shehla Agarwal, consultant dermatologist, who runs a private clinic called Mehak Skin Clinic in New Delhi. “Perspiration damages surface cells, trapping sweat beneath the skin where it builds up, causing bumps. As they burst, one feels the prickly stinging sensation.” Bacterial infestation ensues and manifests itself as severe itching, rash and tiny boils.
What to do: Avoid anti-perspirants, moisturizers, insect repellents or talcum powder, which form added barriers and trap sweat further. Instead, apply ice cubes directly on affected areas. Once your skin is cool and dry again, apply calamine lotion to relieve itching, Dr Agarwal suggests.
— Kavita Devgan
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