A family history of migraine is the most potent and consistent risk factor for migraine, warns Dr Jaideep Bansal.
Headache is one of the most common reasons patients seek medical attention.
Severe headache can have different causes especially if it has been recurring from many years.
The underlying cause may be serious or even life threatening.
Recurrent chronic headaches are usually not life threatening but may be quite disabling, as they affect day to day functioning and may hamper the quality of life.
So how does one differentiate a regular headache from migraine?
On World Brain Day, celebrated July 22 here are some facts you must know.
What is migraine?
Migraine is a very common disorder in which a patient experiences episodic, recurrent and usually unilateral headache, often pulsatile character, may be associated with nausea and vomiting.
It may begin in childhood but usually begins in adolescence, or early adult life in 80% of the patients.
Its frequency decreases with advancing age but it may worsen in some postmenopausal women.
Activation of the trigemino-vascular system, leading to an inflammatory response that is generated by local neural mechanisms has been assigned a role in migraine headache.
In migraine patients it has being found in PET (positron emission tomography) scan that there is activation of an area in pons (area between medulla and midbrain that co-ordinates between two hemispheres of the brain) during the attack.
Typically, migraine can be two types:
Migraine with aura (classic migraine)
Patients may have aura before the onset of headache. Aura may be in the form of visual disturbances with flashes of light or zigzag lines or other neurologic symptoms.
Migraine with aura, frequently occurs after awakening, but may occur at any time of the day
Migraine without aura (common migraine)
In these patients there’s no aura prior to the onset of headache. It is five times more common than the classic Migraine
Warning signs
If you experience one of these signs, it's time to take migraine seriously.
- Either type of migraine may be preceded by vague premonitory changes in mood and appetite
- Sensitivity to bright light, loud sounds or smell and headache increases with head movement, are seen in both types of migraine
- Family history is seen more commonly in classic migraine than common migraine
- One-third of migraine patients have more than three attacks in a month, if untreated the frequency increases so need medicines
The causes
There are several migraine triggers, including:
- Hormonal changes in women: Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women
- Drinks: Alcohol, especially wine, and too much of coffee
- Stress at work or home can cause migraines
- Sensory stimuli: Bright lights and sun glare, loud sounds. Strong smells of perfume, paint thinner or fuel.
- Sleep: Lack of sleep, jet lag can trigger migraines in some people
- Weather: Change of weather or barometric pressure can prompt a migraine
- Food: Cheese, chocolate and coffee might trigger migraines. Also skipping meals or unhealthy fasting
- Food additive: sweeteners and the preservative
Difference between migraine and normal headache
In migraine, headache is usually episodic, starts with half of the head, throbbing type of ache along with nausea and vomiting.
Common headache is generally caused due to stress and it affects both sides of the head.
It is usually dull, stretching type of headache. This is not associated with nausea or vomiting. It is not photophobic or ensitive to light and sound.
A family history of migraine is the most potent and consistent risk factor for migraine, with a two-to-three-fold greater chances of migraine among relatives of people with migraine.
In common headache family history is not relevant.
In some patients, migraine is activated by specific triggers. In common headache there’s no such trigger.
Migraine needs specific treatment and management. Common headache may be managed by minor lifestyle modifications and painkillers.
Dr Jaideep Bansal is director, department of neurology, Fortis Hospital, Shalimar Bagh
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