Coping with migraine attack

Migraine is a common condition affecting approximately 6 percent of men and 18 percent of women worldwide. It is a form of headache where attack lasts for a portion of or a whole day and rarely lasts 2-3 days.
Each attack is characterised by headache plus nausea, vomiting and/or photophobia. The headache is usually a throbbing, unilateral pain although rarely it may be bilateral and constant.
In classical form of migraine, an aura, a strange sensation occur that precedes the onset of headache and this may include visual disturbances, blind spots within the field of vision. The aura may also include unusual tastes and aromas. This form accounts for 25 percent of migraine causes and there is often a family history of the condition, whereas another form called common migraine, happens more frequently than classical migraine, accounting for 75 percent of cases. Patients with common migraine have the same throbbing headache and nausea but do not experience the visual aura or other neurological symptoms. Migraine can last up to 72 hours.
Signs and symptoms during an attack include nausea, vomiting, diarrhoea, sweating, cold hands, sensitivity to light and sound, scalp tenderness, pale color, pulsing temple, pressure pain etc.
Usually the following issues trigger a migraine attack.
• An initiating process, head injury, meningitis, an emotional crisis, hormonal changes (puberty, pregnancy or the contraceptive pill) in women can start attacks.
• Other potential factors include hunger, certain foods — cheese, chocolate, alcohol, citrus fruits, sleep — too much or too little, hormonal variations in women, changes in the environment — heat, cold, excess light or noise, local head pains — sinusitis, upper respiratory infection, pain from neck or eyes, exercise, travel and emotional stimuli, particularly after a period of stress, can all trigger individual attacks.
You can get protection from migraine by regular sleep, regular meals, regular exercise, biofeedback, healthy lifestyle.
Management of migraine involves avoidance of trigger factors and medical treatment aimed either at the acute episode or prophylactic treatment.
Simple treatment in the acute phase includes usual painkiller and anti-vomiting drug. Some other drugs specific for migraine are frequently effective in treating acute attacks. After the acute attack, drugs should be prescribed for prophylaxis of migraine to prevent future episode.
Prophylactic treatment is considered if symptoms happen more than three times a month with a duration of more than 48 hours. Referral to a neurologist is recommended for refractory cases.

The Write up is compiled by Prof Kamrul Hassan Tarafder, Dpt of Otolaryngology, Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU).