How to deal with migraines

Migraines cause real pain like injury-related pain – with one difference: healthy habits and simple non-medical treatments sometimes stop the migraine before it begins!

Medication is a proven way to manage and prevent migraines. But medicine is only part of the story. It is also necessary to take care of yourself and understand how to deal with migraines when it occurs.

The same lifestyle options that promote good health can also reduce the frequency and severity of your migraines.

Knowing how to manage migraine pain through lifestyle and behavior measures, as well as medications, is often the most effective way to manage migraine headaches. At the first sign of a migraine, if possible, withdraw yourself from usual activities.

Turn the lights off. Migraines often produce sensitivity to light and sound. Relax in a dark, quiet room. Sleep if you can. Try thermal therapy. Use a hot or cold compress to your head or neck. Ice packs have an anesthetic effect, which can reduce pain feeling. Ice bags and heating pads can relax in tense muscles. Hot showers or baths can have a similar effect.

Drink a caffeinated beverage. In small quantities, caffeine alone can relieve migraine pain in the early stages or increase the effects of acetaminophen (Tylenol, others) and aspirin. Be careful, because drinking too much caffeine often can lead to withdrawal headache later on.

Migraines can prevent you from sleeping or wake you up at night. Likewise, migraines often occur due to poor sleep at night. Here are some suggestions to help you sleep well.

Determine routine sleep times. Wake up and go to bed at the same time each day, even on weekends. If you take a nap during the day, keep it short. A nap longer than 20 to 30 minutes can interfere with sleep at night.

Check your medication. Medicines that contain caffeine or other stimulants – including some medications to treat migraines can interfere with your sleep. Your eating habits can affect your migraines. Avoid foods that cause migraines. If you think eating certain foods – such as old cheese, chocolate, caffeine or alcohol – is causing your migraines, discard it from your diet to find out what’s going on. During physical activity, your body releases some chemicals that block pain signals to your mind. These chemicals also help relieve anxiety and depression, which may worsen migraines.

Obesity also raises the risk of chronic headaches, so maintaining a healthy weight through exercise and diet can provide additional benefits in treating migraines.

If your doctor agrees, choose any exercise you want. Walking, swimming and biking are often good options. But it is important to start slowly. Exercising a lot can lead to migraines. Tension and migraines often go hand in hand. You can’t avoid daily stress, but you can keep it under control to help manage migraines. Take a break. If you feel overwhelmed, a few slow stretches or a brisk walk can refresh your energy for the task you do.

If you feel anxious or depressed, consider joining a support group or seeking advice. Believe in your ability to control pain!

How to deal with migraines

People who have actually suffered from migraines are the only ones who know, that this pain can be so severe that your daily activities can be hampered severely. It is hard to believe that someone can be totally incapacitated due to a headache but that is how severe a migraine can be. The fact that the exact cause of a migraine is not known makes it worse.

What is a migraine?
Dr K Ravishankar, specialist in headache medicine explains, “The problem of migraine headaches occurs in those with a ‘ready’ brain condition, which is in fact a condition marked by the hyper excitability of the brain. This condition is genetically inherited and about 20 per cent people are migraine prone individuals. Whenever this ‘ready’ brain is influenced by triggers (both environmental and lifestyle mistakes), a severe headache with distinctly recognisable features occur. This headache is called migraine.”

Causes of migraine The triggers that cause migraine in susceptible individuals may cause no headache in normal people. These can be identified as:

Environmental — Heat, high intensity light, increased humidity, changes in weather conditions.
Lifestyle mistakes — Skipping breakfast and fasting, consumption of certain types of cheese and chocolates, red wines, fermented foods, foods with MSG (Monosodium glutamate) such as Chinese food, excessive consumption of colas.

Dr Charulata Sankhla, Consultant Neurophysician, says, “Factors like improper sleep, skipping meals, extreme light/sound, stress and consumption of certain foods such as some variety of cheese, chocolate, foods that contain MSG, etc tend to trigger migraine in susceptible people.”

Neurosurgeon Dr Sunil C Kutty, says, “Causes of migraine are both vascular and neural influences in a genetically susceptible individual primed by environmental factors. In short the exact cause is still undetermined. Some people who suffer from migraines can clearly identify triggers or factors that starts the headaches, but many cannot.”

Migraine builds up gradually and grows into a severe pain that may affect one side or both the sides of the brain. It is a pulsating/throbbing kind of pain that increases in intensity. It may or may not be accompanied with nausea and vomiting. The patient feels uneasy in bright light and loud sounds. He/she feels better after sleeping and would usually like to take rest in a dark and silent room. Migraine can be episodic and can get recurrent i.e. daily or 15 days and more. This is the condition of Chronic Migraine and it can last anywhere between four to 24 hours. A regular sufferer of migraines can identify the onset of another migraine attack. He/ she may feel unease, may feel low and sad, fatigued, experience stiffness in neck, can feel excessively hungry and also confusion or mild disorientation.

Prevention and treatment
Preventing migraine calls first and foremostly for the identification of triggers. If the pain occurs once or twice in a week, medicines such as Triptan can be taken after consulting a headache specialist. However, it is not advisable to take pain killers on a regular basis and without consulting a doctor for there are side-effects involved.

Then there are medicines that play a preventive role — these are Beta blockers. They can be taken on a daily basis (upon consultation) to manage migraines and decrease their frequency and intensity.

Besides, lifestyle management is also essential. You need to have healthy eating habits such as taking carbohydrate-rich, sumptuous breakfast daily. Avoiding fermented foods and others that trigger migraine is recommended.

The condition of chronic migraine, at times, does not respond well to medicine. The patient also grows weary of eating a combination of medicines daily. For such individuals, there is a new treatment available now in the form of injections of Botulinum Toxin Type A (See box). In the West, trials have confirmed that Botulinum Toxin does help in reducing the number of episodes of chronic pain.

Dr Sunil C Kutty says that the old adage, “prevention is better than cure” holds true for migraine and the best treatment would be to avoid the trigger factors. There are several categories of preventive migraine medicine, ranging from diet changes and exercise, to prescription drugs.

The medical treatment of migraine is of two types:
– Abortive therapies — started during aura, or if in its absence after the onset of headache
– Prophylactic therapies — to prevent migraine attack, but has to be taken for prolonged periods.

In patients not responding to medical treatment and with frequent attacks, surgical treatment has been proposed which has reportedly given good results in selected cases.

Botox treatment
Dr Charulata Sankhla, Consultant Neurophysician says, “A new treatment doing rounds these days for chronic migraine patients is the Botox Treatment. It involves giving injections of Botulinum Toxin Type A to the patient in the muscles around eyes, forehead and jaw, closing muscles and back of the neck. The protein relaxes the muscles and eases the pain in chronic sufferers and the results last up to six months. This treatment has shown to decrease the intensity and frequency of migraine episodes in such patients.

It is possible for people to get medication overuse headache (MOH), or rebound headache, when taking too many medications in an attempt to prevent migraine. So, it is always better to be guided by a doctor.