Contributed by Dr Kyaw Zay, Medical Officer, Neurology Department, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre
Migraine is a neurological disorder characterised by recurring severe headaches, affecting millions of people worldwide. Far more than just a headache, migraines bring forth intense pain and a host of other distressing symptoms.
Despite its prevalence, migraine often remains misunderstood and stigmatised.
To address the issue and support those who suffer, it is crucial to raise awareness about the impact of migraines, dispel common misconceptions, and promote a better understanding of this debilitating condition.
Understanding migraine and its impact is crucial to enhance empathy and support for those affected.
THE MIGRAINE BURDEN
Migraine is more than just a headache. It is a complex condition that can significantly impair the quality of life for those affected and can impair individual’s functional ability to work or study.
If you are not a migraine sufferer, you probably know at least one person who suffers from it.
According to the World Health Organization (WHO), migraines are among the top 10 causes of disability worldwide, and the second most disabling condition in the world after low back pain.
The symptoms typically occur in phases:
Before the headache: the “prodrome” phase may precede hours or days before the actual attack, and includes early warning signs like mood changes, food cravings, dizziness, yawning, thirst, and frequent urination.
Sometimes an “aura” can occur, experienced by some individuals, involving visual symptoms such as flashing lights or zig zag lines in the field of vision, and physical symptoms such as tingling or numb sensations. These auras typically last for around 20 minutes to an hour.
During the headache: alongside a mild to severe headache, throbbing or pulsating in nature, symptoms may include nausea, vomitting, sensitivity to light and sound, neck pain, dizziness, and an overall feeling of exhaustion. These headaches can last for several hours or even days.
After the headache: tiredness and irritability may last another two days, leaving the individuals feeling drained. This is sometimes called the “hangover” effect.
CAUSES, TRIGGERS AND LIFESTYLE FACTORS
While the exact cause of migraines is not fully understood, several triggers and lifestyle factors have been identified. Common triggers include stress, hormonal changes (such as menstruation), certain foods and beverages (like cheese, chocolate, caffeine, alcohol, nuts, and foods containing monosodium glutamate), dehydration, jet lag, bright lights, strong smells, and changes in sleep patterns.
Women are approximately two to three times more likely to experience migraine episodes than men.
Many women experience migraines linked to hormonal fluctuations, such as during their menstrual cycles, pregnancy, or menopause.
Genetic factors may also play a role – family history of migraine is a common risk factor.
Identifying personal triggers through self-monitoring can help individuals manage and prevent migraine attacks.
Consider keeping a headache diary, or a migraine app. Noting down the symptoms, associating factors and when they occur can help a person and healthcare professional identify the migraine episodes and possible triggers.
Often, triggers can be partial and additive: you might not get a migraine attack after drinking a cup of coffee, but a cup of coffee plus a bad night’s sleep might do it.
DISPELLING MISCONCEPTIONS
One of the most persistent misconceptions surrounding migraines is that they are simply a result of stress or tension.
While stress can be a triggering factor, migraines are actually a neurological disorder with genetic and environmental components. Another misconception is that migraines are just severe headaches.
In reality, migraines are a complex interplay of brain chemicals, nerve pathways, and blood flow abnormalities.
Creating awareness about migraines is essential for reducing stigma and fostering empathy.
Education initiatives should target not only the general public but also healthcare professionals, employers, and schools.
Public campaigns can help people understand the impact of migraines on individuals’ daily lives, highlighting the need for support, flexibility, and reasonable accommodations.
If your family member, friend, or colleague lives with migraine, show your support by following these: believe them, be sympathetic, do not fault or downplay migraine symptoms, and be supportive.
For those living with migraines, support groups, online communities, and patient advocacy organisations can be invaluable sources of comfort and guidance.
These platforms offer a space for individuals to share experiences, exchange coping strategies, and gain emotional support from others who truly understand their challenges.
TREATMENT
Although there is no cure for migraine, medications can help reduce the symptoms, and more importantly people can try lifestyle changes to possibly avoid or reduce the triggers. These can help reduce the frequency and severity of migraine.
Regular exercise, stress management techniques like deep breathing or meditation, adequate sleep, good hydration and a balanced healthy diet, and avoiding trigger factors (such as certain foods, bright lights, or strong smells) are all important steps that can help minimise the impact of migraines.
Some home remedies may also help with the symptom control, such as using cold packs or masks, aroma therapies, staying in a dim and quiet room, or simply sleeping for some people.
While there is no cure for migraines, there have been significant advancements in treatment options.
From preventive medications to acute symptom relief, individuals living with migraines have access to various pharmaceutical and non-pharmaceutical interventions.
Consulting with a healthcare professional is crucial for proper diagnosis and personalised management plans.
Based on your symptoms and their frequency, your doctor may prescribe pain relief medications such as simple analgesics (paracetamol, ibuprofen) and triptans such as sumatriptan.
These medications should be taken at the onset of migraine for rapidly easing your symptoms and restoration of functional ability.
But these drugs don’t always work and keep in mind that they can have side effects.
It is important to avoid overusing the analgesics, often overuse can cause a rebound headache.
If your migraines are frequent and quite disabling, your doctor may recommend a preventive or prophylactic migraine treatment to stop the headaches from starting, and to reduce the frequency and intensity of attacks.
These types of medicines include antidepressants like amitriptyline, blood pressure medications like propranolol, antiseizure drug like topiramate among many others.
It may take several days to weeks to see an improvement and you need to be regular on these to get their full potential effect.
A single medication may work for some people, but not for others. Your doctor may suggest not to lose hope and keep trying.
And nowadays, there are more treatment options than ever, with a handful of new drugs for prevention and acute treatment of migraine. A person should consult a healthcare professional, or a headache specialist or neurologist, when your migraine symptoms are worsening or unusual.
Some symptoms could indicate another condition that may need urgent attention, such as an unusually severe headache, visual disturbances, a loss of sensation or weakness in one half of face or body, difficulty speaking. Your doctor will evaluate the symptoms and decide on best management.
Migraine is a complex neurological disorder that extends far beyond a mere headache.
Its impact on the lives of those affected can be severe, but with the right understanding and management, individuals can find relief and regain control.
Migraine awareness is a pressing issue that deserves attention from the wider public and medical community.
By shedding light on the realities of living with migraines, dispelling misconceptions, and providing support and resources, we can create a more inclusive and empathetic society for those affected by this chronic condition.
It is our collective responsibility to spread awareness, promote empathy, and support those living with migraines, ultimately fostering a more compassionate society.
