“The top of my skull feels like it's being pressed down on.”
“It begins to be such intense pain that I feel nauseous.”
“I thought I was having a stroke or some kind of brain failure because my vision went out in my right eye.”
Sounds horrible? These are the vivid details of the migraine experiences, as illustrated in this article by SELF.
As an occasional migraine sufferer myself, I experience pulsing sensation on one side of my head whenever migraine happens. It was not fun to say the least.
This is migraine
Not everyone will have a ‘typical’ migraine. There are different types of migraine that involve different symptoms. However, the common symptoms are:
-
An intense, throbbing headache on one side of the head. The pain gets worse when you move. The pain can be so severe that it prevents you from carrying out any normal activities.
-
Nausea & vomiting
-
Increased sensitivity to light and sound. This is why many people with a migraine want to rest in a quiet, dark room.
-
Intense tiredness
Migraine symptoms usually last between 4 hours to 3 days.
Migraine attack stages
Rather than an one-off event, migraine usually takes on several well-defined stages. It is often difficult to predict when a migraine attack is going to happen. Learning these stages may help you to distinguish a migraine from a headache and to predict the pattern of your migraine attack.
Image credit: https://www.migrainetrust.org/about-migraine/migraine-what-is-it/symptoms-and-stages/
Aura?
Notice the second stage, aura, is not always present in every migraine case. In fact, about 1 in 3 people with migraines have ‘temporary warning symptoms’ before the actual migraine attack, known as aura. These include:
-
visual problems – such as seeing flashing lights, zig-zag patterns or blind spots
-
numbness or a tingling sensation like pins and needles – which usually starts in one hand and moves up your arm before affecting your face, lips and tongue
-
feeling dizzy or off balance
-
difficulty speaking
-
loss of consciousness – although this is unusual
Aura typically develops over the course of 5 minutes and lasts up to an hour. Some people may experience aura followed by only a mild headache or no headache at all.
Medications for migraine
The treatment may vary depending on the severity of migraine. If you have never tried any migraine treatment before, consider the following suggestions:
-
Try taking over-the-counter paracetamol according to the manufacturer’s or pharmacist’s instructions. Nowadays, there are many improved formulas of paracetamol products in the market, which usually come with other components such as caffeine that may reduce headache or migraine more effectively than just paracetamol alone.
-
If paracetamol formulations failed to relieve your migraine pain, you may see a GP or pharmacist for other types of medications. Common options for migraine treatment in Malaysia include non-steroidal anti-inflammatory drugs (NSAIDs),ergotamine and caffeine and triptans.
Ergotamine and caffeine
Brand name: Cafergot®
In this medication there are two active ingredients, namely ergotamine tartrate and caffeine. Ergotamine tartrate belongs to the group of ergots. It relieves migraine by narrowing the blood vessels, especially those connected to the brain. The caffeine is added to improve the absorption of ergotamine by our digestive system, although caffeine itself does relieve headache to some extent.
However, ergotamine tartrate is infamous for its side effects. Paradoxically, ergotamine may even worsen the nausea and vomiting symptoms of migraine. Also, long-term use of ergotamine has been found to increase the risk of stroke, heart attack and ischemic complications, especially among individuals who already have risk of heart diseases to begin with.
Therefore, if you have uncontrolled high blood pressure, coronary artery disease, currently on any medications which are supposed to prevent future heart attacks or are pregnant, you should not take ergotamine preparations.
The effectiveness of ergotamine in treating migraine has also remained questionable. A more effective ergot alternative would be dihydroergotamine.
Triptans
Brand name: Imigran®
Due to the notorious side effects of ergots, triptans rise to fame as the most preferred medication for migraine.Triptans is a group of drugs that specifically treats migraine -- it is highly effective because instead of relieving pain, triptans target the underlying mechanism of
headache. Examples of triptans include sumatriptan, zolmitriptan and eletriptan.
Not only is triptans more effective but it also has lesser side effects, and are suitable for the use of patients with heart and cardiovascular issues. The only downside is that Imigran® , a sumatriptan brand in Malaysia, is much more costly than Cafergot®.
You are advised to see a doctor to explore the most suitable migraine treatment plan for yourself.
Identifying and avoiding trigger of migraine
All medications aside, one of the best ways of preventing migraine is identifying the things or events that trigger the attack and finding ways to resolve or avoid them.
Here are some well-known migraine triggers:
-
Changes of hormone level around the time of women’s menstrual period, which usually occur between 2 days before the start of period to 3 days after.
-
Paradoxically yet for a similar reason, menopause can also trigger migraine in some women due to hormonal changes.
-
Emotional triggers such as stress, anxiety, depression and shock
-
Physical triggers such as poor quality of sleep, jet lag, low blood sugar, overwork, strenuous exercise when you are not used to it
-
Food-related triggers, such as coffee, foods contain tyramine (cheese, smoked fish), alcohol, or any specific food that always followed by a migraine attack
-
Environmental triggers such as bright light, flickering screens, loud noises or changes in climate
-
Certain medications such as hormone replacement therapy (HRT) that are taken by postmenopausal women or contraceptive pills
You are encouraged to notice any of these triggers that often supersede your migraine attack. You may do so by keeping a migraine diary that can help you identify possible triggers and monitor how well any medicine you're taking is working.
In your migraine diary, try to record:
-
the date of the attack
-
the time of day the attack began
-
any warning signs
-
your symptoms (including the presence or absence of aura)
-
what medicine you took
-
when the attack ended
Prevent migraine using medication
There are also medications that you can take to prevent migraine. You may see a GP and discuss this option.
References:
