DR. FATIMA NAZIR

MRCGP (INT) – Royal College of General Practitioners

Aster Discovery Gardens

The headache is initially unilateral and localized in the fronto-temporal and ocular area, but pain can be felt anywhere around the head or neck. The pain typically builds up over a period of 1–2 hours, progressing posteriorly and becoming diffuse.

The headache typically lasts from 4–72 hours. Among females, more than two thirds of patients report attacks lasting longer than 24 hours.

Pain intensity is moderate to severe and intensifies with movement or physical activity. Many patients prefer to lie quietly in a dark room. The pain usually subsides gradually within a day and after a period of sleep. Most patients report feeling tired and weak after the attack.

 Prodromal(before headache) feature

About 60% of people who experience migraines report premonitory symptoms that occur hours to days before headache onset.

• Heightened sensitivity to light, sound, and odors
• Lethargy or uncontrollable yawning
• Food cravings
• Mental and mood changes (eg, depression, anger, euphoria)
• Excessive thirst and more urination
• Fluid retention
• Anorexia
• Constipation or diarrhea

What is migraine headache aura?

The migraine aura is a complex of neurology symptoms that may precede or accompany the headache phase .It usually develops over 5–20 minutes and lasts less than 60 minutes. The aura can be visual, sensory, or motor or any combination of these.

Visual symptoms

Auras most commonly consist of visual symptoms.

Tunnel vision

visual defects

Complete blindness

Sensory symptoms

with numbness starting in the hand, migrating to the arm, and then jumping to involve the face, lips, and tongue.

Motor symptoms

symptoms often are described as a sense of heaviness of the limbs before a headache but without any true weakness.

Postdromal (after headache) symptoms

Postdromal symptoms may persist for 24 hours after the headache and can include

• Tired,“washed out,”or irritable feeling
• Unusually refreshed or euphoric feeling
• Muscle weakness or myalgia s
• Anorexia or food cravings

What are common dietary triggers of migraine headaches?

The significance of diet as a migraine trigger is controversial.Nevertheless, individual patients often can identify these triggers. Common dietary triggers include the following:

• Alcohol – Particularly wine and beer
• Caffeine overuse or caffeine withdrawal
• Chocolate
• Aspartame – eg, NutraSweet and Equal
• Monosodium glutamate (MSG) – May be found in Asian food, canned soup, frozen or processed foods, and the seasoning product Accent
• Fruits – Citrus fruits, bananas, avocados, and dried fruit
• Nuts – Peanuts, soy nuts, and soy sauce

Common triggers include the following:

• Hormonal changes (eg, those resulting from menstruation, ovulation, oral contraceptives, or hormone replacement)
• Head trauma
• Lack of exercise^,Sleep changes, Medications (hormonal )and Stress.

Family history

Approximately 70% of patients have a first-degree relative with a history of migraine. The risk of migraine is increased 4-fold in relatives of people who have migraine with aura.

What are the goals of migraine headache treatment?

Migraine treatment involves acute (abortive) and preventive (prophylactic) therapy. Patients with frequent attacks usually require both.

Measures directed toward reducing migraine triggers are also generally advisable.

Many people who have migraines find that over-the-counter painkillers, can help to reduce their symptoms.

It’s not advisable to wait until the headache worsens before taking painkillers, as it’s often too late for the medicine to work.

Triptan medicines are a specific painkiller for migraine headaches. They’re thought to work by reversing the changes in the brain that may cause migraine headaches.

What is the role of activity modification in the management of migraine headaches?

Most studies of aerobic exercise in migraine patients have not found a significant reduction of headache attacks or headache duration, although regular exercise has been shown to reduce pain intensity in many patients.

How are migraine headache

triggers managed?

Patients should avoid factors that precipitate a migraine attack (eg, lack of sleep, fatigue, stress, certain foods,). Encourage to use a daily diary to document the headaches. This is an effective and inexpensive tool to follow the course of the disease.

DD. From Other Causes of headach