Migraine is a 1 hr payday loan lenders common problem and is recurrent in nature. Let me assure you that in migraine, there is no underlying anatomical brain abnormality. The abnormality is in the blood distribution and a proneness to vasomotor change. The chemical transmitter responsible is serotonin released by platelets. In patients with migraine different factors precipitate platelet aggregation and excessive release of serotonin. In prevention, you try to stop the release of serotonin from the paltelets. In the treatment of an acute attack, you try to correct the loss of serotonin, in the cerebral vessels affected by the migraine patho-physiology.
If a headache is always on one side it is not migraine and is serious. Hypertension headaches are common in the mornings. So, if you have headaches when you wake up in the morning, get your Blood Pressure checked. Classical migraine is common among females and cluster headaches (a more severe variant) are common among men. Cluster headache is a chrono-biological disorder that is related to the equinox and returns to the sufferer in the months of January and June. By breathing into a sili sili bag (high concentration of CO2) cluster headache can be relieved though its pain causes people to bang their head on the wall. Cluster headache does not respond to usual migraine treatment. A drop of lignocaine on the spheno- palatine ganglion while the patient is on a chair with the head stretched back relieves the cluster headache when everything else has failed. If cluster headache is not diagnosed, the doctor, employer & family can think that the patient is malingering and he can contemplate suicide because the pain is unbearable. So, if a male has what looks like migraine but does not respond to migraine drugs, think of Cluster headache before you call him a hypochondriac.
Prevention Without Drugs
Fifty percent of migraine improves without drugs by avoiding precipitating factors.
Check eyes for accommodation errors and astigmatism (frequent sties). Check out bad reading habits – with slanted head while reclining on the bed, reading in dim light, reading with book too close to the eyes, reading while travelling as hard pressed Medical students do. When you write, keep your document straight as possible.
Usually, stress and breaking rest brings on the migraine like feeling – hunger, nausea. At that stage those who are frequent sufferers of migraine must relax. Sleep with sound and light shut out is helpful. You can induce vomiting (finger in the throat) and reduce the intensity of a migraine attack when drugs have failed.
It is well known that breaking rest, sleepless nights, TY, delaying meals, colas, tea, coffee, peanuts, cadju nuts bring on the migraine attack in those who are predisposed.
Application of hot or cold fermentation to the side of the forehead, oil of wintergreen is effective. Psych-somatic methods have also proven useful.
Preventive Drug therapy
Preventive drug therapy is considered if the patient has a migraine attack every week or four times a month. Simplest preventive drug is low dose aspirin as given in secondary myocardial prevention. It must be emphasised that, preventive drug therapy would be useless if the patient does not adjust the life style. Propranolol, amytriptaline are the commonest two drugs used.
Drug Treatment of an Acute Attack
In my experience Soluble aspirin is superior to Paracetamol in migraine. Take the soluble aspirin early. Contrary to false advertisements of drug companies soluble aspirin has less side effects than newer expensive analgesics. [Read author in Kandy Medical Journal 1995 (5)1:1-3]
Vomiting may cause the patient to vomit out the drug and that causes ineffectiveness in therapy. Before switching to other drugs, ensure that the patient retains the soluble aspirin by giving an anti emetic. Also, before trying ergot preparations, it must be known that naproxen or diclofenac rectal suppositories have a valued and valid place if oral drug therapy fails.
Codeine should not be tried in migraine.
Our experience is that, with correct advice one can manage migraine with aspirin or paracetamol. In a patient allergic to aspirin, ibuprofen, naproxen or diclofenac can be tried. In clinically effective dosed soluble aspirin has less side effects than naproxen, ibuprofen or diclofenac.
Academic Pharmacology will not recommend the drug combinations available over the counter in trade names. This is with good reason. Before ergotamine preparations are given, one must make sure that the patient is not pregnant, has no hypertension and has no peripheral vascular disease. It is dangerous for patients to use ergot preparations by brand name since this can promote over use and abuse. Ergot preparations should not be given on consecutive days. There must be a gap of 4 days before prescribing ergot derivatives again. One reason for non responding migraine is indiscriminate use of ergot containing drugs.
Migraine sufferers must know that migraine is a common condition with no permanent consequences. Interestingly and expectedly, 20% patients with Irritable Bowel Syndrome (another serotonin mediated condition) have migraine and their bowel symptoms may respond to migraine therapy.
The newer drug sumatriptan should not be used unless all other drugs have failed and only by direct prescription by a physician. Sumatriptan is known to induce coronary ischaemia and should never be given without an ECG and in patients with angina or in those above 35 years.
Newer drugs do not necessarily make the lot of patients easier though they make them