Alana
B had always been a 'headache person'. Back in high school,
a week couldn't go by without her ending up at the nurse's
office, head throbbing. She eventually learned how to
cope by downing a few painkillers. But after the birth
of her son, the headaches returned to haunt her. This
time the pain was more severe. The throbbing intensified
and was often accompanied with nausea, blurred vision
and lethargy. She also found that she was more sensitive
to sound and smells. Between the constant crying and the
sleep deprivation, the situation felt hopeless.
When Alana finally brought the
symptoms to the attention of her doctor, she was surprised
when he suggested that her headaches might actually
be migraines. She had assumed they were just signs of
stress due to the new baby. She was partly right. Close
to 20% of women suffer from migraines — compared
to about 6% of men — and in some cases hormonal
changes, like Alana's pregnancy, can change the frequency
or severity or trigger their onset. Migraines can start
as early as infancy and often occur during childhood.
Their causes are still nebulous but some theories point
to serotonin levels, while others point to genetics
(in the case of 'inherited' migraines). In the meantime,
prevention and pain control are key to keeping migraines
in check. Here are a few tips on how to talk to patients
about migraines and help them control the pain.
MANAGING
MIGRAINE PAIN
When it's more than a headache One of the first
questions a patient may have about migraines is how
they differ from an average, run-of-the-mill headache.
"Well, migraine is a specific kind of headache
and it has specific characteristics," explains
Dr Allan Gordon, a neurologist and associate professor
at the University of Toronto. These characteristics
include one-sided pain (on one side of the head), throbbing,
nausea, a general feeling of unease, light, smell and
sound sensitivity and auras (changes in vision, including
seeing flashing lights and colours). Since migraines
share symptoms with other kinds of headaches, like sinus
or tension headaches, they can be tough to diagnose.
Fact and fiction Many of
your patients who suffer from migraines may worry that
their headaches are actually signs of brain tumours
or brain damage. Dr Gordon stresses that these myths
are just that ? myths. Still others believe that migraine
is a high achiever or upper-middle-class disease. But
anyone can suffer from migraines, regardless of income.
Some people also believe that migraines cause stroke.
"Some evidence shows that migraines are linked
with stroke," says Dr Gordon. This evidence is
still in early stages, but is something to watch out
for.
Set it off For many migraine
sufferers, or 'migraineurs', certain foods and environmental
factors can trigger the onset of pain. It's important
for patients to know what sets off their migraines.
"One of the things that I often do is have the
patient track the headache with a diary," says
Dr Gordon. In terms of specific foods, Dr Gordon names
red wine, beer, cigarettes, certain cured meats and
strong cheeses as common triggers. Others include aspartame
and dairy products like yogurt, buttermilk and sour
cream. The environment can also be a significant factor.
"People always talk about the weather," says
Dr Gordon. "The first time I actually believed
it was when a patient, who was married to a meteorologist,
actually plotted her headaches by following the barometric
pressure."
Nip it in the bud Knowing
how to prevent the pain is essential for migraineurs.
You can tell patients that the first step to knowing
how to prevent a migraine is to be aware of triggers
mentioned above and then to avoid them. For patients
who experience more common bouts of migraine pain, medication
can be helpful. Dr Gordon suggests telling patients
about some herbal remedies that might do the trick.
"A lot of people are more likely to go with natural
substances," he says. "They can try vitamin
B2 (riboflavin), about 4g a day. There is also evidence
that feverfew leaf and coenzyme Q can also be beneficial."
In cases where natural remedies are ineffective, you
might want to try them on more powerful prescription
drugs like beta-blockers (inderal, metoprolol), tricyclic
antidepressants (like amitriptyline), or antiepileptics
(like divalproex sodium and topiramate). Dr Gordon also
notes that most SSRIs are good options. When it comes
to any of these drugs, it may take six to 12 months
for any noticeable improvement in migraine frequency.
Stopping the pain
When a migraine hits, patients need to be prepared to
deal with the pain. You can suggest they try lying down
in a dark, quiet room, with a cold compress over their
forehead. Applying pressure to their temples can help.
Dr Gordon also suggests some over the counter medications
like acetylsalicylic acid, acetaminophen and ibuprofen
to numb the pain. Patients should also know about more
powerful prescription meds like triptans, which are
'abortive' migraine medications. They don't actually
prevent migraines but abort a migraine attack, stopping
the attack itself and the associated symptoms.
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