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When your head pounds endlessly

By WINNIE MABEL January 29th, 2014 2 min read

A man in his late 30s came to the emergency room at around 9am. He was in pain. He said it was a headache, and that he had had such aches in the past.

He was also nauseous, irritable and could not tolerate bright light or loud sounds. A physical examination, other than the obvious pain, was normal. Laboratory tests were also normal.

The diagnosis was a migraine. It took several hours and a number of medications to control the pain. By 5pm, he was pain-free and was released to go home.

Migraines usually begin in childhood, adolescence or early adulthood, and are three times more common in women than men. The attacks, if left untreated, usually last between four and 72 hours.

Migraines may go through four stages; the pro-drome, the aura, the attack and the post-drome, though most of the patients only go through the attack and the post-drome.

The pro-drome occurs one or two days before the attack, and may include emotional lability, a general feeling of unease and abdominal discomfort.

The aura may occur before or during the migraine, and may be in the form of visual disturbances (flashes of light, wavy lines), pins and needles sensation, verbal disturbances, or even limb weakness.

The migraine attack is characterised by moderate to severe pain on one side of the head or the whole head. The headache may be pounding or throbbing.

The pain may also be associated with sensitivity to light, noise or strong smells and may be worsened by physical activity.

There may also be nausea and/or vomiting, abdominal discomfort, blurring of vision, dizziness, feeling of chills and/or hotness of body and fatigue.

The post-drome occurs after a migraine and the individual feels tired and drained.

No exact cause of migraines has been found. Genetics, some brain chemicals and nerve pathways may play a role as well as the environment. However, several triggers have been identified, though they differ from person to person. One of them is hormonal changes in women, either during the normal menstrual cycle, pregnancy or menopause, and also changes brought about by use of hormonal medications.

Other triggers include too much or too little sleep, stress, fatigue, bright light, weather changes, dehydration, hunger, some foods ( such as salty and processed foods, alcohol and highly caffeinated drinks, strong smells like perfumes, smoke and paint thinner, some medicines (like oral contraceptives and some hypertension medications.)

Diagnosis is usually made on the basis of the presenting symptoms and prior history of similar complaints.

Physical, laboratory and radiological examination are usually normal though they may be carried out to rule out other possible causes of headache like infection, low blood level, metabolic disorders or tumours.

There is no known cure for migraines. Mild to moderate migraines can be resolved by use of over-the -counter and prescription painkillers.

When these are not effective, other medications are used to treat the migraines, like triptans, ergotamines and opioids.

Long term use of painkillers can lead to stomach ulcers, and some medications like opioids can be addictive.

There are medications that are also given for a long duration of time to prevent migraine headaches.