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Stop passing off migraine as headache

Byusanewscart.com

Dec 29, 2023

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Migraines are often underestimated and misunderstood. Millions of people worldwide grapple with the excruciating pain, sensory disturbances, and debilitating symptoms that accompany this neurological disorder. Migraines are a major public health concern globally. In 2019, the global incidence of migraines increased to 87.6 million (40.1% increase compared to 1990).According to the Global Burden of Disease (GBD) study, headache disorders are the third leading cause of years lived with disability worldwide. Sadly, many still confuse migraines with common headaches, perpetuating a misconception that hinders accurate diagnosis and effective treatment.
What are migraines?
Migraines are a neurological condition that causes moderate to severe unilateral or bilateral headaches lasting 4 to 72 hours. They are characterized by severe, throbbing headaches along with other symptoms such as nausea, vomiting, sensitivity to light and sound, and visual disturbances, making even the simplest of tasks unbearable. The migraine attack is characterized by prodrome, aura, headache phase and postdrome phase. The prodrome begins 24-48 hours prior to the start of headache characterised by euphoria, depression, yawning. The aura, which
is seen in one quarter of the patients with migraine (migraine with aura), lasts for less than an hour and involves visual phenomenon, tingling, paresthesia and numbness in the limbs. The headache phase lasts for few hours, although it may lasts for 4-72 hours. The triggers for migraine include dietary (alcohol, withdrawal of caffeine, artificial sweetener aspartame), hormones (menstrual cycle, ovulation and progesterone based hormone supplementation), strong sensory stimulation, stress, poor lifestyle (schedule changes, skipping meals, sleep disruptions and poor sleep architecture and inadequate physical activity).

Migraines are a result of an interplay between genes and the environment and involve complex changes in brain activity. This is the key difference between migraines and headaches; hence, they require early evaluation and diagnosis by a neurologist. Family history and genetics can increase one’s susceptibility to migraines, and environmental factors such as stress, certain foods, and hormonal fluctuations can also act as triggers. A specialist may recommend that a patient maintains a migraine diary to keep track of triggers. Migraines can have a devastating impact on daily life as many patients are unable to work, attend school, or participate in social activities. In some cases, it can also lead to isolation, anxiety, and depression. Moreover, with lost productivity and escalating healthcare costs, the economic burden can be substantial.
Challenges and management
Lack of awareness is a key challenge in identifying this condition. Migraines are often misdiagnosed as tension, cluster, or sinusitis headaches due to similar symptoms. Hence, it is important to raise awareness about its signs and symptoms and seek appropriate diagnosis and treatment. If you experience severe headaches, you must consult a specialist who can assess the symptoms and medical history. A precise diagnosis can lead to tailored treatment plans, significantly improving your quality of life.

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Migraine management includes lifestyle changes, preventive medications, and acute therapies. The abortive (symptomatic) therapy of migraine ranges from the use of simple antiemetics (antinausea), analgesics (pain relievers) to specific medications like triptans, CGRP antagonists and monoclonal antibodies. The inadvertent and repetitive use of abortive treatment without proper medical advice can result in medication overuse headache. However, most of these medications can have significant side effects that may not allow many deserving patients to continue these options. And all these medications may not be for everyone, your doctor shall decide on your suitability for a particular drug based on your individual migraine condition and history.
Additionally, long-term use of some migraine medications can lead to dependency or rebound headaches.
Newer treatment approaches
There is a need for drug-free therapies such as neuromodulation devices, which are typically used for patients who do not respond to or tolerate existing drug treatments and those who wish to avoid medications. This can include patients like adolescents, women of vulnerable age groups, the elderly, etc. They can effectively reduce the frequency, severity, and duration of migraine attacks without the risk of systemic side effects. Neuromodulation is a non-invasive technique that uses electrical or magnetic stimulation to regulate the nervous system. For e.g., remote electrical neuromodulation (REN) uses a wearable device and an app to treat migraines. It is a safe, convenient, and personalized treatment with minimal side effects. The burden of migraines is shared by countless individuals, hence, there is a need to support migraine research to improve diagnosis and encourage emerging treatment options.
Migraines are a distinct medical condition. Early diagnosis and appropriate treatment are essential for improving quality of life. Newer treatment options are on the anvil with greater focus on migraine research.
For patients, a more accepting and understanding atmosphere can be created by having candid discussions and busting myths around offering all the therapy options possible upfront at the time of initiating therapy towards the best possible outcomes for this challenging condition.
(Author: Dr. Nirmal Surya, Consultant Neurologist, Bombay Hospital (BHMRC) and Saifee Hospital, Mumbai)



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