migraine black female“E toh fehyah! (She too lazy!) Is she alone dat getting headache den?!” You may have heard them casting such remarks. “I get headaches too, but I do what I have to do! I doh understand that!”

The fact is one headache is not like the other. At some point, the vast majority of us have suffered a tension or cluster headache associated with hunger or some viral syndrome. A migraine headache is a different beast altogether. Today we are going to review how to distinguish it, treatment options and hopefully, how to prevent it.

Causes and symptoms

Migraines can be triggered by a number of things including stress, noise, menstrual hormonal changes as well as certain smells and foods. The final common pathway appears to be swelling of the blood vessels in the head which stretch the nerves resulting in pain.

By definition, a migraine headache presents as an intense pulsating pain in one area of the head. It is the accompanying symptoms that define it. Oftentimes there is nausea, vomiting, light-headedness and even fainting. For hours and days, patients are irritated by light and everyday sounds. All they can think about is finding a dark, quiet place to lie down.

Migraine headaches tend to begin in the younger years which have the effect of colouring ones personality among their peers. The condition may progress through four stages, including prodrome, aura, headache and postdrome, though all patients may not experience all the stages.

Prodrome is the red flag that signals a migraine is imminent. Californians are sensitive to any little sign that ‘The Big One’ (earthquake) is coming. Before there were experts at the Government Met(eorolgical) Office, our grandparents knew ‘Red sky at night, sailors delight. Red sky in the morning, sailors warning.’ It is even documented in Scripture

One or two days ahead, these can signal that an episode is on its way. They include hyperactivity, irritability, depression, food cravings, constipation, neck stiffness and uncontrollable yawning.

Aura may occur before or during some migraine headaches. Auras are nervous system symptoms disturbances, such as flashes of light. Sometimes auras can also involve sensory, movement motor or speech disturbances. These symptoms usually begin gradually and build up over to last anywhere from 20 to 60 minutes. Some people see various shapes, bright spots or electric flashes of light. There may be some temporary loss of vision, pins and needles sensations and weakness in an arm or leg, even experience difficulty speaking.

The migraine attack itself, if not treated, may last up to 3 days, but this varies from one individual to the next. The postdrome is the winding down phase. The patient feels drained and washed out during that time. This is sometimes mixed with palpable relief and happiness that the storm raging inside the head has finally passed.

When to seek urgent medical care

Ask any doctor and they will tell you that few things make them snap to attention than a patient complaining, “this is the worse headache I’ve ever had!” A patient of mine was packing for a trip when she stumbled into her suitcase. “Help me!” she cried out to her husband. He made her some bush tea and cradled her in her arms for some time. When she showed no signs of improvement, he finally called the ambulance. She had suffered a massive stroke. Those were her last words. She never regained consciousness until she was called home a couple years later.

Migraines can be so intense with such dramatic symptoms; some patients fear they are having a stroke. At some point in time, it is advisable to invest in a CT scan to make sure we are not missing a brain tumour, ruptured aneurysm or worse.

There is so much more about migraines in all its manifestations. But suffice it to say, by the time a patient comes for medical assistance, Paracetamol is of little help. Diclofenac and Co-codamol would be more effective at this stage. Something even stronger may be needed. This unfortunately places migraine sufferers at risk of becoming malingerers (frequent flyers wanting excuse for missing school or work) or developing a dependence on pain medication.

It is therefore helpful to have a stable relationship with a doctor who knows your medical history and knows what has worked and not worked before. First thing, early in the attack try drinking a cup or two of coffee, whether you are a ‘coffee drinker’ or not. Caffeine shrinks the blood vessels and relieves the pain. In fact, it is a major component in Cafergot, traditionally, the quintessential migraine medicine.

Next in line is the Triptan medications. Certain anti-depression and anti-seizure heart drugs may also be helpful as well as acupuncture. But the focus has to be on nutrition, exercise and relaxation lifestyle changes to minimize migraine triggers.

At the end of the day, you just haven’t got time for the pain. Migraine headaches can be so savage one might feel better off going to Iraq or Syria and just have them cut it off for you. But there is new hope. We can be kinder and gentler with migraine sufferers, but careful with them too. It is after all, a chronic condition which can be managed better now we have a deeper understanding from whence it came.

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