Why are migraines such a headache? All you need to know of the problem plaguing thousands of individuals

Dr.K.Ravishankar, Consultant in-charge of The Headache and Migraine Clinic, Jaslok and Lilavati Hospitals, Mumbai, speaks to DNA and addresses a common problem that affects all of us: the migraine

How are migraines different from other headaches?

A migraine is a triggered headache in a patient with a predisposition in the form of a genetically inherited brain hyperexcitability. Unlike other headaches, migraine is a complex neurological disorder that may be a result of a dysfunction of an area in the brainstem that is involved in controlling pain perception and sensory activity. A unique trigger(s) can activate this area of the brain leading to headache and sensory disturbances. Migraine is characterized by recurrent attacks of moderate to severe head pain that is throbbing or pulsating and often strikes one side of the head, though both sides may ache. An untreated migraine attack usually lasts anywhere between 4 to 72 hours.

Do migraines have a cure?

It is imperative to seek medical advice if you suspect that you might be suffering from a migraine. With timely intervention and proper prescription, migraines can be successfully managed, and it becomes possible for patients to lead a life with less headaches. However, one needs to avoid self-medication with harmful over-the-counter pain-killers and be rightly diagnosed and treated with specific anti-migraine prophylactics by your doctor. It is also important to understand the various triggers of migraine to avoid frequent migraine episodes as it may worsen the condition.

Why do you think that it has taken this long to connect migraines with neurological disorders?

Migraine is a common neurological disorder with a high prevalence affecting more than 150 million people in India. Despite these huge numbers, migraine continues to be one of the most underdiagnosed and undertreated disorders. Sufferers tend to confuse it with sinus or other common headaches. There are many myths and misconceptions that surround this common neurological malady. Patients also have their own incorrect fixed notions. Since Migraine is a potentially treatable disorder, it is necessary to increase awareness and apprise the general public of potential treatment options that are now available. It is usually not taken seriously by the family physician or Internist. Often patients and also physicians are more focused on treating just the migraine attack while the aim should be to treat migraine the disorder on a long-term basis. Preventing future attacks is the key to successful migraine management.

Are migraine problems genetic?

Most people who suffer migraine headaches have a family history of other members suffering from headaches thus suggesting a strong genetic susceptibility. While genes play an important role, migraine in women often relates to changes in hormones. Some women may experience "menstrual migraines" around the time of their menstrual period. Migraine headaches often cease during pregnancy in more than fifty per cent, while some women develop migraines for the first time when they become pregnant. While the precise cause of migraine headaches in unclear, there is general agreement that blood flow changes in the brain are a key factor.

To put it across in simple terms - people who get migraine headaches have a nervous system that overreacts to a trigger, such as stress, by causing a spasm of the arteries at the base of the brain, thereby reducing blood supply to certain areas of brain. This is followed by the dilation of these arteries, triggering the release of pain producing substances and other chemicals. The circulation of these chemicals and the dilation of the scalp arteries stimulate the pain receptors in the head, eliciting throbbing head pain.