DEAR DOCTOR,

I can’t seem to find any painkillers that ease my constant migraines. I get migraines from time to time and try to sleep them off but sometimes the pain is so intense, I opt to swallow a painkiller, only they don’t seem to help much. What can I do?

TONY

DEAR TONY,

How long have you had "migraine attacks” and how frequently do they occur? What painkillers have you been using?

Migraine typically causes episodic, a one-sided intense throbbing headache, which can last from an hour or so to up to three days.  There may be associated nausea and vomiting. Relief is obtained by lying quietly in a dark room. It is more common in young women, but can occur in men as well. It can begin from teen years up to 40 years or so.  Attacks beginning in teenage years may subside by the time one is middle-aged. The episodes vary in frequency and intensity from person to person. The exact cause of migraine is not known, but genetic factors are implicated.

Bright lights, loud noises, mental or physical stress, lack of sleep, allergy to some foods like cheese, hormonal changes, hormonal contraceptive pills, are known to precipitate migraine in vulnerable individuals. Diagnosis of migraine is made by excluding other physical causes of severe localised headache like trigeminal neuralgias, sinusitis, etc.   This is done by a series of investigations including full blood count, X-ray, C.T scan of brain, MRI of brain and other relevant investigations depending on the symptoms.

Migraine can be prevented by avoiding the risk factors.  Adequate physical and mental relaxation is useful. One can identify any food substance, situation which causes migraine attacks and avoid it. Mild attacks are often   calmed by just lying down quietly in a dark, quiet room.  Painkillers like acetaminophen, ibuprofen may reduce headache, but they may not provide relief in all cases, particularly severe ones. Moreover, if used frequently, one can get rebound headache with them, i.e. relapse of headache, when their effect is over.  Ergotamine, has been known to provide relief in migraine headache and one tablet can be put below the tongue to abort a severe headache.  But it should not be taken beyond a day or two as it can cause side effects like sudden weakness, numbness of one side of the body, slow or fast heart rate. Some anti-depressants, anti-epileptic drugs are also useful for pain relief in migraine.

One can try putting a cold pack or hot compress over the pain site for pain reduction. Drinking plenty of liquids is also useful. Acupressure, acupuncture, and massage are non-pharmacological measures which can be tried to ease the pain, but should be done only after consulting a doctor.

Devices are available that can be put on back of head at start of migraine, which can stop pain by sending magnetic energy or stimulating trigeminal cranial nerves to reduce pain.

Dr. Rachna Pande is a specialist internal medicine