Marie (fictitious name) a young college student was unable to study for her exams. Every three or four days she suffered from severe debilitating headache on the left side. One of her teachers insisted that she should consult a physician. This teacher was suffering from attacks of migraine and feared the same for her pupil. When Marie went to the physician, he took a detailed history of the nature of attacks of headache and confirmed that indeed she had a migraine. The term “migraine” is used to describe a periodic disorder characterized by paroxysmal, severe unilateral headache, vomiting, and photophobia with or without visual aura. There is recurrence at regular intervals and relief is obtained by sleeping in a dark quiet room. Migraine is benign and not likely to cause any complication, yet the symptoms are so severe that it is disabling as well as frightening for the sufferer. It is one of the headaches commonly affecting young adults. Ambitious, tense young adults often suffer from migraines. Women are more affected than men probably being more emotional in nature. Often, the attacks are preceded by or associated with visual aura-like colored halos, bright lights or spots in front of the eyes. Sometimes an attack may be associated with total blindness for the duration the headache lasts, but this becomes very frightening for the patient, especially for the first time. Attacks of migraine may subside spontaneously or after rest in a quiet, darkroom. The duration of an attack may be variably lasting from one to two hours to two to three days. Sometimes one feels weak after an attack. The attacks may be as frequent as three or four times per week or there may be an interval of about a few months or years in between the attacks. Bright lights, loud sounds, emotional tensions and anxieties, and even foods, especially chocolate, can precipitate the attacks. It is very easy to diagnose a headache as a migraine when it presents in a typical way. But not all attacks of migraine may present in this way. Sometimes the headache may be mildly tolerable. The site of the headache may be posterior or diffuse the patient complaining of a tight band-like sensation. Instead of the usual aura, a person may feel giddiness or difficulty in walking during an attack. Pain may even be localized around the jaw instead of the typical throbbing one-sided pain. Here, migraine is diagnosed after excluding other causes of headache. Other causes of headache need to be ruled out by suitable tests. Migraine is said to be due to a vasomotor phenomenon happening inside the head, caused by emotional stress. There are several pain killer medicines used to provide relief in migraine. Ergot alkaloids, Beta-blockers sedatives, and antidepressants have been tried successfully to abort the attacks. But these medications only provide relief during an attack but do not prevent further attacks. In fact, prevention lies in the hands of the sufferer itself. Ginger, coriander seeds or powder, caffeine are some substances which provide relief in migraine pain. Avoiding situations likely to precipitate attacks of migraine is very important. One knows from his or her past experiences very well what is likely to cause an attack. Keeping a cool mind always helps to prevent attacks of migraine. One should know very well that nothing is more important in life than being alive itself. Keeping this in mind, one should not bother about other trivial issues. In fact, with a cool mind, one can find a solution to any other problem being faced. Relaxation techniques, if practiced regularly, help to tame the mind and keep away migraines also. Migraine is a debilitating pain condition that can be very easily prevented. Dr. Rachna Pande, Specialist at Nyagatare Hospital
