Chronic Migraine: Tests That Help In Diagnosis Of Disease & Treatments That Can Prevent Attacks

By Dr. Anil Venkitachalam

A migraine is a headache that one experiences with throbbing pain on a side of the head. Conditions that often accompany a migraine include nausea, vomiting, sensitivity to light and sound etc.

The duration of a migraine attack can be anywhere frin several hours to even days. The pain can often prove to be a big hindrance in the way of daily activities.

Migraine is much more than a mere headache. This neurological disease is a public health concern and therefore it is imperative to consult a neurologist for the right diagnosis and treatment.

‘Aura’ And The Types Of Migraine 

Some migraine patients may get a warning symptom, or what is called an aura, just before the onset of the headache or along with the headache, signalling the migraine attack. This aura can be in the form of blind spots, flashes of light, a tingling sensation in the face, and trouble in speaking, among others. 

Migraine can be of several types. People with Episodic Migraine (regular migraine) have the headahe on 0-14 days of a month. Chronic Migraine is a condition in which the headaches go on for more than 15 days a month for three months or more.

Episodic migraines have a tendency to worsen over a course of time and then they become chronic migraines.

Though there is no cure for migraine yet, a lot of progress has been made in treating the symptoms. 

What Is The Treatment For Migraine?

The response to treatments of migraine and that of chronic migraine is different. For the treatment of migraine, over-the-counter medications may be recommended. Upon evaluation of the frequency and severity of symptoms, prescription medications may also be given. The aim of the treatment of migraine is to stop the symptoms and preventing future migraine attacks. These may include antihypertensives, antidepressants, and antiepileptics.

Those with chronic migraine, however, may not respond well to triptans (group of medicines used to ease the symptoms of a migraine attack) or prescription drugs that block pathways of pain in the brain. So, the treatment of chronic migraine is three-pronged — lifestyle and trigger management, acute treatments i.e., treatment given when attacks occur, and preventive treatments aimed at reduced frequency of attacks.

Though lifestyle alteration helps in reducing the frequency of attacks, medication or other forms of treatment are almost always required for chronic migraine patients.

According to the Migraine Research Foundation, migraine is the third most prevalent and the sixth most disabling illness in the world. Understanding the severity of migraine attacks is the key to managing them in a proper manner. Even with the new age therapies and treatments, it is the right diagnosis that matters the most.

The World Health Organization (WHO) says headache disorders are among the most common disorders of the nervous system, which are underestimated, under-recognised and under-treated throughout the world. Headache disorders are not taken seriously by sufferers since they are mostly episodic, do not cause death, and are not contagious. This explains the low consultation rates even in developed countries as people are unaware about the existence of effective treatments.

Diagnosis Of Migraine

There are several ways in which a neurologist may help you in the diagnosis. These include the HIT or Headache Impact Test, CT scan, MRI, Eye exam, and spinal tap.

HIT is a tool that measures the impact of headaches on daily work, such as not being able to show up at jobs in the case of adults, and attending school in the case of children. HIT is conducted via a questionnaire.

Maintaining a daily headache diary goes a long way in the right treatment. The headache diary can help in recording the duration, frequency and severity of the headaches. It can also help in identifying patterns and determining triggers of the headache and in monitoring the response to the treatment.

All of these help in determining the correct mode of treatment.

The author is Consultant (Neurology) and Movement Disorders, Nanavati Max Super Speciality Hospital

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