Common but much ignored: How migraines and other headache disorders impact life

"It always starts with a shooting pain in the back of my neck, which then progresses to my head leaving me with a headache on one side. I get a throbbing pain and even the slightest sound then starts to irritate me," says Risa Monica, describing her migraine.

The lecturer at a Bengaluru college struggles through at least five such attacks every month.

According to the WHO, nearly 30% of adults globally are affected by migraines and 1.7–4% experience headaches on 15 or more days every month. It says that headache disorders are a worldwide problem but also points out that they are "underestimated, under-recognized and under-treated throughout the world".

"It is definitely underestimated. People usually say, 'It'll go away, it's just a headache'," Risa says.

Just recently, Apollo Hospitals in Chennai launched a one-stop Headache and Migraine Clinic.

According to Dr Prathap C Reddy, Executive Chairman, Apollo Hospitals Group, "The pain caused by migraines can be incapacitating and sometimes even debilitating. Several lifestyle behaviours are increasingly making headaches commonplace and many a times, they can severely impact productivity."

Headache disorders can be controlled with a mix of medicine and therapy.

Rajini S* knows just how wearing migraines can be.

"A migraine can be very debilitating. It can affect your ability to work. Yet, taking a day off for what is essentially a headache seems a bit over the top. So, you pop a pain killer and get on with life. What we don’t know enough about is how to manage a migraine or what triggers a migraine. If we knew more about migraine management we wouldn’t need to constantly pop medicines," she says.

What doctors find especially worrying is the tendency of people to self-medicate till the point when they have no choice but to visit a physician.

Particularly in children and teens, ignored headaches could be symptoms of something more serious. “We've had cases where people ignored headaches in adolescents and children, and the patients ended up having brain hemorrhages,” says Dr Jayasree Kailasam, Consultant, Headache Clinic, Fortis Hospital, Bengaluru.

The specialised clinic sees several patients each week across age groups and demographics.

There are four primary types of headaches, explains Dr Jayasree.

- Migraines, characterised by severe a throbbing headache, especially on one side of the head. They are accompanied by nausea and sensitivity to sound and light, and are more common in women.

- Tension headaches are the most common type. They are the result of muscle tension and usually occur in the form of a dull headache throughout the day.

- Cluster headaches are characterised by severe headaches coming in groups that can recur for weeks or months.

- Medication overuse headaches are common in people who consume too many medicines to treat headaches.

There's also what people refer to as sinus headache, but this is a misnomer, says Dr Jayasree. "Sinus headaches can only take place with any kind of sinus infection. Just because it hurts near the sinus, doesn't mean it is sinus headache."

She also agrees that headaches aren’t seen as much of a problem. "For instance, migraine is a temporary phenomenon. So, after an episode is over, a person gets back to normal condition. So, people don't tend to take it seriously.”

Importantly, she adds, some headaches can be a symptom of a tumour. And so, a word of caution: Those experiencing a new pattern of headache, especially if it is associated with giddiness, numbness or passing out, must consult a doctor immediately.

Why some people are susceptible to headaches

Susceptibility to headaches is usually caused by genetic factors. But environmental conditions such as a stressful lifestyle, food and sleeping habits, and lack of sufficient exercise play an important role too.

Archana Mantri, an education management professional, couldn’t quite grasp what was happening when she got her first migraine attack when she was 17.

"It started with vision impairment in one eye. It took some time for me to figure out what exactly was happening. However, once I informed my mother about it, she knew that it was a migraine, since the condition runs in my family," she says.

What made the headaches more difficult to deal with were their unpredictability. "Though my migraine is not of the severe kind, there was no frequency of sorts," she says, adding that she would sometimes face several months with regular migraines followed by a period free of headaches.

It took Archana over a decade to be able to get a control over the condition. "When I was 30, I was introduced to pranayam. After I practiced it regularly, the frequency of my attacks reduced drastically," she adds.

Migraines can also sometimes be so debilitating that patients find themselves unable to function at all. One young patient of Dr Jayasree, for instance, experienced such agonising pain that she thought she would not be able to take her Board exams.

However, there is no technology at present to image the brain and figure out what exactly happens when a migraine attack is taking place.

"There is no particular test for migraine. For diabetes, there's a blood test. There’s an ECG for a heart attack. For migraines, all we can do now is just eliminate other causes such as seizures or tumours,” says Dr Jayasree.

Headache disorders can’t be cured, but can be controlled with a mix of medicine and therapy.

Dr Jayasree advises those prone to headaches to avoid caffeine, dairy and chocolates as far as possible, and to practice deep breathing, eat a balanced diet and have a proper sleeping pattern.

*Name changed