By Dr N K Venkataramana
We have all had our headaches, both real and figurative. Be they dull and throbbing or sharp and stinging, headaches are always disruptive and often lead to behavioural changes too. But what is not commonly known and has, therefore, given rise to some fairly insensitive jokes is that women are far more likely to suffer from headaches including migraine than men. Indeed, seven out of every 10 migraine-afflicted are women, clearly making it a gender specific condition.
Of all the conditions that affect women, migraine and cluster headaches are among the most common and fall under the category of vascular headaches. In addition, tension-related headaches also afflict women much more than men.
Though there are many kinds of headaches, not all of them are dangerous, nor do they indicate brain tumour. From 2.8:1 to a peak of 3.3:1 women are far more prone to migraine than men. Studies prove that through adolescence the incidence of migraine among boys ranges from 2.9% to 4.1% while it goes all the way up to 9.8% among girls. Hormonal changes and fluctuation in estrogen levels are primarily responsible for this gender bias.
Migraine is essentially a significant fluctuation in the blood flow to brain, which leads to secondary neurological disturbances affecting pain sensitive structures of the head and neck. These can start usually in teens and can continue through to the peri-menopause age. There is also something called childhood migraines that occur in children. Migraines can be ‘Common’, ‘Classical’ or ‘Complex’ but rarely do they last for days on end (Migraine Status).
A few major types of migraines are:
Common migraines – These are typically intermittent pulse type headaches that affect one or both sides of the head, often alternately. They last for a few hours, usually triggered by physical or mental stress and relieved by simple medication and rest.
Classical migraine – These are usually preceded by an aura followed by symptoms of low blood flow such as a severe throbbing headache. The aura is typical and specific to individuals and may manifest itself as blurred vision, light headedness and photophobia, followed by giddiness, unsteadiness or inability to concentrate. One may also experience a very severe pulsatile headache that can spread to different parts of the head, neck, shoulders and upper back, along with nausea or vomiting, irritability and inability to eat. This headache will last for a few hours or the whole day, waxing and waning according to the intensity of physical activity.
Complex migraine – These migraines come with neurological complications or other systemic symptoms. Complex migraines include:
Hemianopic migraine – Here the headache is accompanied by loss of vision in one half of the visual field.
Hemiplegic migraine – In this, one loses movement in one half of the body, like a kind of temporary paralysis during or before the headache.
Basilar migraine – This headache predominantly occurs at the back of the head and includes double vision, slurred speech and imbalance.
Abdominal migraine – This is an unusual kind that manifests as severe abdominal pain, so much so that it can be mistaken for an acute abdominal condition and mislead the treatment.
Epileptic migraine – This headache is associated with symptoms of Epilepsy. Among individuals affected by it, the incidence of Epilepsy is in fact considered to be slightly more.
Secondary migraine – These usually result from structural lesions in the brain, caused by variations in blood flow. The most common ones are AVM’s of either the dura or the brain. Certain kinds of brain tumours with high blood supply, like Meningioma and Haemangioblastoma, also present in a similar way. These structural lesions will carry additional signs that can lead to the diagnosis.
Other major headaches include:
Cluster headache - It is a cousin of vascular headache that usually strikes one side of the forehead continuously for a period of time with a break in between. These are pulsatile throbbing headaches accompanied by vomiting sensations. The typical feature of cluster headache is that it starts at a specific time and is usually severe in intensity demanding treatment.
Tension headache - It is the most common of all headaches, classically associated with heaviness and a constricting feeling around the head. It is due to prolonged contraction of the muscles around the head, often due to anxiety, fear, sleeplessness, and inability to concentrate. It is primarily an anxiety disorder and symptomatic treatment along with understanding of the underlying cause will cause relief.
Is migraine curable?
Migraine headaches usually have a strong family history. A common myth surrounding migraine is that it is incurable and leads to a lifetime’s suffering. This is not necessarily true. But all these headaches need treatment, quite often symptomatically. If the frequency or intensity is high, prophylactic treatment is required which can prevent repeat occurrence. But irrespective of the cause, what is required is timely food intake, proper sleep, a reasonable amount of physical exercise and avoidance of the precipitating factors like bright light, loud noise, irregular eating habits, irregular sleep, excessive physical and mental stress and travel.
Also, certain food contents that precipitate headache need to be avoided. Besides, stress inducing factors at work, home or during menstrual periods need to be addressed. Smoking and alcohol are not only known to precipitate headaches, but also reduce the efficacy of treatment, besides leading to other complications.
Hypertension (high blood pressure) is another aspect that has to be well-controlled. Yoga and pranayama will be of tremendous help here. Also, all hormone related treatments need to be taken with precaution as they can lead to severe complications like Cerebral Venous Thrombosis (CVT).
Specialist consultations and investigations are mandatory for all complex migraines and also for cases that are not responding to treatment, are progressive and or are associated with neurological deficits. Also remember, that any situation that leads to incessant vomiting needs adequate hydration and hospitalization if necessary.
The writer is Founder and Chief Neurosurgeon, Brains Hospitals, Bengaluru. Dr N K Venkataramana is an internationally acclaimed neurosurgeon, researcher and academician.