The bane of migraine

Migraines affect one in seven globally and are a major reason for disability, discomfort and absenteeism from work, leading to major economic losses in the global working population. The risk of stroke and cardiovascular diseases increases three times with the onset of migraines while the anti-inflammatory drugs prescribed for the condition can actually increase the risk of blood clots, leading to strokes. Migraine sufferers have a higher risk due to medication accompanied with unhealthy diet, lack of exercise, insomnia and stress, explains Dr Anand Balasubramaniam, senior neurosurgeon and head of the neurosurgery department at Yashoda Hospitals.

Q Why do migraines increase the risk of stroke and heart attacks in patients?
Various studies have shown an association between migraines with stroke and heart attacks. Multiple factors like anti-inflammatory medications, unhealthy diet, lack of exercise, lack of sleep and stress also put one at risk. A combination of these factors shows that those suffering from migraine have an increased risk of brain attack or stroke and heart attacks.

Q The side effect of anti-inflammatory drugs is stated to be one of the reasons. Should medication be evaluated from time to time?
In 2005, the Food and Drug Administration had warned that taking non-steroidal and anti-inflammatory drugs like ibuprofen and naproxen increase the risk of heart attacks and stroke. These warnings have been issued from time to time as it is one of the reasons for blood clots. Hence, if the drugs are prescribed for a short while or for immediate use, they must be taken during that period only.

Q What are the different types of migraines and what is its incidence in India?
There are two major types of migraines. Migraine with aura is a complicated migraine where there will be visual disturbances 10 to 60 minutes before the actual headache. This is scary for some people who temporarily lose part or all vision. There is also sensory aura where there is abnormal sensation, numbness, muscle weakness on one side of the body and cognitive dysfunction where there is trouble in speaking and confusion.

The other type is the common migraine where there is severe pulsating headache on one side of the head. These migraine attacks last for four to 72 hours and repeat a few times in a week or year. According to clinical presentations, the incidence of migraine in India is found to be between 14 and 20 per cent of the population.

Q What are the challenges seen in Indian patients?
The triggering factors for migraine in Indian patients are sleep deprivation, irregular diet and lack of exercise.

Q Which different therapies are found to work for migraine?
In addition to allopathy, yoga and meditation are also helpful. Newer treatments like Botox are also showing promise in treating migraine.

Q What is the role of exercise, medication and complementary therapies in managing pain?
Regular exercise, yoga and medication can help to reduce the frequency of attacks. But if medication is to be avoided then the triggers need to be identified. And that means having food at regular intervals, sleeping on time, avoiding strong perfumes and deodorants and also foods which trigger these attacks.

Q What is the role of sleep in dealing with migraines? How can the ageing population with sleep problems, cope with it?
Sleep helps in terminating a migraine attack. The ageing population with sleep problems should avoid daytime naps, avoid medications known to disturb sleep,  avoid taking a walk in the twilight and try to sleep on schedule. Another important thing to diagnose in the elderly is to rule out obstructive sleep apnoea, in which sleep is disturbed because of snoring.

Migraine with aura
This is a condition where the headache occurs gradually and affects the visual, sensory and motor skills. 90 per cent of the people suffer from visual problems like blind spots, flashing lights and wavy lines in the vision field. This occurs 20 minutes to an hour before the headache. One in four people suffering from migraine have this condition.