You Ask , They Answer
Q
: What ’ s a migraine and what are its telltale signs ?
A
: A migraine is a common headache disorder that is characterised by repeated attacks of throbbing and onesided headaches . While having a migraine attack , the headache is usually accompanied by nausea , vomiting , and sensitivities to light , sound , or smell . About 10 to 30 percent of persons with migraines see lights and shadows , the so-called aura , before the headache starts . Physical activities can worsen it . Without taking painkillers , the headache would last for more than four hours . However , persons with migraines might have different presentations . For example , some have headaches at both sides , while others do not have sensitivity to light . According to the World Health Organization ( WHO ), migraine is the second most disabling disease globally , with a one-year prevalence of 12 percent and a tendency to affect working people and cause enormous social and economic loss .
Q
: Which are the best treatments to manage migraine ?
A
: There are two categories of migraine treatments — acute and preventive . When a migraine occurs , we rely on the acute abortive treatment to stop the pain . Acetaminophen with or without caffeine , aspirin , non-steroidal anti-inflammatory agents ( such as ibuprofen ), ergotamine , and triptans are the most commonly used acute treatments . However , while triptans are very effective , if people have coronary artery disease , ischemic stroke , or uncontrolled hypertension , they should not use them . There will be newer acute medications available in the near future , including ditans and gepants .
By contrast , the purpose of preventive treatment is to decrease migraine flare-ups . Unlike acute treatment , preventive treatment should be taken regularly , even daily . Preventive treatments should be considered in persons with a higher migraine frequency , i . e ., at least 4-5 headache days per month , according to the American Headache Society . Preventive treatments include beta blockers ( propranolol ), calcium channel blockers ( flunarizine ), antidepressants ( venlafaxine , amitriptyline ), and anti-seizure medications ( valproic acid , topiramate ). Botulinum toxin and anti-CGRP monoclonal antibodies are new but effective , nonoral medications for migraine prevention . However , they are expensive and not available in every country .
Q
: When should people with migraines see a doctor ?
A
: In fact , everyone with migraines could benefit from seeing a headache doctor , usually a neurologist , to receive a personalised treatment plan . I suggest seeking medical attention in two cases . First , the person ’ s migraine is disabling , with migraine frequencies greater than 4-5 headache days per month or migraine attacks not responding well to acute treatment . Second , the person ’ s headache is getting worse , for example , becoming more frequent and less responsive to treatments .
Q
: What can people do to prevent or reduce the risk of migraines ?
A
: Migraine is a hereditary disease , meaning there ’ s not much we can do to prevent it . However , for people with migraine , there are still some tips to avoid migraine attacks . The most important is regular life schedules , including “ regular ” work , rest , meals , sleep , and exercise . Working out , especially aerobic exercise at least 30 minutes per day for more than three days per week , and maintaining similar sleeping and waking up schedules would definitely decrease the risk of migraine attacks . People with migraines should avoid skipping meals or over-eating , which would trigger migraine attacks . Further , people with migraines should not drink alcohol because the chance of alcohol , especially red wine , inducing migraine attacks is high . Some persons with migraines might consider avoiding certain foods if they find them to be migraine triggers . The most commonly mentioned triggers are chocolate , citrus fruits , aged cheese , and monosodium glutamate ( MSG ).
Dr Shuu-Jiun Wang
Dr Shuu-Jiun Wang is the Dean of the National Yang Ming Chiao Tung College of Medicine in Taipei , Taiwan , and the Vice Superintendent of the Taipei Veterans General Hospital .
6 ISSUE 2 | 2024 GlobalHealthAsiaPacific . com