Migraine disease, which is seen in roughly 1 in 5 women and 1 in 10 men, continues to disrupt the quality of life of many people due to wasted time due to misdiagnosis or not receiving proper treatment. When we talk about a disease that covers a person's most productive years and approximately 2/3 of their life, awareness about migraine becomes even more important. When we say migraine headache, we are talking about a pain so severe that it prevents the patient from daily activities and a lost period of time for that patient.
Characteristics of migraine headache:
Migraine head. Pains are throbbing pains that are usually felt more on one side of the head and may be accompanied by nausea and vomiting. When a migraine attack occurs, it lasts between 4 hours and 72 hours. It is not uncommon for migraine patients to be misdiagnosed as sinusitis or neurological headache. However, since migraine is a type of headache that has its own triggers and treatments, it is important to make a correct diagnosis. The patient experiencing migraine headache is sensitive to light, sound and challenging movements such as climbing stairs during the attack. However, movement and walking outdoors are good for nervous headaches. We see that migraine headaches are accompanied by nausea, vomiting and vision problems, the patient's concentration is impaired and he cannot continue what he is doing. 20% of migraine patients experience symptoms such as flashes of light lasting 20 to 60 minutes, seeing broken lines, blurred vision or blind spots, which we call aura, which foretells the coming of pain. These symptoms can be very scary for people experiencing their first migraine attack. Sometimes, these aura periods are not followed by a headache, and if the person does not yet know that he or she has migraine, he or she may consult an ophthalmologist, thus losing time for diagnosis and treatment. Some patients experience mood changes before migraine attacks. They may become more excited, irritable or depressed. Before some attacks, a person may feel a pleasant smell or taste. Feeling tired, frequent yawning or muscle tension may occur before the attack. These pre-disease symptoms, called prodromal symptoms and seen in one in every 4 patients, may occur 24 hours before the pain.
The mechanism of migraine is different from other headaches:
Although it is not known what starts migraine disease, an abnormal electrical discharge starting from the inner parts of the brain spreads to the whole brain, resulting in inflammation and expansion of the arteries in the brain membrane. It is known that this is followed by narrowing of the vessels and that this process is accompanied by the secretion of some brain chemicals. The incidence of migraine increases in people with a family history of migraine. Therefore, it is thought to have a genetic aspect. Again, the incidence of migraine is high along with epilepsy, depression, asthma, anxiety and stroke.
Controlling the factors that trigger migraine headache reduces the frequency of pain:
Flashing bright lights, reflections from snow and water to the eyes, fluorescent lights, television and cinema screens can trigger pain. Using sunglasses that polarize light when going outside and using lighting in the daylight spectrum at home can help control this triggering factor. Emotional stress is a well-known migraine trigger. Although it is not possible to completely eliminate stress from our lives, relaxing exercises, relaxing music, and staying away from stressful environments will be beneficial. People with migraine need regular nutrition and sleep patterns more than anyone else. Low blood sugar and skipping meals trigger a migraine attack. Migraine pain may occur due to a sudden drop in blood sugar, which rises with very sugary foods. There is no evidence for the use of any food in the treatment of migraines, but preventing inflammation and dehydration that cause migraines will reduce the frequency of pain. While drinking just water is ideal, herbal teas, decaffeinated coffee, and skim or reduced-fat milk are also suitable hydration options. Sugary fruit juices, tea and coffee with sugar or sweeteners are high in calories and can be a migraine trigger. Sleeping too much as well as too little can trigger a migraine attack. Working patients with migraine report that they experience frequent headaches after their weekend sleepovers. they say. Although individual sleep needs vary, the ideal is to sleep at least 6 and at most 9 hours a day. Migraine attacks are greatly affected by hormonal changes. We see that in many women, migraine attacks occur during or before menstruation, when estrogen levels in the body decrease. Some women benefit from painkillers and anti-inflammatory drugs taken during these periods before the pain occurs. Hormonal birth control methods can reduce the frequency of pain and sometimes reduce headaches by contributing to balance in women experiencing hormonal imbalance. It is possible to list a long list of foods that are likely to trigger migraine pain. The best known of these are chocolate, red wine, nuts, processed meats, ready-made foods, soy sauce, and aged cheeses. Since migraine triggers may vary from person to person, the most appropriate method would be to keep a headache diary and identify specific migraine triggers and try to stay away from them, rather than giving the same list to all migraine patients. Old, fermented foods that can be stored for a long time contain high amounts of tyramine. Tyramine can cause a migraine attack by causing first narrowing and then widening of blood vessels. For this reason, it may be beneficial to limit the consumption of fermented or stale foods such as cheese, soy sauce, pickles and pickled foods. The effect of caffeine on headache depends on its dose. Some headache relieving medications are combined with caffeine and are very helpful in relieving pain. Most migraine patients can consume 1 or 2 cups of coffee a day without triggering their pain. However, when consumed in large amounts, caffeine itself can become a migraine trigger.
Diagnosis in a migraine patient is made by a good understanding of the headache characteristics:
In a patient presenting with a headache, if necessary, imaging methods are requested to avoid missing an underlying disease, but the diagnosis of migraine is made according to the headache characteristics described by the patient. If your headache comes at intervals, is more on one side and is throbbing, you may be affected by light during the pain. And if you are disturbed by the sound and want to rest inactively, and most importantly, if it is severe enough to prevent you from your daily work, this pain is most likely migraine.
Migraine treatment is individualized according to patient characteristics. It is planned as follows:
Migraine treatment can be roughly divided into two parts: attack treatment and treatment to prevent pain. The aim is to relieve the pain that has started during attacks. For this reason, painkillers are frequently used. Anti-nausea medications are often added to painkillers. Sometimes, pain-relieving treatments specific to migraine pain, which we call triptans, can be chosen. The second part of the treatment is preventive treatments that prevent pain from occurring. In the selection of these drugs, the patient's age, profession, type and frequency of headache, accompanying diseases and treatments are taken into consideration. Treatment with Botox injections can provide relief for 3-6 months in patients with chronic pain, that is, experiencing 15 or more headaches per month, at least half of which are migraine.
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