CHENNAI: Radhika V was in her 20s when she had her first migraine attack ottrai thalaivali in Tamil. What she brushed off as just a ‘severe headache’ became a recurring affair. No amount of Saridon, Anacin and Sinarest could stop the pain completely. “When I used to get these headaches, it was accompanied by vomiting and I used to fear that. So, I started the process of elimination to check what was causing the pain,” she says. Bright lights, sweet treats, blaring sounds and strong scents were the triggers.
It was after such extensive observation and helpful pointers from doctors that she landed on the diagnosis. It has been over two decades now and Radhika has better control of her migraine. Dr Sivarajan Thandeswaran, senior consultant-Stroke & Neurovascular Medicine, Kauvery Hospital, says, “Lifestyle risk factors trigger migraines.
Keeping a migraine diary can help you find out what your triggers are it can be light, sound, food, or environmental triggers like sunlight, pollution, humidity, or even your hormones. Even after avoiding all this, if you still have a migraine, you need medicines to control it. If there is difficulty in controlling then you go on to the next level of tests and other interventions.” Migraines affect one in seven people and are often caused due to external factors.
It can be classified as one of the most common kinds of headaches. It is hereditary and often seen in women than men, probably because of hormonal changes, he says. There are about twenty different types of migraine and at least 15 among them are common. Helping us decode these migraines, Dr Sivarajan lists a few that might need your attention.
Classical migraine is migraine with aura. Aura has an associated sensory phenomenon. It can be visual, like an insect flying near your eyes, zig-zag lines or vision constriction. Around 70 per cent of people
get this type of migraine.
If a migraine persists for more than 15 days a month, then it is classified as chronic migraine.
Classification is important because patients might often get misdiagnosed and get prescribed the wrong medicines. Once classified as chronic migraine, the treatment is different as they do not respond to regular medicines. Patients might need specialised treatments like botox injections and a lot of high-end treatments like monochronal antibody infusion. They may also need a nerve block an anaesthetic block given to the nerves around the head.
Menstrual migraine: Women get this kind of migraine during their periods. They get it two days before the periods start, and goes on till three days after the periods; typically the cycle time. Routine medicines might not help. Since it comes during menstruation, oestrogen supplements need to be given. Doctors need to ask when the pain occurs because not all women are willing to share that they get it during their periods.
Hemiplegic migraine: This is a complex, dramatic and terrifying type of migraine. During an attack, the patient will appear like he/she has had a stroke and half of the body stops functioning completely. In a very severe form, they may even go into a coma. This is one of the rarest migraines and often a gene test is done to find out. It can be treated with normal migraine medicines but sometimes the patient might need anti-epileptic medicines as it can be associated with fits too.
Migraine with brainstem aura: It is a common variant but is often misdiagnosed. The patient feels like an insect is flying across his/her body from the top of his/her head to leg like a current shock. They may have severe imbalance because of that. They may fall while walking and/or have slurred speech, along with severe headache. Brain stem is the space where the right and left hemispheric globe of the brain converge before the spinal cord starts. The pain comes from there. Since it involves the brain stem, patients may have speech difficulties and double vision. It is often classified as a psychotic disorder and patients don’t get the right treatment and attention. They are put on anti-psychotic medicines instead of one for migraines. This is one of the big issues with this kind of migraine.
Retinal migraine: Retina receives all the inputs that we see and converts the electrical inputs into images to the brain. When you have electrical changes in the retina and suddenly get a coloured halo or feel like an insect flying in your eyes, that is a retinal migraine.
Abdominal migraine: This is a rare and interesting type of migraine. I have seen a lady who came from West Bengal. She went to different hospitals on her way to Chennai. Everywhere, she had to get an endoscopy done as this pain manifests like severe abdominal pains, cramps. Her reports were normal, multiple times. Patients with this kind of migraine will have severe pain and a severe rush to go to the toilet. The pain will exist for an hour or so and they will slowly get better. They will also have mild heaviness in the head. This is most often overlooked and misdiagnosed. Anti-migraine medicines can treat this.
Opthalmoplegic migraine: In this type of migraine, the patient’s eyes become small. They experience a debilitating headache, eyes water and the pupils turn small. They tend to see everything in double and cannot move the eyeball left and right or up and down properly. Once the attack is under control and the pain reduces, they come back to normal.
Cyclical vomiting syndrome: A type of paediatric migraine where children get frequent bouts of vomiting associated with migraine. This usually happens in the early teenage years. Every school will
have three-four children with this condition. This is again a variant that is not easily believed by parents or guardians.
Vestibular migraine: The pain comes like in the case of vertigo. Instability in the vestibule structure inside the ear causes this pain. When you have vertigo, you feel like the room is spinning and you feel nauseous. The difference here is that the same feeling is associated with mild heaviness in the head, headache, vomiting, and other migraine features like light sensitivity, sound sensitivity, and caused by common migraine triggers. In such a case, vertigo medicines alone won’t help. Additional migraine treatment needs to be given.
PADASIL: This is an extremely rare form of migraine predisposed to people who often have strokes. In such patients, small strokes get accumulated in their brains. This usually happens when they are in their 30s or 40s and can lead to them becoming disabled in the next five years. It is a genetic condition. Another type called NILAS is also a genetic condition where a patient gets recurrent strokes associated with migraine.
Atypical migraine: In this type of migraine, the patient will not have a headache, but have giddiness, slurred speech, sudden speech impairment and then, they become normal.
Migraine aura triggered seizure: This is also called Migralepsy where migraine and epilepsy come together. This may come to a person repeatedly and in every attack, they behave like they have
had a seizure.
Status Migrainosus: This is the severest form of migraines. Some patients get a continuous migraine attack, with a debilitating pain that confines them to their beds. Some times, they bang their heads against the wall to reduce the pain. We admit such patients and give drips. That will abort the attack and then we can put them on anti-migraine therapy.
Alternating hemiplegia of childhood (AHD): This is a form of paediatric migraine, where one side of the limb of a child will suddenly stop moving. When they get the next attack, the other side
gets affected; it keeps alternating. Parents and guardians often think that the child is ‘acting’ to not to
go to school and ignore such attacks or not believe them.