Migraine: Who gets it ? Why do they get it? What happens in a migraine attack ? How to ward it off ? Lots of questions and a few answers.
By Dona Suri
Migraine affects 39 million Americans, and is a leading cause of disability worldwide. It diminishes quality of life and reduces productivity. Many pain-killers are available to banish the pain — some are available over-the-counter; others require a doctor’s prescription.
But why does migraine strike in the first place? What kind of person is most at risk? What is happening inside the head to cause that aweful pain? How can risk of migraine attack be reduced? Medical science can answer many questions about migraine, but it doesn’t yet have ALL the answers.
Doctors know what happens when migraine strikes: blood vessels in the brain constrict. But what makes them constrict? The jury is still out on that question.
Researchers suspect that chemical compounds and hormones, such as serotonin and estrogen, are involved. The theory is that migraine pain happens due to waves of activity by groups of excitable brain cells. These trigger chemicals, such as serotonin (which affects both sexes) or estrogen (which affects women only) and blood vessels constrict in response to the surge of chemicals/hormones.
The symptoms of migraine are easily recognized. In fact, they have been recognized for at least 3,000 years. Back around 1200 BC an Egyptian doctor wrote down the symptoms and a cure (“tie clay crocodile on patient’s head, pray”). The ancient Greeks sought migraine cures and so did the Romans. For those who don’t suffer from migraine, it’s enough to say that it feels like a very bad hangover: pain plus nausea, vertigo and brain fog.
Migraine can also cause aura. Migraine auras are sensory symptoms (neurologic, gastrointestinal, and autonomic) that can occur before or during a migraine episode. These symptoms can include flashes of light, blind spots, or tingling in the hands or face. These symptoms can be mistaken for symptoms of a stroke.
Migraine sufferers are typically sensitive to light, sound, smells and movement and but there are many other things that trigger an onset.
Meals: too heavy/too light, different hours
Sleep: too much/too little, different hours
Caffeine: too much/not enough Weather changes Fatigue
Certain foods/drinks Dehydration Light
Air pollution Alcohol Noise
Menstrual periods Exercise Stress
Many migraine sufferers report that the attacks are worse and more frequent during periods when the mercury is rapidly rising or atmospheric pressure is dropping. Since migraine sufferers are usually sensitive to light, it makes sense that glaring sun would bring on an attack. It’s not only intense light, high temperature may bring on a headache too.
Data suggests that heat per se is not the villain, but rapid rise in temperature. Individual migraine sufferers respond differently to humidity or the lack of it; likewise, some people report attacks when barometric pressure is falling.
One trigger affects all migraine sufferers and that is dehydration. Your blood vessels shrink when you are dehydrated. Even 1 or 2 percent dehydration can spell trouble.
Many apps are available that remind you to drink water or keep track of how much liquid you have consumed but Harvard Medical School and MIT’s Media Lab have taken hydration and blood sugar monitoring to the next level. They’ve invented a tattoo ink that changes color according to these vital signs!
It’s not just water that must be constantly replenished; the body also needs electrolytes (sodium, potassium, chloride, calcium, phosphate and bicarbonate). Keep your iron, magnesium, and vitamin D levels up to scratch too. Nutrient deficiencies are known to migraine triggers.
Soft drinks or iced tea are not great rehydration choices, chiefly on account of their caffeine and sugar content. A better idea to keep a big jug of water laced with rock salt and lemon in the fridge and just keep sipping throughout the day. Carry a bottle of it with you when you go out.
Exercise is good for migraine sufferers because it maintains vascular health and counters stress. But if you get migraines DON’T undertake exercise that exposes you to glaring sunlight, heat or to air pollution. A strenuous workout is not a good idea either. It may bring out that old devil, dehydration. The watchword is moderation: pace yourself, work out indoors, or if you like being outdoors, then choose cool morning or evening hours.
“Protect yourself” is good advice for anybody during hot weather, but if you get migraine’s then it’s especially important. Obviously, you should avoid the scorching afternoon hours. Whenever you go out wear sunglasses, a hat or a large scarf. A large cotton bandana is great because you can wet it in cold water and keep it on your head or neck.
An umbrella protects you from rain; a parasol protects you from sun. If you think of parasols at all, you are likely to associate them with Japan, Polynesia or South India, or perhaps they seem decidedly retro, a la Paris fin de siècle. All we can say to that is that the whole world is rapidly warming and migraine sufferers – wherever they live — would be well advised to shed their inhibitions and learn from cultures that have been dealing with extreme heat for a long time.
If you are out somewhere and feel migraine coming on, head for the nearest restaurant and ask for ice or cold water. Apply on cheeks, palms, and soles of the feet. Blood vessels in these areas don’t contract when ice or cold water is applied, which means that more blood is cooled faster. Previously, first aid training advised applying ice packs on large blood vessels (neck, groin and armpits) because of the volume of blood going through them, but microcirculation in the palms, soles and cheeks is such that heat transfer works more efficiently at these places. Short a cold shower, this is the quickest way to lower your body temperature.
Vacation time is when familiar schedules tend to get dumped or forgotten. For some people, the result is migraine. Stick to routine mealtimes and bedtimes.
Most migraine sufferers are on some medication of some kind. Often, they are on prescription medication. At home, you are careful to store your meds in a cool place at home but when you’re on holiday it may just not occur to you that those pill bottles you threw into the suitcase are getting exposed to high temperatures in the plane’s luggage hold or in the trunk of your car. Keep the pills with you, and, when you get where you’re going, keep them in a cool place.
Until medical science discovers the root cause(s) of migraine, cure will remain a dream. For now, all sufferers can do is
- Avoid things they know to be their personal migraine triggers,
- Take medicines that reduce the symptoms and
- Adopt a healthy lifestyle with particular emphasis on hydration, sleep and stress reduction.