Migraine
Dr Arun kumar Sharma
Consultant Neurologist
More than "just a headache"
The aim of writing this monograph is to apprise you of the characteristics of migraine and the recently made available, highly effective treatment, with only six monthly injections. Once you realize that migraine is an acute, intense headache with associated unique symptoms like vomiting, heightened sensitivity to loud sounds or bright lights, scalp tenderness, visual phenomena like zig zag spectra or blindness in one half of visual field, you will stop wasting your time and energy making rounds of other specialities and head for a Neurology expert for consultation and treatment. This monograph will also equip you with a remarkable insight into the dramatic revolutionary, recent advances in treatment aimed at achieving a long lasting or almost permanent relief from migraine attacks.
Migraine is an inherited tendency to have headaches with sensory disturbance. It’s an instability in the way the brain deals with incoming sensory information, and that instability can become influenced by physiological changes like sleep, exercise and hunger.
What is migraine?
Migraine is a complex condition with a wide variety of symptoms. For many people the main
feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light,
sound and smells, feeling sick and vomiting. Migraine attacks can be very frightening and
may result in you having to lie still for several hours.
The symptoms will vary from person to person and individuals may have different
symptoms during different attacks. Your attacks may differ in length and frequency.
Migraine attacks usually last from 4 to 72 hours and most people are free from symptoms
between attacks. Migraine can have an enormous impact on your work, family and social
lives.
Are there different types of migraine?
There are different types of migraine. In 1988, the International Headache Society produced a classification system for migraine and headache which has been adopted by the World Health Organisation. This has been updated since then and is the established basis for defining types of headaches. The International Classification of Headache Disorders system gives different names to the different types of migraine and headache that involve different symptoms. This helps doctors to diagnose and treat them.
The most common types of migraine fall into two categories:
- Migraine with aura
- Migraine without aura
The ‘migraine with aura’ label is also used for some of the rarer forms of migraine, which
also have another name. These include migraine with brainstem aura, where symptoms
such as loss of balance, double vision, or fainting can occur. Familial hemiplegic migraine,
where reversible paralysis occurs, is also classed as ‘migraine with aura’. There are other
rare forms of migraine, which are classed separately.
Not everyone will have a ‘typical’ migraine. The experience of the condition will be unique
to you.
Headache or migraine?
Distinguishing between different types of headache can be difficult. You can experience different types of headaches at different times of your life for varying reasons. For example, if you have migraine you may also experience other types of headache. Keeping a migraine or headache diary is really useful and can be invaluable in trying to identify a specific headache type.
What is the latest treatment of migraine?
The complex nature of migraine means that the treatments available are varied and differ
from person to person. Recently a novel way of treating migraine headaches has been
broached by new approaches. The neurotransmitter responsible for pain and vomiting in
migraine has been identified as Calcitonin G Related Peptide (CGRP). There are two ways to
neutralize the noxious, nefarious actions of CGRP.
First is to administer a monthly injection
of a humanized monoclonal antibody (that means it is as acceptable to normal human
biology as any nutritional supplement can be)
. We administer this subcutaneous (just
under the skin) injection, a total of six doses by a painless technique for six months.
Thereafter the migraine patient is almost cured and stops experiencing the debilitating
attacks of this intensely painful malady. No more reporting sick, no more loss of work days,
no more economic detriment to either the employer or the employee.
The second approach is to stop CGRP from entering the brain, a group of medicines called
Gepants.
These oral medicines are also extremely effective in preventing recurrence of
these miserably morbid headaches.
What causes migraine?
There is no known cause for migraine, although most people with it are genetically predisposed to migraine. If you are susceptible to migraine there are certain triggers which commonly occur. These include stress, lack of food, alcohol, hormonal changes in women, lack of sleep and the environment.
DR. ARUN SHARMA
MD, DM (Neurology), PhD (Neurology), FRSM (UK)
Former Professor of Neurology (PGI Chandigarh)
Medical Director and Specialist Neurologist
Emirates Hospital Clinic
Conrad tower, Dubai
