The Myths & Facts about Headaches and Migraines:
John was on a business trip in Europe and decided to visit his sister, Linda, in Ireland. He had not seen her in a while and was looking forward to spending some time with her. Given John’s busy schedule, he could only spend 36 hours in Dublin. When John arrived at the airport early in the day he found Zed, his brother-in-law, waiting to pick him up. Linda was experiencing a headache and could not make it.
Upon reaching home Linda was in bed with the lights switched off and the blinds drawn shut. She greeted her brother John and they then chatted together for a short while. Tired and pale, Linda had vomited twice in the morning and once more later in the day. She spoke in a soft voice and moved sluggishly. Despite ingesting Panadol and ibuprofen, she experienced no relief and soon retired to bed and did not see John until the next morning. The next morning Linda was feeling better although she continued to experience a mild residual headache. She had received an injection late in the evening and that did seem to help. John, Linda, Zed and their son Gianni had lunch together after which it was time for John to fly over to Munich to meet with his next client.
Linda was experiencing a migraine attack. She had been experiencing migraine headaches since her late teens and their severity and frequency fluctuated widely over the years. Migraine is a common disorder of the brain and in the US, 1 out of every 5 women and 1 out of every 15 men suffer from migraine headaches. There are several misconceptions about migraine headaches:
Many people think that if they had migraine headaches they would surely know about it. In the US alone, an estimated 12 million migraine sufferers are undiagnosed. Of patients in the UAE that I have diagnosed with migraine headaches many have had a long history (sometimes on the order of more than a decade) of headaches but have not been previously diagnosed.
Some believe that if the headache is not severe enough to require bed rest, then it can not be a migraine. Although many migraine attacks are quite severe in intensity, as in Linda’s case, some are mild in nature and do not require bed rest.
Others believe that if a headache is quite severe then it can not simply be ‘just a migraine’. In a statement about the impact of pain on the quality of life, the WHO has equated the discomfort experienced from an attack of severe migraine to the experience of a day with paraplegia (paralysis from the waist down). Migraine headaches can be quite severe and incapacitating.
Although migraine classically involves half of the head, this is not absolutely necessary. Many people fulfill the criteria for migraine headache while experiencing pain on both sides of the head.
Some may experience nausea, vomiting or sensitivity to light or sound as part of their migraine attack. Although these features are commonly seen in patients with migraine headaches, the absence of any one of them does not necessarily preclude the diagnosis.
Many patients experience discomfort in the forehead or the cheeks accompanying their headaches and go on to assume that they have sinus headaches. Indeed, many such patients are often misdiagnosed by physicians, who are inexperienced in the management of patients with headaches, as having sinus headaches. Migraine pain can be felt in many different locations: the same nerve that causes migraine pain also runs through the sinuses and may thus result in sinus pain associated with the migraine attack.
There are many triggers for migraine some of which may result in pain signals being felt in the back of the neck. People sometimes misinterpret these as tension headaches whereas they truly represent migraine headaches triggered by tension or stress.
Headache is one of the most common complaints that patients present with. Life style modification, medications and other modalities such as physiotherapy and alternative therapy can help in providing you with adequate relief. Your family physician can usually adequately evaluate your headaches and institute appropriate therapy. Should you not experience adequate relief or have further concerns, then you will need to undergo an assessment by a headache specialist. Among the various specialties, neurologists are the most qualified to assess and treat patients with headache disorders.
D M Kayed, MD
These sites have been compiled from several sources including:
- The American Academy of Neurology Patient Information Guide
- The US Department of Health & Human Services Booklet of Neurological Disorders – Voluntary Health Agencies & Other Patient Resources
- General Search of the World Wide Web
Headache and Migraine:
National Headache Foundation www.headaches.org
American Council for Headache Education www.achenet.org
The following sites provide information about various Neurological Disorders:
Stories about persons living with various Neurological disorders. www.thebrainmatters.org
National Institute of Neurological Disorders & Stroke. www.ninds.nih.gov
The American Academy of Neurology. www.aan.com
The following sites address caregiver issues:
National Family Caregivers Association. www.nfcacares.org
Family Caregiver Alliance. www.caregiver.org
Well Spouse Foundation. www.wellspouse.org
C-Mac Informational Services/Caregiver News. www.caregivernews.org
Brave Kids. www.bravekids.org
Friends’ Health Connection. www.friendshealthconnection.org
MUMS National Parent-to-Parent Network. www.netnet.net/mums
National Council on Patient Information & Education.
National Organization for Rare Disorders. www.rarediseases.org