Dr. Mohammed Bulgani

Headaches and migraines can vary drastically depending on their duration, specific symptoms and the person they are affecting. The more you know about your specific type of headache or migraine, the better prepared you will be to treat them—and possibly even prevent them. The two types of migraine are- 

1. Migraine without aura: The majority of migraine sufferers have Migraine without Aura. 
2. Migraine with aura: Migraine with Aura refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes.

Symptoms of migraine vary and also depend on the type of migraine. A migraine has four stages: prodrome, aura, headache and postdrome. But it is not necessary that all the migraine sufferers experience all the four stages.

Prodrome: The signs of this begin to appear a day or two days before the headache starts. The signs include depression, constipation, food cravings, irritability, uncontrollable yawning, neck stiffness and hyperactivity.

Migraine Aura: Auras are a range of symptoms of the central nervous system. These might occur much before or during the migraine, but most people get a migraine without an aura. Auras usually begin gradually and increase in intensity. They last for an hour or even longer and are 

• Visual: Seeing bright spots, various shapes, experiencing vision loss, and flashes of light
• Sensory: Present in the form of touch sensations like feeling of pins and needles in the arms and legs
• Motor: Usually related with the movement problems like the limb weakness
• Verbal: It is related with the speech problems

Headache: In case of a migraine attack one might experience:

• Pain on both sides or one side of the head
• Pain is throbbing in nature
• Vomiting and nausea
• Sensitivity to smells, sound and light
• Vision is blurred
• Fainting and lightheadedness

Postdrome: This is the final phase of the migraine. During this phase one might feel fatigued, though some people feel euphoric.

Red flags that the patient may be having underlying serious disorder not migraine

1. Onset of headaches >50 years 
2. Thunderclap headache - subarachnoid haemorrhage 
3. Neurological symptoms or signs 
4. Meningism 
5. Immunosuppression or malignancy 
6. Red eye and haloes around lights - acute angle closure glaucoma 
7. Worsening symptoms 
8. Symptoms of temporal arteritis

These patients require CT scan / MRI or CSF examination. Most Migraine patients do not need these tests. 

Diagnosis of Migraine: Usually migraines go undiagnosed and thus are untreated. In case you experience the symptoms regularly then talk to the doctor, who evaluates the symptoms and can start a treatment. You can also be referred to a neurologist who is trained to treat the migraines and other conditions. During the appointment the neurologist usually asks about the family history of headaches and migraines along with your symptoms and medical history.

The doctor might advise for some tests like:

1. Blood Tests: These reveal problems with the blood vessel like an infection in the spinal cord and brain.
2. CT scan: Used to diagnose the infections, tumors, brain damage, and bleeding that cause the migraines.
3. MRI: This helps to diagnose the tumors bleeding infections, neurological conditions, and strokes.
4. Lumbar Puncture: For analyzing infections and neurological damages. In lumbar puncture a thin needle is inserted between the two vertebrae to remove a sample of the cerebrospinal fluid for analysis.

Treatments

Migraine treatments can help stop symptoms and prevent future attacks.

Many medications have been designed to treat migraines. Some drugs often used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Some medications aren't recommended if you're pregnant or breast-feeding. Some medications aren't given to children. Your doctor can help find the right medication for you. If you wish to discuss about any specific problem, you can consult a Neurologist.

1. Boost immunity

It’s important to take care of our health throughout the year but during the winter months it becomes even more essential. Eating well, getting enough sleep and staying active are all important during winter to help keep you and your family healthy and to support your immune systems. Supplements containing herbs and nutrients such as echinacea, garlic, vitamin c, and zinc will help to support healthy immune function.

2. Keep moving

While it’s a little harder to find the motivation to exercise when it is cold outside, remember that keeping active during winter is essential to support our health and wellbeing. Moving your exercise indoors during winter will help to keep you warm as well as fit and healthy. Be sure to spend time warming up before you start your exercise as it can take a little longer for your joints to loosen up in the cold weather.

3. Eating well

As winter sets in it can be tempting to start eating more of those warm comfort foods that are often high in fat, salt and sugar. Instead, find comfort in foods such as warming and nourishing soups and stews full of flavour and healthy vegetables. Be sure your diet includes winter fruit and vegetables packed with vitamins and minerals such as sweet potato, green leafy vegetables, beetroot, kiwi fruit, mandarins, bananas, garlic and ginger.

4. Weight management

Ditching the exercise as well as the salads during winter can often lead to weight gain. While it may only be a small weight gain, it begins to add up as you get more and more winters under your belt! although it’s tempting to hide behind those bulky winter clothes, by sticking to your healthy diet and exercise routine all year round, you’ll be much healthier in the long run and won’t dread the next swimming season with the kids!

5. Sleeping well

Proper sleep (eight hours for an adult) can help keep the body's immune system healthy and fight off colds. Avoid alcohol, caffeine and cigarettes as these substances can affect the quality of your sleep. Regular, moderate exercise, relaxation techniques and establishing a regular sleep routine may help to promote improved sleep.

6. Skin health

The cold weather can affect our skin and contribute to conditions such as dry, itchy skin, chill blains and eczema. This may be due to the reduced humidity, drinking less water than you would during summer or possibly due to reduced circulation which may decrease the flow of blood and nutrients to the skin. Using moisturisers daily may help to keep the skin moist and supple whilst supplements containing vitamin e or garlic help assist blood circulation. If any of your family suffers psoriasis or eczema, try taking fish oils. These provide omega-3 which can help manage these itchy skin conditions. And don’t forget the sunscreen, it is important to remember we can still get sunburnt when the weather is cold!

7. Keeping bugs at bay

Although we can do a lot to support our health and immunity during winter it is not always possible to avoid catching a cold or flu. The viruses that cause colds are spread by sneezing, coughing and hand contact. Wash or sanitise your hands regularly and avoid close contact with someone who has a cold. Keep household surfaces clean as well as kids’ toys when someone in the family has a cold. If you are ill, be sure to drink plenty of fluids, including water, hot tea and soup. Avoid alcohol and caffeine and get plenty of sleep. Supplements such as vitamin c, zinc and echinacea may help relieve the symptoms and reduce the duration of a cold.

8. Stress and healthy mood

While stress is a part of everyday life, and some stress helps us to meet challenging situations, excessive amounts of stress may be linked to negative effects across a range of areas. Stress can lower the resistance to nasty bugs by depressing the immune system. Importantly, stress increases your need for dietary magnesium which is important for muscle and nerve function. Many of the b vitamins e. G. B1, b5, b6 and b12 are also needed for a healthy nervous system. The herb st john's wort may help to relieve nervousness, irritability and help support emotional balance. It may also be beneficial to help promote healthy mood balance but speak to your doctor or healthcare practitioner before starting a supplement like this.

9. Circulation

During winter our hands and feet can often feel cold. Our hands and feet are at the extremities of our bodies which means they are the furthest from the heart which is pumping blood around our body to help keep us warm. Vitamin e and the herb ginkgo help to support peripheral blood circulation, thereby alleviating cold hands and feet. Keep moving with gentle exercise to help improve circulation to the extremities of the body and don’t forget your socks and gloves! if you can’t seem to keep your hands warm (and it’s not bothering you excessively) take solace in the old saying “cold hands, warm heart”!

10. Stay hydrated

Don’t forget to keep drinking water! as the weather cools down and our thirst decreases it is easy to forget to drink enough water. You still need to aim for about two litres/day of water during winter as it is essential for our body to function. If you struggle with plain water (like we do sometimes) try herbal tea. There are so many flavours available now that you’re sure to find some you enjoy.