Migraine: An Under Diagnosed Case in Nepal
Nepal is a country of high diversity in geography, culture, and religions and so is also in diseases. I am a student studying clinical medicine in china. During my summer break, I came back to Nepal to visit my parents and have a clinical exposure in hospitals in Nepal and I got an opportunity to join as an observer (Junior Physician) to learn clinical skills in one of the hospital in Nepal.
I used to go observe and shadow the consultant doctors at work. At the hospital, I used to spend most of my time in the neurological department as it was of my key interest. Lots of patients used to come and visit the neurology consultant with complaints of headache. These patients were of different age groups mostly of middle age but I was surprised as I saw some young patients (School Kids) as well who came with a chief complain of headache. But, half of the time these headache lead consultant to diagnose it as MIGRAINE which still we Nepalese people are not aware of. Headache disorders are very common in Nepal.
Migraines are unusual, and strongly associated with living at altitude, which in very large part accounts for the high national prevalence: the age- and gender- standardized prevalence in the low-lying Terai is 27.9 %. Headache occurring on ≥15 days/month is also common. (Kedar Manandhar et. al, 2015)
How to differentiate Headache and Migraine?
A very severe headache like tension headache might be mistaken for a migraine but there are some specific differences. However, they are triggered by different factors and people feel distinctive symptoms. What happens immediately before the patient experiences pain and during the attack can help in making a diagnosis. The tension headache, the most common kind and a migraine are compared to show how they impact the patient. A tension headache gives the patient a feeling that an elastic band is squeezing his or her head. The headache is caused by the contraction of muscles between the head and neck. The dull pain, experienced across the head, is usually mild to moderate, although it can, in extreme cases, last for days. It more commonly lasts half an hour to a few hours. A migraine, in comparison, tends to range from moderate to very severe throbbing pain at the front or the side of the head. It can be unrelenting and carry on for days and is accompanied by other symptoms sometimes described as the ‘aura’. Migraines usually last for a few hours or up to a few days. During a migraine, the patients will usually have symptoms beyond the head pain and will be unable to carry out everyday tasks. He or she may have to rest or sleep. The patient may suffer from continued aura symptoms, most commonly flashing lights or zigzags in their eyes, feeling nauseous or dizzy, loss of vision and feeling extremely tired. Some people also feel sensitivity to light and sounds. Migraines can often start during sleep.
Migraine gives warning signs or auras beforehand. Aura symptoms can be visual, auditory, psychological or physiological. This is due to changing neurological effects and reactions in the brain. Visually aura symptoms can present as an alteration the patient’s perception by causing: wavy or jagged lines, flashing lights, dots, dark or colored spots, stars or ‘sparkles’. These are usually accompanied by a sensitivity to light, which can exacerbate the problems. Auditory symptoms include speech and hearing disturbances. These are usually accompanied by sensitivity to loud or complex sounds. Psychological symptoms include sudden change in mood, tiredness, thirst, hunger, confusion, feelings of fear, lack of control and memory changes. Physiological symptoms include numbness, tingling, the sensation of spinning or vertigo, increased urination, weakness and fainting. Different patients will have their own key symptoms which they may be able to recognize over time and will help them get themselves into a quieter and less visually active environment to cope with the symptoms. There are two types of ‘non aura’ migraines, which can present without the above symptoms, but with a distinctive set of other symptoms. ‘Basilar’ migraines are characterized with symptoms of fainting, double vision and loss of balance; and ‘familial hemiplegic’ migraines are characterized by reversible paralysis.
Triggers for a migraine headache can come from many sources as well. Initially they are thought to start from chemical reactions in the brain. For some people a migraine can be prompted by hormonal changes. Some women experience migraines around menstruation, menopause can also have an impact. It can make migraines worse in up to 45% of women who are going through it. For Low blood sugar, from not eating when we need to, can trigger migraines too. Alternatively, eating a meal which is too high in sugar can have a negative impact. Other causes can be emotional anxiety, physical factors, exercise, medicines, contraceptives, medicines, dehydration, alcohol, computer screens and diet.
Prevention and Control
Prevention is better than cure, so the ideal treatment goal is to prevent migraine attacks. There’s currently no cure for migraines, although a number of treatments are available to help ease the symptoms. The main prevention for migraine is to stay away from triggering factors as possibly can. It may take time to work out the best treatment for a patient. One may need to try different types or combinations of medicines before you find the most effective ones. Most people find that sleeping or lying in a darkened room is the best thing to do when having a migraine attack. Others finds that eating something helps or they start to feel better once they’ve been through headache. Many people who have migraines find that over-the-counter painkillers, such as Paracetamol, aspirin and ibuprofen, can help to reduce their symptoms. The tendency of medicine is to be most effective if taken at the first signs of a migraine attack, as this gives them time to absorb into your bloodstream and ease symptoms. It’s not advisable to wait until the headache worsens before taking painkillers as it’s often too late for the medication to work. Tablets you dissolve in a glass of water are a good alternative because they’re absorbed quickly by your body. If you can’t swallow painkillers because of nausea or vomiting, suppositories may be a better option. These are capsules that are inserted into the anus. If medication is unsuitable, or it doesn’t help to prevent migraines, you may want to consider acupuncture. Acupuncture is believed to be most effective on the patients suffering from migraine headache.
Advice: -Do not take stress in your life, take everything lightly; you got just one chance to live so enjoy your life. Everyday exercise/Yoga is also a vital factor to stay healthy along with healthy food. “Eat healthy and stay healthy”. If you’re disciplined in your life style then no disease will ever follow you.
Attention: – This article is an informative form of the disease migraine. Author doesn’t encourage use of the medicines whose name is mentioned in the article without proper prescription of the doctors. Author encourages patients to go visit doctor first if seen symptoms like migraine.