Migraines and when to seek help

Posted on 7 October 2016

Dr Zaheer Sacoor, a neurologist at Mediclinic Pietermaritzburg, helps us understand the difference between a headache and a migraine, plus the triggers and symptoms to watch out for and when to seek medical help.

What is a migraine?

A migraine is basically a very painful headache that may be accompanied by sensory warning signs. Migraines are a treatable genetic condition that’s triggered by environmental factors; however, there is no cure.

There are two types of headaches that neurologists generally see: The first is a sinister headache, which is caused by a condition such as meningitis or a tumour. The second is classified as primary headache disorder and is characterised by severe recurring headaches. However, with blood tests, a brain scan or a lumbar puncture to help diagnose the reason for the pain, the results usually come back as normal. These headaches include migraine, tension headache and cluster headache, and are caused by physiological changes or changes in brain chemistry.

When is a headache a migraine?

There are different types of migraines, but studies have shown that 90% are either the classic or common migraine.

The classic migraine tends to be a recurrent, debilitating headache preceded by neurological symptoms, such as seeing an aura around objects (this is called a scintillating scotoma) or patterns like zigzags in the visual field. There may also be olfactory warnings before the onset of a migraine attack, such as smelling overripe strawberries.

These neurological symptoms usually last from a few minutes up to an hour before the evolving, throbbing, pulsing headache begins and worsens with time. The patient may also feel dizziness, nausea or extreme tiredness. Migraine sufferers are often light and sound sensitive.

With a common migraine there’s usually no aura or other neurological symptoms, and fewer instances of warning signs like nausea and dizziness. The patient experiences a throbbing pain that’s caused by inflammation around the blood vessels in the brain.

The best form of treatment for both classic and common migraines is sleep, in combination with a simple anti-inflammatory.

What can trigger a migraine?

Triggers differ between patients. For some it’s dietary – research has found that foods high in tyramine or phenylethylamine, such as chocolate, cheese, coffee, fizzy drinks and caffeine can trigger migraines. Dr Zaheer Sacoor recommends that patients keep a headache diary to determine what behaviours, factors and foods could be causing their migraines. It could be one specific trigger or a combination of factors. Other possible triggers include skipping meals, dehydration, stress, lack of sleep, hormonal changes, some medications, flashing lights and bad posture.

When should you seek medical treatment for a migraine?

Studies have shown that one in 240 headaches are serious. If someone is experiencing severe recurring headaches, their first stop should be the GP. If the headaches continue despite treatment recommendations, the patient could be referred to a neurologist who may run further investigations or treat the migraine with prophylactic as well as acute medications.

Never ignore a seriously bad headache – that means a headache that’s progressive and worsens with time without improvement, or a sudden-onset extremely severe headache that may be accompanied by neck stiffness, or a headache that wakes you up at night or is accompanied by a high fever.