Migraine = stroke?

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When life’s a headache

Some people do not think that migraine is real because there are no visible symptoms. -NST

Wed, Aug 25, 2010
New Straits Times

By Kasmiah Mustapha

LET’S clear up a few misconceptions about migraine.

First, it’s a real sickness, second, frequent headaches are actually mild migraines and third, the symptoms are not confined to severe pain and blurred vision as each sufferer experiences a different severity of the disease.

Pantai Hospital Kuala Lumpur consultant neurologist Dr Lee Moon Keen said some people do not think that migraine is real because there are no visible symptoms. Having never experienced a headache, they assume migraine sufferers are exaggerating.

“If a person is infected with a virus, for example, he or she would have flu with sneezing, a runny nose and fever, symptoms that can be seen or measured.

“The only thing that they can see in migraine sufferers is them clutching their heads, saying they have a headache. Their pain is not visible, so migraine sufferers get little sympathy.”

Mild migraine usually results from fatigue and lack of sleep.

“This has lead to another misconception that only severe, debilitating pain that incapacitates can be classified as migraine. There is a wide range of pain severity among migraine sufferers depending on the person’s genetic make-up and the trigger factors. This is why we suspect migraine is under-diagnosed.”

Dr Lee said people who suffer from severe migraine often worry that they have brain tumour because of the similar symptoms that these two illnesses share.

“I’m afraid people have been influenced by the Internet because they do not know how to interpret the symptoms they see in the Web. Some insist we do a scan. Occasionally, we will comply because they are so fearful. But if you do too many scans, it could be harmful. It’s also expensive.

“If the headache pattern is stable and there is no neurological abnormality, we would treat the symptoms and the pain would be controlled. However, if there is change in the pattern of the headache, or when the pain is more frequent and severe and accompanied by neurological symptoms, then we would advise the patient to do a scan to rule out other causes of headaches.”

Dr Lee said migraine, a common neurological condition, has a typical set of symptoms: pounding or pulsating pain on one side of the head. Often, the pain is also associated with giddiness or vomiting or both.

The trigger factors for migraine can be psychological (stress, anger, shock, depression), dietary (dieting, eating chocolate, irregular meals, fried food and caffeine), or physical (lack of sleep, jet lag, waking up late, change of climate).

Menstruation, loud noises, intense smells, smoking, sleeping pills, bright sunlight, and the glare from computers and TV sets can also trigger migraine.

“Migraine usually occurs in people with a family history of the condition. It is more common in women than in men. The reason for this could be hormonal. Although there is no single gene for migraine, we cannot rule out the genetic factor. Only one type of migraine known as hemiplegic migraine can be traced back to a gene. In other types of migraine, the causes are many.

On other health problems caused by migraine, Dr Lee said those who experienced severe migraine would previously be prescribed addictive painkillers such as non-steroidal anti-inflammatory drugs that could cause gastritis and kidney damage. In recent years, doctors avoid prescribing too much of these drugs.

“Recently a study linked migraine to stroke but it is not confirmed yet. There are many highly capable people who have migraine and they are all right.”

Researchers from Johns Hopkins University School of Medicine in Baltimore report that people who suffer migraines are about twice as likely to suffer a stroke caused by a blood clot compared with those who do not suffer these headaches. Studies also show migraine sufferers to be twice as likely to suffer an ischemic stroke as people without migraines. However, experts are not sure why this is so. It is not known whether the migraines themselves directly lead to strokes in some people.

As for treatment, Dr Lee said those who have mild migraine should be aware of the trigger factors. They need to adjust their lifestyles, eating a healthy diet and finding ways to reduce their stress as well as seek medical advice on the type of painkillers they can take.

For people with recurrent migraine, they may need to consider preventive treatment. Severe migraine is described as two or more attacks a month that cause incapacitation. There are many effective preventive medications for migraine.

“Although a person has a predisposition to migraine, there are phases in life when it would act up and times when it would be in remission. “Most of the attacks usually happen when the person is going through a difficult time in his or her life.”