Migraines are often disregarded as just another headache. Pain or ache in the head is just one of the many symptoms of migraines which are a neurological disease that involve nerve pathways and chemicals. If someone has a headache for 15 days a month, out of which eight days the headache occurs with migraine features, and this happens for three months or more, they are probably suffering from chronic migraine. What begins as headaches of a lesser frequency develop a more frequent pattern, thus becoming chronic. Chronic migraine is, much more than a headache. To identify and distinguish a chronic migraine from common headaches, one must know and identify the symptoms which include moderate to severe intensity headache, throbbing pain, pain on both sides of the head, dizziness, vomiting, nausea, and sensitivity to light, sound, and smells. Chronic migraine and migraine shares same symptoms. The difference is in the timing. To be diagnosed with this condition, you’ll have headaches at least 15 days a month.
Every person who has chronic migraine, has different triggers, but common ones include a lack of sleep, caffeine, and being under stress. Most people who get chronic migraines are women. This is because of the hormonal changes at different stages of life. During menstrual phase, pregnancy or menopause, women undergo a lot of hormonal changes and hence can experience or act as a trigger to chronic migraine attack.
Chronic Migraine goes much beyond being a headache as it results in several neurological symptoms, which can be quite disabling. The quality of life of a chronic migraine patient gets severely affected as they cannot perform their daily tasks such as going to work or attending school. These disabling symptoms may even occur without an accompanying headache in some instances.
The hope for people with chronic Migraine is to control the headache. With timely diagnosis and a suitable treatment plan, it is reasonable to believe that the number and severity of migraine headaches can be reduced. Unfortunately, many patients with chronic Migraine may revert to migraine episodes over time.
There are other options for patients with chronic migraines that have not responded to previous treatments. Some patients need more aggressive hands-on advanced techniques and trigger point injections.
Doctors often prescribe pain relief for migraine for short periods of time but if those suffering from headaches take them for a longer duration, such medication can trigger more headaches which are called drug-induced headaches. These are also known as medication overuse headaches or rebound headaches.
It is important for patients with medication overuse headaches to detoxify their bodies of previous medications under medical supervision. It is thus important that pain relievers and other such medication should only be taken for a short duration and if your condition doesn’t improve or worsens, you must consult a doctor, preferably a specialist for your migraine rather than using the same medicine as prescribed earlier.
And lastly, a team approach is required for patients with the most challenging chronic migraines to treat, who are not responding to any treatments or detoxification method. The team, consisting of healthcare professionals from neurology, psychiatry, psychology, nursing, physical therapy, and social work, meets together with the patient and the patient’s family over weeks to develop a plan of care and monitor progress. Patients with difficulty treating migraines should ask their doctors to refer them to facilities that offer multi-team, patient-centred programs.
Chronic migraine can be prevented by controlling the triggers. Treatment of chronic migraine focuses on managing lifestyle choices and headache triggers, managing and providing preventive treatments to reduce attacks. For example, managing lifestyles like- losing weight, beginning an exercise plan, caring, controlling stress, developing a routine regimen regarding meals, staying well hydrated, initiating treatment for any existing mood disorder. There are also many typical and preventive treatments aimed at reducing the number of headaches. Therefore, consulting with a neurologist at the early stage as soon as one observes any of the chronic migraine symptoms.
(Dr. Rahul Kulkarni, Neurologist, Deenanath Mangeshkar Hospital and Research Center, Pune)
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