Headaches can be more complicated than most people realise and many people don’t know how to recognise it, warned Dr Johan Reid, who heads up The Cape Headache Clinic. “Different kinds can have their own set of symptoms, happen for unique reasons, and need different treatments.” 

Successful treatment of migraine and other headaches depends upon the accurate diagnosis of the source of the pain

Successful treatment of migraine and other headaches depends upon the accurate diagnosis of the source of the pain. Partly due to a lack of understanding of what migraine is, and how drastically it can affect people’s lives, migraines tend to go undiagnosed and undertreated in at least 50% of patients. 

“Headache and migraine are legitimate neurobiological diseases, said clinical neurologist and headache specialist, Dr Reid. “Over the last 50 years much has changed. With aid from advanced technology and clinical innovation, there are more treatment options than ever before. However, we understand that these diseases are still largely misunderstood and that finding the right treatment options requires insight.” 

DIAGNOSIS 

The World Health Organization (WHO) describes a migraine as a primary headache disorder (the headache is the condition itself, not a symptom of another condition) characterised by recurring attacks. These intense headaches are often described as pounding, throbbing pain. They can last from four hours to three days and usually happen 1-4 times a month. “A variety of symptoms differentiate migraine from other types of headaches, said Dr Kaushik Ranchod, a neurologist at Life Fourways Hospital. He explained that migraine attacks typically progress through four phases: 

  • PHASE ONE: THE PRODROME 

Symptoms may include excessive yawning, neck stiffness, irritability, and food cravings. 

  • PHASE TWO: AURA 

This presents as visual symptoms (bright shapes or objects, for example), auditory symptoms (such as noises and music), or sensory symptoms (for instance burning, pain, or numbness). 

  • PHASE THREE: HEADACHE 

Usually unilateral (one-sided) and throbbing. Its intensity increases over time, and it’s often associated with nausea, and light and sound hypersensitivity. 

  • PHASE FOUR: THE POSTDROME 

The headache subsides. The patient feels physically and mentally drained. 

While some migraines are mild, others can be so severe that the WHO classifies them as among the most disabling illnesses. 

MANAGEMENT 

“Migraine headaches can potentially be stopped by the prompt intake of medication, and symptoms are frequently better after lying down and sleeping,” said Dr Peter Haug, a neurologist at Mediclinic Milnerton. “Usually, migraines respond to anti-inflammatories, which should be taken as early as possible at the onset of pain. Anti-nausea medication can boost the effect of migraine medication. Most over-the-counter migraine kits can be effective concoctions, but shouldn’t be taken in repeated doses or long term.  

“Patients with frequent or debilitating migraines can benefit from the daily intake of a low-dose oral antidepressant at night, or a low-dose anti-epileptic that blocks certain ion channels and acts as a nerve stabiliser, also at night. However, the chronic daily intake of painkillers for muscle tension headaches following migraine attacks must be avoided,” warned Dr Haug.