Chronic Migraine, more women than men affected in India, Dr. Atul Prasad

Chronic migraine is most prevalent in people between 20 to 50 years of age and as many as 70 per cent of the sufferers are women. Hormonal changes make women more prone to the disease, says Dr.Atul Prasad, Senior Consultant and Director, Department of Neurology, BLK Super Specialty Hospital New Delhi.

Rehana, 30, an editor at a publishing house had been experiencing severe headaches for the past 5 years but never took then seriously. In the initial years, the headache was severe but occasional. However, with time the frequency of the throbbing pain increased, so much so that for almost three days a week, she would return from work in a wretched state. Some days, the pain would cause her to throw up. Her productivity affected, she was forced by her friends to meet a doctor who immediately recognized it as chronic migraine. After several rounds of medication and other treatment options, she was recommended injections of OnaBotulinum toxin type A, popularly known as Botox, to relieve her pain. After six years of living with that constant companion called headache, Rehana today lives a more normal and more productive life. She is now planning to turn a writer.

In a tete-a-tete, Dr. Prasad speaks about general migraine, chronic migrane and how it impacts women more than men to Jayshankar Menon. Excerpts:


JM: What are the general symptoms of a migraine?

AP: Frequent bouts of headache that often lead to vomiting, nausea, sensitivity to heat, light or sound and dizziness, these

are the general symptoms of migraine. Migraine can be a debilitating ailment that can wreck the quality of your life, often force you to stay indoors and impact your productivity. Many people often lose out 10-15 hours of their valuable time to migraine headaches every week. Many others ignore the problem as in our general perception, it is not considered as serious as some other diseases.

JM: How about the chronic migraine?

AP: Chronic migraine shall not be taken lying down. With effective medical intervention and treatment, it can be treated and

controlled. Medications, nutritional supplements, lifestyle alterations and avoiding the migraine triggers can help a lot. So can injections of OnaBotulinum toxin type A.

JM: Can you elaborate about chronic migraine in detail?

AP: Chronic migraine is the term referred to migraine headaches that lasts more than three months. Some people continue to live with them for years altogether. The pain is marked by frequent spills of headache on one side of the head, pulsating throbbing sensation which aggravates from moderate to severe which are aggravated by stress and other triggers that vary from person to person.

JM: Amongst which strata of society have chronic migraine and why women are afflicted with this condition than men?

AP: The disorder is more common in people who are in the profession of higher intelligence such as doctors, lawyers, scientists and invariably, women are more prone to it than men. Chronic migraine is most prevalent in people between 20-50 years of age and as many as 70% of the sufferers are women. Hormonal changes make women more prone to the disease.

JM: What exactly happens when a patient is afflicted with chronic migraine?

AP: Migraine headaches result from a combination of blood vessel enlargement and the release of chemicals from nerves that causes the sympathetic nervous system to respond with feelings of nausea, diarrhea, and vomiting. Often they can be debilitating and lead to sensitivity towards light (photophobia) and sound (phono phobia) in the sufferer. In extreme cases such people avoid going in crowded areas and like to be left alone in a ‘dark room’.

JM: Are children been spared of migraine?

AP: We are encountering cases of childhood migraine as well and we see school children are also coming with the complaint of chronic migraine. The symptoms in children are lack of concentration, abdominal pain and giddiness.

JM: Globally, how many people suffer from migraine?

AP: According to the World Health Organization, 303 million people worldwide were ‘migraineurs’ or migraine sufferers (as per a 2003 study).

JM: What is the exact medication a migraine affected person should take?

AP: Chronic migraine sufferers often reach a state where popping in commonly-available painkillers do not help; usually a combination of specific medicines is required then, to be taken throughout the day to keep a check on their recurrent headaches. Migraine attacks cause significant pain for hours to days and are so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots or tingling in your arm or leg.

JM: What causes migraine?

AP: The cause of migraine headache is unknown. However, the most supported theory is that it is related to hyper excitability of the cerebral cortex (a part of the brain responsible for information processing and plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness) and/or abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

JM: What are the preventive treatments you suggest for migraine?

AP: Preventive treatments of migraines can be an important part of migraine management, which includes medications, migraine surgery, nutritional supplements, lifestyle alterations, such as increased exercise, and avoidance of migraine triggers like acidity, sun exposure etc. The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraines, and to increase the effectiveness of abortive therapy. Another reason to pursue these goals is to avoid medication overuse headache (MOH), otherwise known as rebound headache.

JM: How does Botox comes as a relief to migraine patients?

AP: Yet, there are people on whom conventional medicine too fails. For such people OnaBotulinum toxin type A, popularly known as Botox, comes as a huge relief. Approved by the Food & Drug Administration of the USA for prophylaxis in adult patients who suffer headaches on 15 or more days per month, each lasting more than four hours, the drug proves of great help in managing the severe pain in many people.

The drug works by temporarily blocking nerve signals that release such chemicals that cause inflammation and pain. Though chronic migraine cannot be cured permanently, OnaBotulinum toxin type A can significantly decrease the severity and frequency of migraine attacks. In ideal patients, the drug is administered in prescribed doses at specific sites on patient’s head and neck. The effect of this treatment lasts up to a minimum of three months subject to severity of migraine. However, the patient might require a lower dose of this in the subsequent sittings. For people like Rehana, such latest treatments options are a boon.


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