Dr. Bhakti Gajjar, Consultant Neurologist, HCG Hospitals Ahmedabad
People who live with migraine know the actual grief they bring in – rattling auras, throbbing pain, nausea, pain in the eyes, and seeing spots of flashlights, sensitization to various environmental factors. It may look like just another kind of headache for a common person, but people accustomed to it know what a nightmare it can be. Whether they happen continuously or are episodic, migraine attacks can cause stress. Also, stress can trigger migraine episodes, a vicious cycle that may be difficult for you to escape.
Migraine commonly affects young age group and is triggered by work pressure, anxiety, stress and many environmental factors. Most people who suffer from migraine find difficult to give their full in work or do routine activities during an episode, so it affects many aspects of person’s daily life.
What Is Migraine?
Migraine is a neurological condition, a type of primary headaches that leads to pulsating headaches, mainly on one side of the head but can involve whole head. The symptoms can be mild, moderate, or severe that vary from person to person. Migraine episodes can last a few hours to days, and pain can be so bad that it impedes your normal routines. There are many trigger factors like light, stress, lack of sleep, empty stomach for long time, sudden change of atmosphere, cold weather, hormonal changes and many more. It is variable from person to person.
Common types of migraine include migraine with aura and migraine without aura.
1)Migraine without aura develops in phases. Premonitory phase-person experience symptoms like fatigue,mood changes,sensitivity to light and sound. Headache phase-moderate to severe headache lasting for 4-72 hours, throbbing and worsen with physical activity. Postdrome follows the migraine attack, have symptoms like fatigue and low mood.
2) Migraine with aura-An aura is a term used to describe the symptoms a person may experience before sometime of headache attack. An aura presents with temporary vision issues like flashes of lights or blind spots or other hindrances such as a tingling sensation on one side of the face or in the arm or leg and problems speaking.
3) Chronic migraine-A headache on at least 15days per month, with 8 of those days featuring migraine symptoms, must occur for more than 3 months. When people overuse pain relievers, they may develop drug overuse headache.
Other types :
Migraine with brainstem aura
Diagnostic criteria vary depending on the type of migraine. We clinicians look for a pattern of recurring headaches and accompanying symptoms. Also duration and intensity of symptoms. Migraine diary with type, duration and frequency of symptoms could be of great help.
What Is Association Between Migraine And Mental Health?
Well, both migraine and mental health are intimately related. It is essential to understand the potential impacts of migraine on mental health and vice versa. Moreover, regulating one often involves managing both. At times people with migraine develop anxiety, while mental health condition comes first for a few people. Not only anxiety but many mental conditions like depression, stress disorders, sleep disorders are interconnected with migraine. These conditions are more likely to affect a person if someone else in the family has them. Migraine and many mental health disorders affect similar chemicals in the brain.Following areas are involved in migraine and mental conditions.
There are several reasons why chronic migraine can affect a person emotionally. Thinking about when the next episode will spurt can cause anxiety, and living with persistent worry can also lead to depression. Also, chronic pain itself is so stressful for both the mind and body. Long-term stresses are known to impede the balance of hormones and chemicals in the brain and nervous system, affecting moods, and eventually, stress can make migraine bad.
Migraine, in most situations, can intrude with work, home, and social well-being, making you feel isolated and affecting your mental health. Also, the impact of chronic migraine can harm your self-esteem.
Current hypotheses on the neurobiological mechanism underlying the contribution of depression and anxiety to pregression of migraine include shared dysfunction of the serotonergic system.
If you have chronic migraine:
Take measures to look after your mental health
Do things that can lessen stress and anxiety
Seek medical help when needed
Cause Or Effect?
The cause-effect relationship between mental ill-health and migraine is unclear , with possibility of bidirectional relationship. Depression is believed to be a strong predictor for episodic to chronic migraine; however, treatment for migraine does not ease anxiety or depression.
This link is bidirectional, with both contributing to the progression of the other. Some studies reveal that both migraine and depression may be caused by an underlying genetic factor, an environmental trigger, or both. Also, serotonin dysfunction plays a remarkable role in developing anxiety and depression. Genetic mutations can impede serotonin signalling in individuals with stress as well as those with migraine.
In addition, certain medications that treat migraine (triptans) work by targeting serotonin receptors in the brain. Thus, serotonin also controls the relationship between migraine and mental wellbeing.
Hormones also play a role.
Some women experience menstrual migraine, which develops immediately before or after the cycle. In addition, oestrogen levels are low during menstruation, which indicates that oestrogen deprivation may play a vital role in the development of migraine and mental ill-health.
Migraine attacks are commonly managed by abortive medications like non-steroidal anti-inflammatory drugs. Preventive medications like antidepressants, antiepileptic drugs are added to treatment. For a few people, combining antidepressants with other medications that directly treat migraine may be very beneficial. We can use mono-therapy for both migraine and headache, different treatments for both conditions or sequential treatments.
Behavioural treatments are often used to treat migraine. Biofeedback therapy measures stress signals like muscle tension or body temperature to help people recognize the causes of stress so that they can react in real-time to enhance relaxation. Since psychiatric comorbidities so intricately affect migraines, their management becomes essential part to screen in patients with migraines.
Biofeedback therapy is mostly combined with relaxation training, which is a proven technique to ease stress which includes:
Gradual muscle relaxation
Simple Tips to Manage Your Mental Well-being
Well, following a disciplined lifestyle help a person control emotional health, which can eventually help you have lesser or milder headaches.
Stay connected with family and friends
Get sound, restful sleep
Practice relaxation techniques to mitigate stress