[Health Tip] Unbearable Migraine: Immediate Medication and Keeping a 'Headache Diary' Help

Professor Lee Hak-yeong, Department of Neurology, Kangdong Kyung Hee University Hospital, Suggests

Migraine is one of the most common types of headaches. It is characterized by repeated headache attacks accompanied by gastrointestinal symptoms such as nausea or vomiting, along with throbbing pain on one side of the head. It can occur at any age but often begins in the teenage years. In particular, the incidence of migraine in women is reported to be more than three times higher than in men.

Professor Lee Hak-young, Department of Neurology, Gangdong Kyung Hee University Hospital. [Image source=Gangdong Kyung Hee University Hospital]

The exact cause of migraine is not clearly known. It is presumed that repetitive pain occurs due to abnormal responses of the cranial nerves and cerebral blood vessels that mediate pain in response to sudden changes in the internal or external environment of the body. Migraines occur more than three times as often in women than in men, and this is believed to be related to the menstrual cycle, during which hormone levels change rapidly. Additionally, genetic factors such as family history are also involved. Various triggers can provoke migraines, including irregular lifestyle habits such as lack of sleep or excessive sleep, and stress. Certain foods, bright lights, loud noises, and specific smells like perfumes can also trigger migraines.

Migraine is not simply a headache. It manifests through four stages: prodrome, aura, headache, and postdrome, each with various symptoms. The prodrome stage, occurring before the migraine attack, involves mood or energy changes such as lethargy, fatigue, loss of appetite, constipation, or diarrhea. The aura stage, just before the headache, temporarily presents symptoms like darkening of one side of the visual field or seeing flickering lights or shimmering waves. The headache stage lasts 4 to 72 hours and includes throbbing pain, nausea, vomiting, and eye pain. Finally, the postdrome stage follows the headache, bringing mood decline or fatigue.

The pain during the headache stage of a migraine attack can vary. Usually, the pain is localized to one side of the head, but it can spread to both sides or present as a general headache without a specific location. The pain is often described as pulsating or throbbing.

If not treated properly, the pain usually subsides after 4 to 72 hours. The patient may suffer from pain for up to 2 to 3 days, unable to move comfortably. Nausea often accompanies the pain, and in severe cases, vomiting and intense eye pain may occur. Bright lights and loud noises worsen the discomfort, so patients often try to sleep or lie down in a dark place.

Once a migraine attack begins, it is necessary to take migraine medication as soon as possible. Many patients hesitate to take medication and only do so after the headache becomes unbearable. However, acute migraine treatment is more effective when medication is taken as soon as possible after the headache starts..

Along with acute medication, preventive treatment is sometimes used to reduce the frequency, intensity, and duration of pain. Preventive treatment can be considered if headache attacks are too frequent or severe, significantly affecting daily life, or if acute medication cannot be used. Various medications are selected based on the patient’s condition and used for at least 2 to 3 months to evaluate preventive effects. Botulinum toxin injections, known as Botox, are also used for chronic migraine prevention, administered once every three months.

To identify individual migraine triggers, it is important to keep a headache diary. Although there is some controversy about triggers, if a definite trigger is identified for an individual patient, various coping strategies can be implemented to avoid or reduce exposure to the trigger. For example, reducing stress, getting adequate sleep, or exercising to regulate lifestyle habits can be helpful.

Professor Lee Hak-young of the Department of Neurology at Kangdong Kyung Hee University Hospital stated, "It is necessary for patients to understand the frequency, intensity, duration, and triggers of their migraines. Along with this, consulting a specialist to establish a treatment plan tailored to individual triggers is important."