Migraines can be difficult to manage
“To begin, let me clarify one thing: not all headaches are migraines,” says Dr. Abubaker Almadani, Head of Neurology Department at Rashid Hospital, Dubai Health Authority.
With over two decades of experience in neurology, Dr. Abubaker is one of the most recognized names in the field in the country. “Although I say that not all headaches are migraines, I must mention that migraine is a very common disease,” adding that around 10-15% of the population could be affected.
Frequent and debilitating headaches should not be ignored, he advises. “If the headaches are severe and debilitating, please seek medical attention. They will be able to advise you on the type of treatment needed for the headache you have,” says the Emirati neurologist.
“Furthermore, most headaches do not require magnetic resonance imaging (MRI) of the brain. Some people think they should have an MRI if they have a headache. A brain MRI is not necessary for typical migraine patients.
With June being Headache and Migraine Awareness Month, we asked the doctor to shed some light on the condition, how it affects people, and what steps can be taken to alleviate it .
Here are some excerpts from the interview:
Can you give us an overview of migraine?
Migraine is considered a primary headache. Primary headaches consist of three main types – tension-type headaches, migraines, and cluster-type headaches, which are the least common. Usually a migraine is unilateral, but can also be bilateral. This means that it can be located on one side of the head or on both sides. It is also possible to experience it from the front and sides. A migraine can last from 4 to 72 hours and is usually made worse by light, sound and activity. Nausea and vomiting are also associated with migraines. The pain may be intense and throbbing or a throbbing sensation.
How common is migraine in the UAE?
I would say migraines are very common. If, on average, I see 10 patients a day, about 5 or 6 could have a migraine. We are in the process of collecting data on the prevalence of migraine in the UAE.
Based on currently available data, we have found that the highest population of migraine sufferers are between the fertile ages of 20 and 40. The frequency and severity of migraines begin to decrease as you begin to age. In fact, I rarely see someone who is 60 and has migraines.
With regard to sex, women are more often victims than men. The ratio could be 3:1 to even 4:1 (women to men). The disease is also not tied to any nationality or demographic group and can be seen worldwide.
That said, we found that the prevalence of migraine is slightly higher in countries where people eat spicy foods compared to countries where people eat less spicy foods. For example, Mexico has a slightly higher prevalence rate than the United States. The same is true for the Indian population compared to that of, say, Southeast Asia. This finding, however, is not conclusive; studies are still in progress.
A family history of migraine could also mean the odds are higher. Again, migraine has not been proven to be genetic, but research is ongoing.
What are the common causes of migraines?
We don’t really know the true cause of migraines, but we do know that it happens when there is an imbalance of certain chemicals in the body, including serotonin, which control or regulate pain in the nervous system. A peptide called calcitonin gene-related peptide may also have a role to play.
The peptide has been noted to be elevated in people with migraine, especially acute migraine. Researchers are still studying this disease to learn more about it and how to prevent, manage, and cure it.
Could lifestyle, diet and increased screen time be causal factors?
If we want to examine the causes in more detail, we can find some clues. We may not have a lot of data on the internal pathology or chemical causes of migraine at this time, but we think work stress, sleep deprivation, workload pressure, Light exposure, among other things, could aggravate or, in some cases, trigger a migraine attack.
I have known people who have photosensitivity – exposure to bright lights that could trigger or worsen their migraine.
For example, they often tint their vehicle windows heavily or wear sunglasses indoors and at work. This could cause their colleagues to laugh at them or make hurtful comments. My request to those who do not understand what a migraine patient is going through to try to help your colleagues or friends and not make fun of them. They could have chronic, debilitating headaches. Support them by providing a quiet, reasonably dark area to work in so productivity isn’t affected. Diet is another possible and very important cause. Dairy products, chocolates and sweets, high fat, spicy and highly aromatic foods can also trigger a migraine. I advise my patients to try certain foods and see if they trigger a migraine attack. Keep a diary of foods that can be eaten and those that should be on the “no-eat list”. Triggers can be subjective; a certain food may be suitable for one patient, but not for another.
When should a headache be considered serious and require medical attention?
Migraines can sometimes go undiagnosed or untreated. If you suffer from regular headaches, it would certainly be useful to inform your doctor. You may associate some headaches with workload stress, high blood pressure, or sleep deprivation. But if these episodes of headaches are repeated, a doctor will find it necessary to examine in detail, to deepen the history, to find out if it is a migraine or if there is another cause.
Is there a misconception that you would like to dispel regarding migraine?
If someone regularly has severe headaches, they may conclude that they have brain cancer and may need brain imaging, among other tests. This is a common misconception.
Yes, you may need brain imaging, but it happens in less than 1% of all headache types.
I have encountered many types of headaches in my practice and none of them were typical migraines requiring imaging. I can reassure anyone susceptible to migraine that you don’t need imaging if you have a typical migraine and the pattern has not changed in severity.
Migraine is a clinical diagnosis. No blood test can be done to confirm a migraine. This means that if you have clinical signs of migraine, which is typical and without serious side effects, the condition is migraine.
Can lifestyle changes help manage this condition?
We have found that drinking two or three liters of water a day with good sleep, exercising regularly like walking for half an hour but not in direct sunlight, and avoiding triggers that cause headaches can greatly help relieve migraine symptoms and headaches in general.
Medication overuse could also be a cause of chronic migraine and medication overuse headaches. Additionally, those with underlying depression are more likely to develop chronic migraine.
Any good news about migraine?
Yes there is. We are preparing for a major paradigm shift in the field of migraine management. Until recently, we told the chronically ill that we’re sorry and we don’t have medicine for you. But now that is changing. We can now offer them very promising new drugs to effectively manage migraine. There are many ongoing studies. The test results are good. I don’t mean to say they promise miracles, but there are now drugs that can target and control severe headaches by 50-60%. In fact, there is some data showing that some migraine patients have been headache-free for several months after treatment. Also, some medications only need to be taken once a month or even once every three months, compared to once a day for some people with chronic conditions.