Policy & Issues

Pain in the… head?

Rest is essential to get over a migraine headache  

Ever experience recurring, long-lasting and throbbing pain on one side of your head, accompanied by intolerance to light or sound and an inability to function properly? If this sounds familiar to you, then you are one of the 18 per cent of women, 6 per cent of men and 4 per cent of children worldwide that suffer migraines.

A migraine is often dismissed as a mere headache and the often unsought advice most victims get is to pop a painkiller and get back to work but it is sadly not that simple.

Varsha Pillai, a 33-year-old working mother from Bangalore, says the first time she experienced a migraine was during a Hindi exam. She says, “I remember asking the teacher if I could put my head down for a while, because I couldn't concentrate on anything owing to the piercing headache. After 10 minutes, I ran to the restroom to puke, then went back to writing my exam. I remember thinking if I hadn't wasted my time resting my head I could have scored more in the paper.”

Meher Mirza, a 33-year-old Mumbai-based media professional, says, at one point she was suffering migraine attacks once a week. “The pain usually occurred on the entire left side of my head causing tremendous photo sensitivity, and at times, vision blurring and nausea. Since I avoid painkillers, I would lie down in a darkened room and get some sleep.”

Meher and Varsha are not isolated cases. Dr. K. Ravishankar MD, a specialist in Headache Medicine from Jaslok and Lilavati Hospitals in Mumbai says, “Migraine was a problem more commonly observed among the younger age group but it is becoming increasingly manifest today because of stress and other lifestyle-related factors that are much higher than they were 10 or 15 years ago.”

Typically anyone from the age of 15 to 40 can suffer from a migraine. Migraines may occur due to genetic reasons and are more common in women as they are linked to female hormones such as oestrogen. Dr. Rahul Chakor, MD & DM, in charge of Neurology at T. N. Medical College and B. Y. L. Nair Hospitals in Mumbai, says, “Migraine affects women and men in a 3:2 ratio.” He says even a crude estimation of the prevalence of migraine at 17 per cent puts the figure of its victims in India at nearly 200 million!

According to Dr. Ravishankar, there are many factors that contribute to migraine, which include our professional lifestyle, with its erratic timings and increased stress. He says “many of us have jobs that involve prolonged exposure to the computer and phone. We end up eating fast food more often, have minimum exercise and endure a lot of stress.”

However, Dr. Ravishankar clarifies that although patients think stress is the most important reason for their migraine, it is a compounding factor but not the cause of the problem. He says the primary trigger is heat and humidity in India, where the weather is hot and humid for nine months a year in most parts. Second, food triggers such as coffee, tea, aged cheese, chocolate and red wine and the habit of skipping meals, especially breakfast, could lead to migraine. Dr. Chakor says a migraine is worsened by fatigue, exhaustion, lack of sleep or disturbed sleep, excess caffeine or alcohol, menses, travelling and strong smells.

Dr. Ravishankar says patients usually figure out their trigger by a process of elimination and using common sense, before they approach a doctor. The more clarity a patient has about his trigger, the easier it is for the doctor to devise a treatment plan. A doctor may also order a CT or MRI scan to rule out any other serious neurological problems that may also cause headaches.

Most victims show symptoms of mild migraine that occur 4-5 times a month and last for a couple of hours. Over a period of time, when left untreated, these can become chronic. According to Dr. Chakor, “A chronic migraine is when the patient has a headache for 15 days of a month lasting four hours every day for three consecutive months.”

No permanent cure

There is no permanent cure for migraines, as Dr. Ravishankar says, it is a “hereditarily ingrained vulnerability worsened by our environment,” it can at best only be managed. If it is a mild migraine, analgesics such as paracetamol (that don’t contain caffeine or codeine) work best, according to him, as old school painkillers, but if overused, can cause rebound migraines over time. Other home remedies, he says, are pain balms and foodstuff like ginger, while cold compresses or hot baths also help.

Both Meher and Varsha avoided taking analgesics for their migraines. While Varsha says she has given up cheese, coffee and ice cream to control her attacks and has tried Jal Neti, a yoga therapy, Meher says, “I have found that there is nothing preventive in allopathy — they’re just painkillers, which doesn’t solve anything, but merely suppresses. I chose homeopathy, because it has worked in the past for me.”

The fact is, no two migraine victims are alike; their triggers and conditions can differ vastly. Hence, treatment varies from person to person. Chronic migraine sufferers may opt for allopathy treatments which, as Dr. Chakor says, typically consist of drugs such as amitryptiline, topiramate, flunarizine, beta blockers and divalproe. Some of these can cause side effects by way of weight loss or gain, renal failure and memory loss but most patients don’t report these and there is a 70 per cent chance of reduction of migraine with these treatments.

But the consensus is that identifying your trigger, and avoiding those conditions is best. And, of course, there is no substitute for getting adequate sleep, eating meals on time and exercising regularly to avoid stress. That’s probably a lifelong health mantra we could all do well to adopt.


- Throbbing/ pulsating/ hammering headache

- Recurring headache – lasting from 4-72 hours or at least 5 times a month

- Starts on one side of the head — front, side or back — and gradually becomes more intensive and may end up affecting both sides of head

- Accompanied by sensitivity to light/ noise and nausea

Home remedies

- Pain balms

- Cold compress

- Hot baths

- Darkening rooms

- Supplements such as magnesium/ riboflavin/ feverfew/ butterbur

- Foods such as ginger, red pepper (which contain capsaicin), green tea and eucalyptus oil

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Printable version | Apr 15, 2021 8:50:38 PM | https://www.thehindu.com/sci-tech/health/policy-and-issues/pain-in-the-head/article5079110.ece

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