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What is up with these persistent migraines and is there anything I can do about them?


Migraines are a curious thing if they weren't so painful, disruptive, and for others debilitating.

Often striking just one side of the head, these pulsating, throbbing headaches last up to 72 hours and are seemingly caused by anything and everything — from tremendous heat to eating cheese, from glaring sunlight to stress, from lack of sleep to too much sleep to red wine — and for women, their menstrual periods.

All are correct, except migraines are not caused by anything.

According to Dr. Rogie Ignacio-Alcantara, a neurologist at Makati Medical Center, migraines are classified a primary type of headache. Along with tension type headaches, migraines "don't have any underlying cause," she says.

Instead, migraines have triggers. "Sensitivity to light, to sound — those are triggers," Ignacio-Alcantara explains.

Dr. Hazel Zuellig, a practicing neurologist at the Brain Institute of Cardinal Santos Medical Center and in Centre Medicale Internationale in Bonifacio Global City, adds "you have to differentiate between cause and trigger," explaining what actually goes on when a person experiences a migraine.

"Migraines don't come from the brain itself but from circulation —  yung ugat, the blood vessel and the structures of the arteries that bring blood to the brain." Migraines are a vascular circulation issue, she says.

What happens during a migraine attack? 

According to Zuellig, migraines begin when blood vessels constrict. "Blood will not flow in that part of the brain where it constricts," she says.

The constriction phase, she says, is often referred to us as the aura phase. "That's the first part of the migraine."

According to Zuellig, during the first 15-30 minute of the migraine, during the aura phase the patient will have neurological manifestations — this is where they feel the triggers. Suddenly, they become sensitive to light, or they feel gastritis coming up, or nausea so they want to throw up."

Why different manifestations of migraine, you might ask? It's because constriction of the blood vessel can happen anywhere in the brain.

"Most patients, when you ask them if they know their migraine will start, they will say yes. They do," she says.

According to Zuellig, triggers are the things "that make the artery constrict. The artery itself, puwede siya mag-close kasi there are smooth muscles in the wall of the artery. So puwede siya mag-close pag na-trigger siya."

She adds there is a  long list of triggers that includes intense heat, change in weather, too little or too much sleep, red wine, processed meats, and hormones.

"Maraming hypothesis for migraines, Ang pinaka-common is that [migraines] hormonally related, kaya it's more common among women," Ignacio-Alcantara explains.

"Estrogen play a key role in migraines," Ignacio Alcantara adds, which is why it's common during teenage years, during menstruation, during pregnancy, and during, before, and after menopause.

After 30 minutes, the constricted blood vessels open up "so gagalaw na ulit yung dugo, carrying with it the pain chemicals. That's when the real headache begins. "Ito na yung gusto mo na umpugin yung ulo mo sa pader," she says.

When migraines become full blast, almost nothing can relieve it, she warns.

Treatment, not cure 

There are different kinds of migraine medication — from abortive treatments to stop the attacks, to pain relievers when the headache reached its peak.

Zuellig says "timing is important" and recommends taking the very basic medication at the aura stage or the first 15-30 minutes. "That would be your paracetamol. When you're in the 30 minutes, choose to take [something stronger like] ibuprofen. Because if you don't level up, you won't be able to contain your headache."

Interestingly enough, one of the things she recommends at the aura stage of migraine is strong black coffee. "Because caffeine opens up arteries. So when it's tight and constricted, you take your coffee and it will make your circulation better," Zuellig says.

Its effect though won't be the same when you take it at the 30-minute mark of the migraine. "If your headache is already bad — bukas na ulit yung circulation at bumabaha na with pain chemicals, taking your caffeine will open up your blood vessels even more, letting in more pain chemicals. So then coffee is  going to make it worse," she explains.

According to both doctors, having different triggers doesn't mean needing different relievers. "Triggers set off the same process," Zuellig explains. "So you have to avoid your particular set of trigger."

Which is where it gets tricky. According to Ignacio-Alcantara, there isn't a test patients can take to know what their triggers are. "Mahirap talaga alam ang trigger, and it's a long list, so I tell them to really know their by heart para maiwasan nila."

Ignacio-Alcantara emphasises that pain management for migraine is different from trigger management and from cure.

"There is no cure for migraines," she says. "You just prevent the symptoms from occurring."

Still, there is such a thing as chronic migraine — migraines that occur 15 days in a month.

For those experiencing chronic migraine, there is a growing consensus that botox can actually help. Because it paralyzes the blood vessels, botox can in controlling the constrictions of the blood vessels.

But Botox treatment is expensive. Injected every 4-6 months, Botox treatment is anywhere between "P10,000-P12,000. And you inject all points in the head kaya rin masakit," Ignacio-Alcantara continues. 

She shares there's another drug, also an injectable, which given to a patient every 28 days. "It's like insulin, injected to a patient. It's a lot cheaper than botox and it's less painful."

Zuellig agrees, saying such maintenance medications are really for severe and frequent types of migraines.

For typical migraines though, it's all about knowing oneself and one's triggers.

"You have to know yourself and your triggers because not one migrainer is the same as the other. There's no cause and there's no cure, but you can control it," she says.

She emphasizes not to be afraid of taking medication. "People think migraine is part of the life, titiisin na lang nila. But you have to understand the process, why you have to take certain medications, why you need to avoid certain thing so as not to disrupt your life." — GMA News