Migraine, a common neurological disorder -- an unbearable headache, for laymen -- is among the most under-diagnosed, underestimated and under-treated of ailments. It is not possible to completely alleviate this head-splitting agony, but with proper treatment it can be brought under control. However, what a lot of patients and doctors are not aware of is that it is not so much a psychological ailment, as a biological one.

Migraines occur in 18 per cent of women and six per cent men. Only one-third of all migraine sufferers consult a doctor, while the remaining do their own patchwork cures with painkillers.

Unlike the flu, malaria or jaundice, this cannot boast of instant results. There is no magic here and since it involves a lot of patience, by both patients and doctors, most people drop out in the middle of the treatment. The three types of headaches are: migraine, tension type headache and cluster headache. There exists a grey zone between the first two kinds.

Migraine is a one-sided unilateral throbbing headache, where one has feelings of nausea and an aversion to light and sound.

During a migraine attack, changes in various brain chemicals, particularly serotonin, occur. There is also an inflammation of blood vessels, following which changes in the blood flow to the brain are also noted. As a result, chemical changes cause dilation and inflammation of the blood vessels around the brain, which triggers off the headache.

The treatment of migraine has significantly changed in the last 20 years. The goal of a doctor is to reduce the frequency, intensity and duration of the headache. It should be treated as any other chronic ailment, such as high blood pressure or diabetes. With today's treatment, 70 to 90 per cent of patients can be helped.

It helps the patient a great deal if the person accompanying them shows some interest in the treatment as well. The doctor also has to listen carefully. The pain can be reduced if the right drug is taken at the right time. Scientists abroad have formulated a drug, Sumatripton, for acute cases of pain. Other drugs are Cafergot and DHE. These again should be taken only when prescribed.

Educating the patient about headaches also helps in the treatment of migraine. The patient should be informed of the various headache triggers that can be avoided or modified. A change in lifestyle can also be helpful. The Headache Clinic - a new approach:

migraine is a major health, social, economical and personal problem. Often, over-the-counter and prescription pain medications are ineffective. Over the last few years, all over the world, physicians with a special interest in headache have supported the recognition of chronic headache as a major health problem, which has led to the the concept of a headache clinic. It is with the same purpose of providing a holistic approach to the headache problem that we have started the Jaslok Headache Clinic. The purpose will be to provide a comprehensive evaluation of the headache patient, to make an appropriate diagnosis, to initiate prophylactic or preventive treatment, and to provide continuity of care. This approach is somewhat different from that of a busy physician who, because of time restraints or other factors, may not be able to provide comprehensive headache management. A patient with an occasional headache or headache due to cold or fever is best managed by a family physician or internist, and may not require headache evaluation. However, referral to the headache clinic may be considered when:

* Diagnosis is uncertain or doubtful

* Chronic recurring headache does not respond to conventional therapy

* Relief from headache is frequently sought on an emergency basis

* habituation and tolerance to pain killers is suspected

* Headache occurs with neurological symptoms

* Comprehensive headache management cannot be provided by the family physician

In conclusion, migraine headache is perhaps one of the most common, yet least understood medical disorders. Despite being a chronic disabling condition, it has received neither the recognition nor the attention it deserves. Migraine is not a psychological disorder, it has a biological basis, and can be diagnosed and effectively treated. Migraine sufferers do not have to live with pain, agony, despair and frustration. Instead, they should seek medical attention and proper treatment, which can change their lifestyles for the better.

For details contact: Dr K Ravishankar on 4092312/ 4074257/ 4933333

-- as told to Sudipta Basu

Copyright © 1997 Indian Express Newspapers (Bombay) Ltd.