“To start with, let me make one thing clear - not all headaches are migraine headaches,” says Dr Abubaker Almadani, Dubai-based Consultant Neurologist and Neuromuscular Specialist.
With more than two decades of experience in neurology, Dr Abubaker is one of the most recognised names in the field in the country. “While I do say that not all headaches are migraines, I must mention that migraine is a very common disease,” adding that around 10-15 per cent of the population could be affected by it.
Frequent and debilitating headaches should not be ignored, he advises. “If headaches are severe and debilitating, please consult a doctor. They will be able to advise you on the type of treatment required for the headache you are having,” says the Emirati neurologist.
“Also, most headaches do not necessitate a magnetic resonance imaging (MRI) of the brain. Some people believe they have to do an MRI if they have a headache. An MRI of the brain is not necessary for typical migraine patients.”
With June being the Headache and Migraine Awareness month, we asked the doctor to shed more light on the condition, how it affects people, and what steps can be taken to mitigate it.
Here are some excerpts from the interview:
Can you give us an overview of migraine?
Migraine is considered as a primary headache. Primary headaches consist of three major types – tension type headache, migraine headache and cluster-type headache, which is the least common one. Usually, a migraine headache is unilateral but can be bilateral as well. This means it can be located on one side of the head or on both sides. It is also possible to experience it in the front and on the sides. A migraine headache can last from 4 to 72 hours and is usually aggravated by light, sound, and activity. Nausea and vomiting are also associated with migraines. The pain can be severe and throbbing or a pulsing sensation.
How common is migraine in the UAE?
I would say cases of migraine are very common. If, on average I see 10 patients a day, around 5 or 6 could be having a migraine. We are in the process of collecting data on migraine prevalence in the UAE.
From the current available data, we have found that the highest population of migraine sufferers are between the fertile ages of 20 and 40 years. The frequency and severity of migraine headaches start reducing as you start ageing. In fact, I rarely see anyone who is 60 and has a migraine headache.
When it comes to gender, women are more common to be sufferers than men. The ratio could be 3:1 to even 4:1 (females to males). The disease is also not related to any nationality or demographic group, and can be seen across the globe.
That said, we have found that the prevalence of migraine is slightly greater in countries where people consume spicy food when compared to countries where people take less spicy food. For instance, Mexico has a slightly higher rate of prevalence compared to the US. Same is the case among Indian population compared to those in, say, South East Asia. This finding is not conclusive, though; studies are still ongoing.
A family history of migraine could also mean chances are greater. Again, migraine has not been proven to be genetic, but research is continuing.
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, that control or regulate pain in the nervous system. A peptide called calcitonin gene-related peptide could also have a role to play.
Peptide was noted to be elevated in people who suffer from migraine, especially acute migraine headache. Researchers are still studying this disease to find out more about it and how it can be prevented, managed and cured.
Could lifestyle, diet and increased screen time be causative factors?
If we are to examine the causes in more detail, we can find some pointers. We might not have a lot of data on the internal pathology or chemical causes of migraine at the moment, but we do believe that work stress, sleep deprivation, workload pressure, exposure to light, among other things, could aggravate or, in some cases, trigger a migraine attack.
I have known of people who have photosensitivity - exposure to bright lights that could trigger or worsen their migraine.
So, they often heavily tint their vehicle windows or wear sunglasses indoors and while at work. This could lead to their colleagues making fun of them or passing hurtful comments. My request to those who don’t understand what a migraine patient goes through to please try and help your colleagues or friends and not mock them. They could be having chronic and debilitating headaches. Support them by providing them with a quiet and reasonably dark area to work in so productivity is not affected. Diet is another possible and very important cause. Dairy products, chocolates and sweets, foods that contain a lot of fat, spicy and highly aromatic flavour can also trigger a migraine. I advise my patients to try certain foods and see if they trigger a migraine attack. Maintain a logbook of foods that can be consumed and those that should be on the ‘no consumption list’. Triggers can be subjective; a certain food item could be fine for one patient but not be for another.
When should a headache be considered severe and require a doctor’s attention?
Migraines can sometimes go undiagnosed or untreated. If you experience regular headaches, it would surely help to inform your doctor about them. You might associate some headaches with workload stress, hypertension, or sleep deprivation. But if these headache episodes are repeated, a doctor would deem it necessary to examine in detail, go deep in the history, to find out whether it is migraine-related or if there is another reason.
Is there a misconception you would like to bust regarding migraine?
If someone is having regular headaches that are severe, they might conclude that they have cancer of the brain and that they might need to undergo brain imaging among other tests. That is a common misconception.
Yes, you may have to undergo a brain imaging but that happens in less than 1 per cent of all headache types.
I’ve come across many headache types in my practice and none of them were typical migraine headaches that required imaging. I can reassure all people who may be suffering from migraine that you don’t need to have an imaging done if you have typical migraine headache and if the pattern has not changed in severity.
Migraine is a clinical diagnosis. There is no blood test that can be done to confirm a migraine. This means if you have clinical signs of migraine, which is typical and without serious side effects, the condition is migraine.
Can lifestyle changes help in managing this disease?
We have found that drinking two or three litres of water a day along with good sleep, regular exercise like walking for half an hour but not in bright sun, and avoiding triggers that cause headaches can go a long way in alleviating migraine symptoms and headaches in general.
Overconsumption of medications could also be a reason for chronic migraine and medication-overuse headaches. Also, those who have underlying depression are more prone to developing a chronic migraine.
A piece of good news about migraine?
Yes, there is. We are preparing for a major paradigm shift in the area of migraine management. Until recently we would tell chronic sufferers that we are sorry and that we do not have any medicines for you. But now that is changing. We can now offer them new medicines that are showing great promise in effectively managing migraine. Ongoing studies are aplenty. The results of trials are proving to be good. I don’t want to say they are promising miracles but there are medicines now that can target and control severe headaches by 50-60 per cent. In fact, there are some data that show that some migraine patients have not had any headaches for several months after treatment. In addition, there are some medicines that need to be taken just once a month or even once in three months compared to once a day in the case of some chronic sufferers.
