No, it's not just a headache

When you think of someone having a heart attack, your mind probably goes to some version of Shah Rukh Khan’s cardiac arrest scene in Kal Ho Naa Ho. There’s the clutching of the chest, a shooting pain in the arm, and a dramatic collapse, gasping for air. For women, however, a heart attack doesn’t necessarily resemble the above. We might experience pain in our jaws, nausea, and shortness of breath, without so much as a chest pain. Called silent heart attacks, these anti-climatic episodes affect women more than men. 

It’s typical for men’s health to be seen as the default, both in society and the medical community. Women’s illnesses tend to be afterthought, if they are thought of at all (it’s a phenomenon known as medical gaslighting). As any woman who has gritted her teeth through a cold, metallic speculum at the gynaecologist knows, women’s discomfort is often underrated. And that’s my explanation for why I got into a fight with my boyfriend over home decor. 

You see, when we were moving into our new flat, he and the electrician both insisted that white LED bulbs were the most practical option. I warned that the harsh lights might trigger migraines. But he was under the impression that a migraine is just a headache that will clear up with some Crocin – at least, until he came home one evening to find me in the dark with a blinding headache, puking my guts out in the bathroom. 

Of course, any migraine sufferer could have told him it’s not just a headache. According to the Cleveland Clinic, migraines are the sixth most debilitating condition in the world. But since three out of four people who experience migraines are women, perhaps it should come as no surprise that they’re still widely seen as less serious than they really are. In fact, migraines are a neurological disorder that mostly affects women between the ages of 15 to 55, characterised by throbbing pain in the head that lasts for four hours and can go on for days. Migraines are also more likely in people who have conditions such as depression, anxiety, and epilepsy. 

Dr Manoj Rohra has a clinic in Mumbai where migraine patients frequently pass through. He says that although some are as young as ten, there are patients in their 50s and 60s and who are getting a migraine diagnosis for the first time. “There is no test for migraine. So we have to take MRIs, blood pressure, conduct psychiatric evaluations to rule out other possibilities,” he explains.

Since migraine symptoms are both highly individual and misunderstood, it’s not uncommon for sufferers to be unaware of what they really are. I was in my teens before I realised that most people’s headaches aren’t two-day long pain parties where any sensory input makes you wish for the sweet release of death. So the next time someone tells you that it’s just a headache, or you’re wondering what you’ve done to anger the migraine gods now, take comfort in knowing that a) they’re wrong, and b) you’re not alone. 

Migraines come in as many varieties as the people who have them. Around 80% of migraine disorders are genetic – mine is inherited from my mother. Mitali Shah, 25, is a Mumbai-based writer who also suffers from migraines. “I got it from my mother, who got it from my grandfather,” she shares. For many of us, this is a chronic condition that develops as early as childhood and never goes away. Being a neurological disorder, migraines can manifest in all kinds of ways, but these are some of the more common types. 

Migraine without aura

This migraine brings on a headache and other typical symptoms such as nausea, fatigue, vomiting, and extreme sensitivity to external stimuli. Bright light, sounds, and smells become unbearable for many migraine sufferers. 

Migraine with aura

An aura is a sensory disturbance that can warn you of an approaching migraine. You might see lights, experience blind spots in your vision, feel a tingling sensation in your face or limbs, ringing in your ears, or even be unable to speak properly. A brainstem aura can lead to vertigo, loss of balance, and slurred speech preceding the migraine.  

Auras are nervous symptoms apart from the headache, and they can be alarming if you’re not used to them. They will usually pass after a few minutes, but can go on for an hour. Around one-fifth of migraine sufferers have auras. 

Menstrual migraines

Hormonal changes are a common trigger for migraines, which is a major reason why women are so much more likely to have them. Hormones also affect a host of other body functions that can cause you to be at greater risk for migraine attacks (find out how to regulate your  hormones and improve your overall health.) Before I could take hormonal birth control, I had to see a neurologist to assess my risk for blood clots. 

Silent migraines 

It’s possible to get a migraine without any headache at all. These migraines don’t come with any pain, but do have an aura and any other symptoms of migraine. 

All of these migraines occur across any combination of four stages. You might cycle through every stage, or only have one.

Stage 1 – Prodrome

Migraines often begin with a prodrome, which can last from a few hours to a couple days. This is the stage before the headache begins, when the early warning signs might become apparent. These include stiffness in the neck, frequent yawning, increased urination, food cravings, and mood swings. 

Stage 2 – Aura 

For some people, the prodrome is followed by the aura phase. This lasts anywhere between a few minutes and an hour, before the headache kicks in. 

Stage 3 – Headache 

Not everyone has a prodrome or aura before the main event: the migraine itself. These throbbing headaches often begin on one side of the head and can go on for anywhere from a few hours, up to three days. Migraines exceeding 72 hours are rare, and this condition is known as status migrainosus. During the headache phase, you might feel severe pain around the eyes, head, and neck. Expect increased sensitivity to light, sound, and smells. Nausea and vomiting, chills, dizziness, slurred speech, and loss of appetite are common. 

Stage 4 – Postdrome

Finally, there’s the migraine hangover, or postdrome, which affects 80% of migraine sufferers. Feelings of depression, cloudiness, and fatigue may persist for a couple of days. Some lucky ducks even ride a euphoric wave through their postdrome.

Now that you know what a migraine looks like, how can you stop one from taking over your life? One study on workplace productivity in the Journal of Headache and Pain points out that in the UK alone, migraines cost over 8.8 billion pounds a year in lost productivity, to say nothing of nearly 1 billion lost in healthcare costs. All while only a small percentage of migraine sufferers who seek treatment actually end up getting any.

That adds up to an awful lot of sick days without any reliable medical respite. Since migraine triggers and symptoms are so individual, most people are left to figure out prevention and remedies on their own. Common triggers include stress, caffeine, no caffeine, alcohol, lack of sleep, salty foods, umami foods, no food, hormone fluctuations, sex, and thunderstorms or other barometric changes. 

Whew – it’s a daunting list for migraine patients who are trying to be vigilant towards their personal triggers. By now, I’ve realised that when I’m jet lagged or hung over, a migraine is likely to creep up on me. My 63-year-old mother gets migraines from being out in the sun, while I can happily lie on a beach in the afternoon. 

Mitali Shah, for instance, can’t walk into the perfume aisle of a beauty store without risking her ability to get out of bed for the rest of the day. Others can time their period to their monthly migraine, or blame it on the summer humidity index whenever their head starts to throb. Dr Sonam Shah, a dentist at Jehangir Oracare Dental Centre in Pune, explains how sinusitis due to molar infections can trigger migraines. “Sinusitis and migraine have very similar symptoms, so it’s easy to confuse the two to a patient with a history of migraine,” she says. Dr Rohra agrees, as excess intake of cold food can cause migraine-like symptoms that are actually sinusitis. 

A healthy lifestyle can go a long way to extending the time between your migraines, and lessening the severity of the symptoms. Practising regular yet gentle exercise, such as yoga or tai chi (read about the mind-body benefits of this unique martial art form) can increase endorphins and get your heart pumping, both of which keep migraines at bay. Some studies show that a diet rich in magnesium – found in leafy greens, nuts, and wholegrains – can stave off migraines. Riboflavin is another potentially migraine-fighting vitamin to work into your daily routine by eating more eggs, mushrooms, dairy products, and lean meats. Getting your eight hours of sleep and drinking plenty of water can prevent migraines, too. 

Keeping track of your triggers is vital, and if you’re getting frequent migraines, logging your food, water intake, sleep, and exercise can help you identify trigger patterns. For medical professionals too, a log makes it easier to identify what kind of migraines you experience, or whether migraines are your problem in the first place. 

Of course, even knowing your triggers like the back of your hand isn’t a foolproof strategy. For one thing, they might easily change, or simply be unavoidable. There will be times when you can’t get a good night’s sleep or make it to your zumba class. So what can you do once the migraine is rampaging on despite your best efforts? It depends on the migraine, but for the usual headache symptoms, you can try these remedies. 

Caffeine

Although caffeine can trigger migraines in some people, a cup of java can give a much-needed boost to your strained nervous system, particularly if your migraine is caused by vasodilation, AKA dilated blood vessels. Call it the hair of the dog philosophy. Drink in moderation, however, as too much caffeine can make matters worse. 

Painkillers

Over-the-counter painkillers can help soothe a headache, especially if taken in the early stages of a migraine. Ibuprofen, aspirin, and paracetamol are all safe and possibly effective options. Unfortunately, because migraine pain is often more severe than an ordinary headache, these medications don’t always work. 

Cold compress

A washcloth dipped in ice water or frozen gel pack applied to the head, neck, and eyes works to constrict vasodilation. Even if that’s not the cause of your headache, there’s no denying that a cold compress just feels good. I sprinkle mine with cologne water for a refreshing scent that calms my nausea – though I wouldn’t recommend that approach if you are sensitive to smells. 

Botox

While this is not a cure for this chronic condition, botox can make life easier for people who suffer frequent debilitating migraines. “Patients can go six months without an attack after botox,” says Dr Rohra. Botox is recommended for those who have migraine symptoms for as much as two weeks per month. It acts on the neurotransmitters to keep pain signals from reaching your nerves, allowing you more pain-free days.

Going to bed

Sometimes the best strategy is to crawl into bed, turn out all the lights, and pray that every member of your household does the same so you won’t be further pained by the whir of the mixer-grinder and Taarak Mehta at full volume. If you’re prone to migraines, blackout curtains are a good investment, as well as comfortable earplugs. And maybe a Do Not Disturb sign. 

As intergenerational traumas go, I suppose there are worse things to inherit than migraines. It’s not easy to be down and out for days at a time, especially when no one seems to believe that a migraine can do so much damage. But whenever I do succumb to the mother of all headaches, I know it’s a sign that I’ve had too many stressful days and sleepless nights. If I have to look on the bright side – or perhaps the dimly lit side, so as not to make it worse – migraines force me to slow down and prioritise my health.

If you’re a victim of migraines, drop these fact bombs on the next person who brushes it off as ‘just a headache’. It’ll save you the trouble of explaining, and it just might get you out of having harsh LED lights in your home.