Ahram Online: How could a person differentiate a migraine from a headache?

Dr. Messoud Ashina: There is a misperception that migraines and headaches are the same. In fact, a migraine is a disabling disease; it’s a common neurological disease that affects women more than men with a ratio of 3 to 1, while a headache is a symptom that happens due a wide range of diseases. Based on the studies, migraines affect one billion people around the world. In Egypt if you ask women if they had a recurrent bad headache over the past year 15 percent of them will confirm having these symptoms. If you ask them if they have ever experienced a migraine during their life 25 percent would confirm having a migraine at least once. If you take the Egyptian population (100 million citizens) you would find 10-15 percent experienced migraines in their lifetime and 5-6 percent suffer from that disease on a weekly basis. A migraine is an invisible disease, and we identify it based on a list of repetitive symptoms. Any kind of headache, which reoccurs once or twice weekly and is associated with a certain sensitivity for light or sound, nausea and sometimes vomiting, is by default a migraine.

AO: Is there an explanation why migraines are more common in women?

MA: We know from the studies that 20 percent of women with migraines may have these attacks during the menstrual cycle and if they undergo operations to remove the uterus and ovaries their migraine attacks get worse. On the other hand, these women get better when they get pregnant until delivery then the attacks return once more. That’s why it is important that these patients get the proper medication that will enhance their quality of life.

AO: Where exactly in the head does the migraine attack take place?

MA: In the old days, a migraine was always associated with a half of the side of the head. Now we know that it’s not scientifically correct, as it may happen in different parts of the head. Some patients may suffer the pain starting from the backside and gradually moving to the frontal side of the head. In short the localization of migraines is variable from one patient to another. In terms of intensity the attacks are normally severe and if the patient decides to walk or move the headache becomes worse and throbs.

AO: Are Migraines a hereditary disease?

MA: Fifty percent of the cases can be explained by the family history with the disease. We also know from epidemiological studies, that there are inherited gene variants that constitute the risk of developing migraines. We know of about 140 gene variants that run in the families of the vast majority of cases suffering from migraines. In addition, the environment and people’s lifestyle can also increase the risks of getting a migraine.  

AO: What is the age range of patients suffering from migraines?

MA: According the studies, for children below 10-years-old, the prevalence of the disease is between eight to 10 percent and there is no difference between boys and girls in that regard. During puberty until 40-years-old, women’s risks of getting migraines are higher than men’s. Among the cases, 50 percent got migraines before the age of 25 and suffered from the disease during the most productive years of their life. As people get old the attacks decrease. You barely see patients suffering from a migraine when they are more than 70-years-old.  Based on the global report on the disease burden, a migraine is the number one disabling disease for women between 18 to 50-years-old.

AO: Could we know in advance if a patient is susceptible to become a future migraine patient?

MA: Generally, if the disease runs in the family there is a high probability that the offspring may suffer as well, but you can’t do a genetic counselling for that because it is a common disease. What is interesting scientifically is to study why some patients are susceptible to the treatment more than others. We are trying to find some biomarkers that would give us a hint to define the cause of certain patients’ response to treatments compared to others.

AO: What would be your recommendations for migraine patients?

MA: These patients normally stay in bed when they get the attacks for one to three days to recover. There is no cure for this disease. Mainly, there are two lines of treatment; one is an abortive medicine for the attacks. It has been available globally for the past 30 years, it is specifically designed to treat migraines and it is more effective than painkillers. The second class of medication has been recently approved globally and it blocks chemicals that are released when you have a migraine and reduces the severity and frequency of the attacks. We have also found that there are cheaper medicines that are used for other diseases like blood pressure and epilepsy that can reduce migraine attacks.

AO: Are there certain habits or disease that may exacerbate migraines?

MA: Studies have shown that medication overuse increases migraines. Obesity also can increase and complicate migraines. Blood pressure in some cases can increase migraines. In addition, migraines may overlap many different health conditions. Furthermore, stress and tension increases migraines. There are as well several daily habits that exacerbate the attacks like skipping meals, smoking, not drinking enough water, drinking alcohol. Also, strong odors and perfumes may increase migraines. That’s why we recommend that patients play sports, avoid stress, and live a healthy lifestyle to manage their migraine attacks.