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Migraines 101: Symptoms, Causes and Treatments

Migraines 101: Symptoms, Causes and Treatments

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If you are one of the 1 billion people with migraines, you may know how uncomfortable a migraine attack can be. If you are not, how does it feel to be one of God’s favourites?! 

Keep reading to find out the answer to that 😉

Here's what a migraine feels like:

Most people describe it as a pulsating, pounding, dull ache that spreads across their forehead. You can feel the pain on one side of your head or both sides. Sometimes you can even feel it shift. 

What causes a migraine attack?

The direct causes of migraines have still not been identified. However, researchers believe that ‘abnormal’ brain activity affecting nerve signalling, blood vessels and chemicals are the root cause of migraines. Researchers have identified the following as significant triggers for migraines:

  • Severe heat
  • Dehydration
  • Bright lights
  • Unusual smells
  • Hormonal changes in women (oestrogen and progesterone fluctuations) during menstruation, pregnancy or menopause
  • Changes in sleep pattern

Hereditary history of migraines and being a female are some risk factors for developing migraine conditions.

causes of migraine attacks

How does a migraine attack arise?

Stages of migraine

Let’s learn about the process of how a migraine attack occurs and its respective symptoms.

  1. Prodrome Phase

This is the initial stage of a migraine. Usually occurring around 1-2 days before the migraine attack or any other headaches related to it, here are some prodrome symptoms:

  • Food cravings
  • Neck stiffness
  • Depression
  • Fatigue
  1. Attack Phase

It is during this phase that people have reported extremely uncomfortable sensations. The pain typically begins above your eyes and might spread over to one side of your head, your entire head or shift from side to side. Throbbing in the head may worsen if you exert yourself or move.

Other notable symptoms to look out for during the migraine attack phase include:

  • Increased sensitivity to light and sound
  • Nausea
  • Feeling faint

The symptoms of a migraine attack could last between several hours to two days, depending on the patient.

  1. Postdrome Phase

The migraine attack is followed by the postdrome phase. You may feel sick for up to a day. You may also experience:

  • Extreme tiredness
  • Pain in the head  that increases when you move too quickly or lean over
  • Confusion

You must gain sufficient rest after experiencing a migraine attack to recover effectively.

Now that we have broken down each stage of a migraine, did you also know there are different types of migraines, each with varied symptoms? Keep scrolling to find out more

Different types of migraines that exist

There are two common types of migraines: 

  • Migraine with aura
  • Migraine without aura

Along with the previously mentioned symptoms of a migraine, a person might experience either a migraine with an aura or a migraine without an aura.

Aura? What’s that?

It may sound like a pretty word but, it’s not a comfortable sensation. Aura is a condition that involves minor impairments to your vision, senses and speech for a period of time. Common signs involve blurry vision, coloured spots, neck stiffness, inability to hold your balance, difficulty speaking or forming words.

1. Migraine with aura (Brainstem Aura)

A person who experiences a migraine with brainstem aura would experience pain at the back of the head on both sides. They would face the following symptoms before the main migraine attack happens.

                                        Aura symptoms

  • An aura with visual problems
  • Numbness of body, face and tongue
  • Speech problems
  • Problems with moving

                                     Brainstem symptoms

  • Difficulty talking (unclear speech)
  • Vertigo (a spinning feeling)
  • Ringing in the ears
  • Eye problems in one eye (blind spots, flashes of light, temporary blindness, etc.)

2. Migraine without aura

Although, others may not experience an aura before their migraine attack or headaches. The following are some symptoms of a migraine without aura.

  • Migraine occurs only on one side of the head 
  • Throbbing/pulsating pain in the head
  • Pain gets more intense as you move (Eg: Walking)
  • Becoming sensitive to light
  • Becoming sensitive to sound
  • Nausea with or without vomiting

Treatment and tips for managing migraines

But wait! There’s some good news. Although migraine is not something that can be cured, you can still manage and control migraines from occurring through the following methods. As a result, it may lead to fewer attacks.

  • Adjustments to your lifestyle

You must ensure that you minimise or avoid any migraine triggers mentioned above. Along with this, managing your stress would also help you reduce the intensity of migraines.

  • Keep a journal

Maintaining a journal to list the instances you face migraine symptoms and attacks will help identify your triggers. This will allow you to avoid events and circumstances that trigger these symptoms.

  • Apply a cold compress on your forehead

This method slows down the nerve signals involved with migraine pain and generates a soothing, cool feeling that can help reduce the severe headache.

  • OTC pain or migraine medications

These medications include Nonsteroidal anti-inflammatory drugs (NSAIDs), Paracetamol, etc. These would reduce the intensity of migraine headaches and attacks. It is advisable to consult a doctor and receive a prescription before taking these medications.

  • Stay hydrated

Often when we are out in an environment with severe heat, we may forget to keep ourselves hydrated. Dehydration is a main trigger of migraine attacks. Therefore, ensuring an adequate intake of fluids will rule out the possibility of dizziness and headaches associated with dehydration.

Did any of the above symptoms and triggers sound familiar to you?  Feel like you’ve experienced them? If you have, it is possible that the ‘really bad headache’  you experienced was actually a migraine attack. Consulting a doctor about these symptoms may help diagnosis and treatment of your ailment. .

Consult a GP via the oDoc app to receive expert medical advice on reducing the highly uncomfortable symptoms of migraines and improving your well-being.

Sources

  1. Everything You Want To Know About Migraine, Healthline (2021)
  2. Migraine with brainstem aura, Genetic and Rare Diseases Information Center (2022)
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What Goes Wrong in Sleep? An Overview of Sleep Disorders

What Goes Wrong in Sleep? An Overview of Sleep Disorders

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Written by Dr. Ruwanthi Jayasekara

Consultant Respiratory Physician (MBBS, MD Medicine, MRCP UK, ESRS/ Expert Somnologist)

Good sleep is essential for a good life, and we spend about one-third of our lives sleeping. Therefore, it is essential to be aware of disorders that can occur during sleep, how to identify them, and treatments are available for them.

What types of sleep disorders are there?

There are many types of sleep disorders but here are some of the most common ones: 

  • Insomnia (difficulty in falling asleep and/or staying asleep)
  • Sleep related breathing disorders (eg. Sleep apnoea)
  • Central disorders of hypersomnolence (conditions with excessive sleep)
  • Parasomnias (involves unusual and undesirable physical events or experiences that disrupt your sleep)
  • Sleep-related movement disorders 

Let’s take a deeper look into each of the above-mentioned sleep disorders including how each affects the patient and what they can do to prevent them.

types of sleep disorders

Insomnia

People with insomnia find it very difficult to fall asleep and/or sleep well at night despite having a suitable environment and time to sleep. This will result in an impairment in their daytime functioning. In some people, this can be short-term, such as in anticipation of a stressful event like facing an exam or starting a new job. In others, this goes on for many months and years, causing distress to the patient.

Patients with insomnia will be evaluated using 

  • Sleep diaries – These let you measure and record when the patient went to bed, when they woke up during the night and woke up in the morning
  • Actigraphy – It is a wearable sleep test that tracks the patient’s movements while they are sleeping to analyse when they’re asleep and awake
  • Polysomnography (sleep study) – It is a comprehensive test that records brain waves, oxygen level in blood, heart rate, breathing, leg movements, etc during the sleep study.

This condition’s management includes sleep hygiene measures, medication revision and cognitive behavioural therapy.

Sleep-related Breathing Disorders

These conditions are involved with abnormal and difficult respiration during sleep. While some of these sleep-related breathing disorders have low health impacts, others may have serious consequences due to their effects on the patient’s sleep and balance of oxygen and carbon dioxide in their blood.

There are a few types of sleep-related breathing disorders. They are 

  • Obstructive sleep apnoea 
  • Central sleep apnoea
  • Sleep-related hypoventilation disorders
  • Sleep-related hypoxemia

Some risk factors of obstructive sleep apnoea are 

  • Male sex
  • Ageing
  • Obesity
  • Smoking
  • Alcohol use 
  • Certain craniofacial features such as receding jaw or small chin
  • Patients or their bed partners complain of loud snoring
  • Fragmented sleep
  • Getting up frequently to go to the toilet
  • Feeling excessively sleepy in the daytime
  • Feeling irritable and moody in the daytime

Apnoeic Spells and its Treatments

Sometimes a spouse may notice that the patient stops breathing at night for prolonged periods. This phenomenon is known as an apnoeic spell. Patients are evaluated with sleep studies called ‘polysomnography’, tests that evaluate sleep in detail and diagnose the underlying sleep disorder. The first line treatment is CPAP therapy (a device that provides continuous positive airway pressure). Additionally, weight loss with exercise and a healthy diet are also substantial.

Central Disorders of Hypersomnolence

These are a rare group of sleep disorders where patients complain that they are always sleepy during the day and the night. Patients tend to fall asleep in the daytime even after adequate sleep. E.g. Narcolepsy. Some patients with excessive sleepiness may have an underlying undetected medical or psychiatric condition. 

Excessive sleep has a significant detrimental impact on the patient’s life. These patients must be evaluated with sleep studies and blood investigations before starting their treatment.

Circadian Rhythm Sleep-Wake Disorders

Circadian rhythm sleep-wake disorders are a group of disorders where the patient’s body’s clock, which helps to maintain a regular day and night pattern, is affected. 

There are several types of circadian rhythm sleep-wake disorders.

  • Delayed sleep-wake phase disorder

This is where the patient does not fall asleep until the morning and tends to wake up in the afternoon – the patient’s circadian clock is delayed compared to the average population. These patients may struggle to wake up on time for school and work. 

  • Advance sleep-wake phase disorder

On the other hand, this disorder tends to have an early sleep pattern and early rise pattern. There are various types of disorders. Shift workers also suffer from the detrimental effects of not sleeping on time and staying awake when they should be sleeping. 

  • Jet lag disorder 

This is another condition in which people suffer due to crossing time zones. Understanding these conditions is vital as many treatment modalities help reduce these problems.

Parasomnias

Parasomnias are another set of sleep disorders involving a lot of sleep movement. In certain sleep stages, some people have confusional arousals, sleepwalking, sleep terrors, sleep-related eating, violent movements in sleep, acting out dreams, nightmares etc. Patients are evaluated with a sleep diary and polysomnography. These conditions must be identified and treated as many patients suffer from poor sleep and daytime dysfunction due to these issues.

Sleep-related Movement Disorders

Sleep-related movement disorders include restless leg syndrome and periodic limb movement disorder, where the patient has a lot of leg movement at night, leading to disturbed sleep.

How do you prevent sleep disorders from occurring in the first instance?

The baseline management of any sleep disorder is the maintenance of good sleep hygiene practices.

  • Maintain a regular sleeping and waking up time
  • Have regular meals
  • Avoid caffeinated drinks close to bedtime
  • Avoid smoking and alcohol
  • Keep your devices away at least one hour before bedtime

Despite these measures, if a patient feels that they have an issue with their sleep, it is best not to delay diagnosis, as sleep is essential for a healthy life. They can consult experienced sleep specialists via the oDoc app to have a comfortable and convenient consultation in just three taps within the comfort of their own home.

Dr Ruwanthi Jayasekara

SLMC 25147

Chest Physician

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Sources

  1. How Is Actigraphy Used to Evaluate Sleep, Sleep Foundation (2022)
  2. Sleep-Related Breathing Disorders, Sleep Foundation (2022)
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Pedal Power: Health Benefits of Cycling

Pedal Power: Health Benefits of Cycling

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Fuel shortage in Sri Lanka leads to more cycling

In a state where public transport has also been limited, and bus ticket prices have risen exponentially, the lack of transport options has made daily commuting and travelling during emergency situations increasingly difficult. As a result, walking and cycling have become almost the only choice for many Sri Lankans.

Cycling is a low-impact aerobic exercise that offers a wealth of benefits. It is a great exercise that keeps you moving and helps establish a physically and mentally healthy lifestyle.

1. Cycling can help you lose weight

Cycling is a great aerobic workout that burns calories and helps people lose weight and belly fat. To lose weight, you must burn more calories than you take in. Depending on your intensity and weight, cycling can burn between 400 and 1000 calories each hour.

Body parts that are exercised, targeted, toned, and used while cycling

  • Foot: Ankle dorsiflexion and plantar flexors
  • Arms: Triceps and biceps 
  • Shoulders: Deltoids
  • Calf: Gastrocnemius and soleus
  • Buttocks or Gluts: Gluteus minimus, gluteus maximus, and gluteus medius
  • Thigh: Quadriceps and hamstrings

2. Cycling boosts mental health and brain power

Cycling can ease feelings of stress, depression, or anxiety as it may help take your focus away from the mental chatter of your day.  When cycling, concentrating on the road or your cadence might help you improve your attention span and awareness of the present moment. Here are a few ways cycling could boost your positive mental health.

  • It improves your mood. Cycling increases blood flow throughout your body, allowing endorphins and other feel-good chemicals like dopamine, norepinephrine, and serotonin to spread quickly.
  • It promotes positive mental health. Exercise is known to have significant effects on self-esteem, sadness, anxiety, and stress. Still, cycling has been identified as one of the most beneficial exercises for the head and heart.
  • It helps you sleep better. Regular riding helps synchronise your circadian rhythm and can help to reduce levels of stress hormones that can make proper regenerative, deep sleep difficult.
  • Improves your memory. Riding a bike helps build new brain cells responsible for memory. 
  • Improves creative thinking. The regular, uniform movement of cycling relaxes the brain, stabilising both physical and mental functions.
  • Cycling promotes new thought patterns that promote feelings of calm and well-being. You can use it as a type of meditation and a great way to “zone out.”
benefits of cycling

3. Cycling improves balance, posture, and coordination

As you stabilise your body and keep your bike upright, you’ll improve your overall balance, coordination, and gait.

Maintaining balance is important because it tends to deteriorate with age and inactivity. Therefore, enhancing your balance can help lower your risk of injury and keep you off the sidelines by preventing falls and fractures.

correct posture of cycling

4. Cycling can reduce the risk of heart diseases

Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases such as strokes, high blood pressure and heart attacks.

Cycling also helps your cardiac muscles become more robust and lowers your resting pulse and blood fat levels.Additionally, research shows that people who cycle to work have a lung function that is two to three times better than those who commute by car.

Drawbacks of cycling and safety

Cycling has a few disadvantages to consider, and these primarily relate to cycling outside, which involves factors beyond your control.

There could always be a risk of an accident, whether in an urban or rural area. Hence, 

  • Obey the law at all times. Even if you have the right of way, exercise caution when passing through crossroads and crowded locations. Invest in a good helmet and any other necessary safety equipment.
  • Avoid wearing any loose clothing that could get caught in your bike chains.
  • Unfavourable weather might also be a barrier. So, invest in rain and cold weather gear and have a backup transportation plan for when conditions are unsafe for riding.
  • For extended daytime rides, use sunscreen on all exposed skin.
  • Take a break if you experience pain, fatigue, or muscle soreness.
  • If you have any cycling-related injuries, staying off the bike is best until you fully recover.
tips for cycling safely

The bottom line

Given the current situation in Sri Lanka, cycling to your destination may seem like the only option. However, just play it safe and use caution when necessary, especially on busy roads or during unfavourable weather.

If you have any injuries or need clarification regarding conditions that cycling may affect, speak to a general practitioner or a physician via the oDoc app.

Sources

  1. 15 benefits of cycling: why cycling is great for fitness, legs and mind, Cycling Weekly (2022).
  2. 12 Benefits of Cycling, Plus Safety Tips, Healthline (2021).
  3. Cycling – health benefits, Better Health (2021).
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