Migraine can be a big headache!
Dr R.Kumar

Rita, 30, rushed to a doctor’s clinic on a Sunday evening with the complaint of a severe headache, believing that she was suffering from migraine. The doctor tried to reassure her, “You are not suffering from migraine.”

“Doctor, I am fed up with the headache for the last three days; it starts on the top of my head and then migrates to both eyes. I have avoided food, but taken coffee cups repeatedly to feel well. Painkillers have not helped me either. I get into panic whenever I see bright light or hear loud sound; what will happen? It started when I shouted at my son, who failed to stand first in the examination!”

The typical migraine headache affects one half of the head. It may be preceded by the blurring of vision, nausea, vomiting, sensitivity to light and sound. As many as 40–60 per cent of the migraine sufferers may have symptoms like altered mood, irritability, depression or euphoria, fatigue, yawning, excessive sleepiness, stiff muscles in the neck, hot ears, constipation, increased urination, etc, before the attack of migraine. Immediately before the headache starts there may be symptoms of aura viz. image distortion, vision loss, flashing or scintillating lights, zigzag or “fortress-like” appearance, etc.

An attack of aura will last several minutes but not longer than an hour. There could be the following symptoms as well: a noticeable change in the five senses — seeing, hearing, smelling, tasting, touching — a sudden change in the mental status such as memory loss, difficulty in walking or standing, slurred speech. This entire migraine phenomenon may end in only a few minutes, but usually lasts as long as 20-30 minutes.

Causes and symptoms

The exact cause of migraine is unknown, although evidence suggests involvement of blood vessels of the brain. The symptoms usually begin in the early morning or during the day with intense, gripping pain on the one side of the head that may gradually spread. It reaches the peak of severity in minutes to an hour or two, and lasts hours or even days, unless it is treated. It is often terminated by sleep. Visual disturbances are common. Pain around the eye accompanied by nausea, vomiting and double vision are common.  Stress, premenstrual changes, alcohol consumption, smoking, hunger or the use of oral contraceptives can cause migraines in some people. Certain foods may produce attacks. These include red wine, chocolate, old and stale cheese, milk, chicken livers, meats preserved in nitrates, or foods prepared with monosodium glutamate. Some people report that exposure to sunlight or exercise can trigger attacks.

In most cases, migraine may be harmless, but not in all. Similarly, other causes of similar symptoms must be excluded by an eye specialist. 

Summers and migraine 

Some people believe that migraines are more common during summer. During this season there is a lot of pollution, and people who have allergies can develop migraines. During summer headache is caused by changes in the weather conditions such as humidity, bright light and heat. By keeping a diary for your headaches you have a better perspective to find out what might be triggering your headaches. Some allergy headaches can also be sinus headaches since the clogging of nasal cavities often have to do with some sort of allergy. Dehydration caused due to heat exposure can also be a trigger!

Treatment of ocular migraine

The management of a migraine consists of avoiding any precipitating factors, together with prophylactic medicines, if necessary. During acute attacks, many patients find it helpful to rest in a quiet, darkened room until symptoms subside. Cafergot, a combination of ergotamine and caffeine, is helpful. Sometimes, a painkiller and a tranquilizer are used. However, treatment with Ergotamine can bring more headaches and other side-effects such as nausea, vomiting, cramps and tingling sensations. It should be used only a few times a week and not at all during pregnancy or while breastfeeding. Sumatriptan injection can abort attacks. Medicines may be used only under medical supervision. 

Prevention 

1. If migraine headaches occur two or three times a month, use medications like aspirin, propranolol or amitriptyline as a preventive.

2. Go in for regular exercises

3. Take a balanced low-fat diet, wholegrains, fruits and vegetables

4. Maintain a good posture and avoid repetitive motion or standing for a long time

5. Avoid coffee, smoking, alcohol and heat exposure.

Dr Kumar, an eye-specialist, has many medical books to his credit. Email:  drrkumar16@gmail.com

Managing high cholesterol
Dr R. Vatsyatan

An essential element of the cell chemistry, cholesterol is a fat (lipid) which is vital for the proper functioning of the body. While building the outer cell membrane, it performs multiple physiological functions like helping to make bile and certain important hormones besides metabolizing some of the vitamins and insulating the nerve fibres. Produced by the liver, cholesterol is carried in the blood by molecules called lipoprotiens, a compound containing both fat and protein.

When we talk about cholesterol, we are drawn to its three main types — the LDL (low density lipoprotein), the HDL (high density lipoprotein) and the triglycerides. The first one is often referred to as bad form of cholesterol, the excess of which  can increase the risk of arterial diseases. The HDL, or its good form as it is called, does the opposite of the LDL and takes the cholesterol away from the cells and back to the liver where it is broken down and expelled from the body as waste. The triglycerides form the blood fat and originate either from fats in the food or are made in the body from other energy sources such as carbohydrates.

Thousands of years ago ayurveda described the ‘medo dhatu’ or the fat tissues among the seven types of  group of cells which constitute our body. It says that the fat tissue in itself is not bad and is actually essential for the body to function properly. A balanced digestive process is necessary for the healthy formation of the body tissues, including the fats. A bad functioning ‘agni’ or the wrong metabolism supported by dietary and lifestyle indiscipline can disturb the quality and quantity of the ‘medo dhatu’ or can mar the formation of healthy fat or good cholesterol.

The formation of high cholesterol or the excessive ‘medo dhatu’ can result due to a number of factors which include high intake of dietary fat, saturated oils, bakery products, eggs, red meat and many other such things. Lack of exercise and adopting sedentary lifestyle, smoking and regular use of alcohol accompanied by fatty snacking are known reasons of cholesterol aberrations. Many times genetic trends and individual idiosyncrasy also play an equally important role to gain bad lipids even from natural foods.

According to ayurvedic beliefs, if wrong lifestyle is the reason of high cholesterol a person can generally get his lipids back to normal by adopting certain precautions. After checking the cardiovascular status one should do  regular and reasonable amount of exercise. Eating wholegrain cereals, vegetables, fruits with pulp and roughage not only has numerous other health benefits but  act  as good fillers also. Unsaturated fats, red meat, fried snacks and regular outdoor eating, alcohol and smoking should be reduced to the minimum.

Of the numerous prescriptions, the simple Triphala powder is the foremost natural remedy to correct any metabolic disorder, including the cholesterol uprising. Another herb called guggul or Commiphora wightii  is the chief ingredient of many of the classic preparations and has a proven anti-lipid action. To correct the malformed ‘medo-dhatu’ or bad cholesterol and arrest its rebuilding, ayurveda advises the use of  many other reducing herbs like Kanchnar, Pippali, Turmeric, Nagarmotha, Kuth, Vacha, Kutaki and Chitrak.

The writer is a Ludhiana-based senior ayurvedic consultant. E mail – yourhealth@rediffmail.com.

Never ignore shoulder pain while sleeping
Dr Ravinder Chadha

Shoulder pain while sleeping/lying on the affected side not only disturbs one’s sleep but is also an important symptom of many diseases like frozen shoulder, rotator cuff injury and sub-acromial bursitis. People suffering from this symptom start taking medicines without undertaking proper treatment. Delay in initiating treatment leads to pain, restriction in the range of movement and pain with overhead activities.

Frozen shoulder is neither arthritis nor does it progress to become arthritis. It is a painful condition which may follow an injury to the shoulder but can also get initiated on its own, progressing gradually with no prior warning. Individuals suffering from diabetes or thyroid problems are more commonly affected.

In a frozen shoulder case inflammation leads to building up of sticky fluid which contracts the capsule surrounding the joint. The capsule also sticks to the underlying bone resulting in pain and a decrease in the range of motion. In the initial stages, pain aggravates with movement which worsens at night.

Rotator cuff injuries

Rotator cuff comprises a group of muscles and tendons that hold the bones of the shoulder joint together while we play golf, do swimming, play tennis and throw in ball sport (cricket). These muscles are under constant pressure to keep the humeral head in the glenoid cavity. Muscle weakness with enhanced stress can cause injury or tear off the rotator cuff muscles. Symptoms include pain when we are sleeping. If not treated well in time, chronic instability and muscle weakness occur.

Shoulder bursitis can occur due to a fall, lifting of heavy weight, etc. Bursa (a sac of fluid) under the acromiun gets inflamed and is painful while lying on the affected side. Such patients are advised a sling to provide rest to the shoulder. The shoulder joint is a ball and socket joint. If it is not moved intermittently, then there are chances of restriction in its movement. Therefore, it is advisable that the shoulder movement is started as soon as possible in a pain-free range.

Symptoms

 Pain experienced midway between the elbow and shoulder joints especially while sleeping on the affected side.

 Numbness/weakness in the arm.

 Decrease in the range of motion.

 Difficulty/discomfort while lifting one’s arm above the head and while reaching behind the back.

Treatment

 Medication can often help relieve minor aches and pains.

 Avoidance of painful motions.

 Electrotherapeutic modalities such as ultrasound and interferential stimulation may be used.

l Injection corticosteroid provides instant relief. A doctor has to counter a lot of queries from patients when advised steroid injections. Patients are apprehensive, as they tend to think that these injections are similar to oral corticosteroids which have drastic side-effects only when taken in high doses over prolonged periods of time. These are also confused with anabolic steroids, which are taken by sports persons to enhance performance. Steroid injections are used in varied sports injuries, orthopaedic problems like arthritis, tendinitis, a frozen shoulder, etc. They are primarily used for their anti-inflammatory properties.

 As most injuries are due to muscle weakness, strengthening of the shoulder muscles is of considerable importance.

Exercises:

Exercises when done correctly go a long way in early and effective recovery

 Shoulder roll — Standing with yours arms by the side, move your shoulders forward and then backward 10 times.

 Pendulum exercise — Stand leaning over with the affected arm hanging, swing your arm in small circles 20 times in the clockwise and anticlockwise direction.

 Rotator cuff stretch — Moving with a bent elbow at a 90 degree angle towards the other shoulder. Simultaneously with the other hand push the elbow towards the shoulder until a stretch is felt over the shoulder. Hold the stretch for a count of 20.

 Internal/external rotation using resistance band Attach a resistance band to the door-knob/wall, standing with the right side to the wall. Hold a resistance band with the right hand, bending the elbow at a 90 degree angle, your hand facing forward with the elbow close to the body. Rotate the hand toward the middle of the body and then return to starting position. Repeat it 10 times.

 Then stand with the left side to the wall, holding a resistance band with the right hand. Start with the right hand in the middle of the body, your elbow bent at 20 degrees. Stretch slowly by moving your arm outwards until the back of the hand facing backward. Repeat it 10 times.

The writer runs a pain management clinic in Chandigarh. E-mail chadha_r2003 @y ahoo.co.in