HEALTH MATTERS - Is It A Migraine Or Something More Serious?

A severe headache may be a sign of subarachnoid haemorrhage, which is bleeding in the brain and a medical emergency. Here's how to tell if it's just a 'regular' headache or something more serious according to our specialist Pank Jit Sin.

We all get headaches at some point in our lives. Sometimes the pain is severe and it is termed as a migraine. Migraines are a type of headache which occur as a result of changes in the brain. The pain is often severe, only on one side of the head and is paired with sensitivity to light, sounds and smells.

Certain symptoms are also associated with migraine. These include eye pain (at the back of the eyeball), nausea, vomiting and of course, severe pain commonly described as pounding. As migraine sufferers know, the pain can be debilitating and can last for hours to days.

Now, migraines aren't life threatening or uncommon, but there's a more pernicious condition called subarachnoid haemorrhage (SAH) or basically bleeding in the brain caused by aneurysm (a localized swelling or ballooning of the wall of the artery) rupture. Most symptoms are identical and hard to discern even by doctors. This writer's friend recently went to the GP for severe migraine and vomiting and was given painkillers and medical leave for four days. He finally went to the emergency department on the fifth day and was subsequently diagnosed with a bleed in the brain.

HOW TO TELL THE DIFFERENCE

How then does one differentiate an aneurysm rupture from a normal migraine episode? We spoke with Professor Datin Dr. Chia Yook Chin, family medicine specialist and president of the Malaysian Society of Hypertension, about the difference between a migraine and a possible brain bleed. Dr. Chia had a few tips to share. According to her, the first thing a doctor should do is to take a detailed history of the patient and look at the sex. Migraines are rarer in men than women, of the 38 million people in the US suffering from migraine, 28 million are women.
In the young, migraine is more prevalent in boys than in girls. This pattern shifts at puberty, where the prevalence rises in girls. In fact, girls are more likely to experience their first episode of migraine in the same year their periods begin than at any other time in their lives. After puberty, migraine in women increases until age 40 or so, when it begins to decrease and can come to a complete stop upon menopause.

Secondly, migraines rarely develop suddenly. "If a patient is more than 30-35 years and comes to the clinic with severe migraine, then I have to be on the alert," said Prof. Dr. Chia. Migraines usually develop in the teenage years and appear periodically, sometimes in cyclic fashion in women due to their menstrual cycles.

Another warning sign is the description of symptoms. Most migraine sufferers know in advance when a full-blown episode is coming as there will be warning signs. They may have sudden mood changes, frequent yawning, neck stiffness and changes in vision (aura). In contrast, those experiencing a brain bleed episode often describe their onset of pain as a flash of lightning and subsequently being hit by a car or a hammer. The pain is so severe that movement is disabled.

Symptoms of an SAH, as mentioned earlier, are similar to that of migraine. However, Dr. Chia said the increase in pressure in the brain as a result of bleeding causes the neck of the sufferer to be very stiff. "They can't move their necks," she said. Brain bleeds can also increase pressure in the brain to such an extent that herniation of the brain can occur and could lead to paralysis and heart malfunction.

Those who are fortunate enough to survive an initial brain bleed episode will need to get to the hospital immediately. The doctors will try to ascertain the extent of damage and determine the best course of action. One of the procedures that can be performed is surgical clipping or endovascular coiling, where a catheter is brought close to the location of the abnormal blood vessel and a small thin platinum wire is inserted into the ballooned area. The wire coils up (hence coiling) as it enters the aneurysm and multiple coils are packed inside the dome so that no blood flows into it. With this procedure, a clot then forms in the aneurysm and prevents it from rupturing.

Remember to ask your doctor for a referral or go straight to the emergency department of your nearest hospital if you experience sudden, severe headache with no prior history.