Coming events cast their own shadows, Richards mum always told him. Ever since he has met Aku Shika at JSS he not been able to get her out of his mind. To him it is love at first sight and for 10 years he has been trying to win her affection. However, all his best efforts have come to nothing. They are good friends but nothing more. How can he win her love and what extra thing should he do? Valentine’s Day provided another opportunity to take things further. Richard bought Aku flowers, cards, lots of chocolate and a bottle of expensive red wine. He had them delivered to her workplace and she called promptly to thank him. Is he winning her heart or is she just being courteous? He sent her text to say how much he loved her. She sent one to say that she had just developed a headache. He asked her to eat some of the dark chocolate he sent and promised to take her for dinner. She ate the chocolate but that only made things worse. When he picked her up for dinner, she still had the headache. On arrival at the restaurant, he ordered a bottle of red wine hoping the alcohol will dull her senses sufficiently for her to forget the headache. She took a glass of the wine and then things started falling apart. The headache grew worse and Aku became extremely irritable. She started feeling dizzy and saw flashing lights across her eyes. She felt nauseous and wanted to leave the restaurant immediately. Poor Richard saw his well laid-out plans falling apart. He made one more effort but this was greeted with a swift upper-cut from Aku who at that time felt Richard had certainly put something in her drink. He protested his innocence to no avail and saw the love of his life leave the restaurant and take a taxi home alone. Richard felt sad and depressed and walked to the nearest pharmacy looking for help, advice and direction. How could Aku be so unreasonable and how can she change so suddenly? How can she blame him for putting something in her drink? It was in the midst of explaining all the events of the day to the pharmacist that he was told by the kind and gentle pharmacist that Aku was probably having a migraine attack! The worsening of the headache following intake of chocolate and red wine all make it more likely that Aku was having a migraine attack. Migraine? What is it and how come it has caused him to lose the love of his life? Are there any medicines he can take to her to treat the condition and how can future attacks be prevented? Migraine Migraine is a throbbing, intense, severe headache, usually in one half of the head. The word migraine comes from the Greek hemicrania meaning only half the head. Migraine attacks are sometimes associated with nausea and vomiting and may be preceded by warning symptoms which affect the eyesight (referred to as an aura. These include seeing zigzdag lines, feeling dizzy or having a strong intolerance to noise. Migraine affects people of all ages but it occurs more frequently in women than in men. Symptoms The symptoms of migraine include headache on one side of the head in adults though in children the pain is rather felt in the stomach. Prior to these symptoms, the sufferer (called migraineur) feels a lit bit not all right. He or she may see flashing lights or zigzag lines. They may have impaired concentration and feel unusually happy, sleepy, depressed, hungry or even irritated. These symptoms may explain why the mood of migraneurs can sometimes change all of a sudden. Migraneurs may find noise intolerable, yawn a lot, develop stiff muscles and crave for certain foods including chocolates. In extreme cases, the patient may feel numbness in one part of the body and may confuse the migraine attack with a stroke. Causes Migraine attacks can occur as a result of tiredness, exhaustion, stress and even changes in the weather. In women, hormonal changes, especially during menstruation has been associated with onset of migraine. Some ladies therefore take the necessary precautions to manage migraine headaches which occur during their periods. In addition, certain foods, for example cheese, dark chocolate, certain processed fish and meats, some types of beans and some drinks including red wine and coffee have been known to trigger migraine attacks. Awareness of these is important to reduce the frequency of attacks. Monosodium glutamate which is used as seasoning in several foods has also been implicated in migraine. Treatment Migraine can be treated with medicines though the first step in any treatment process is to modify one’s lifestyle. Sufferers should keep a diary to record any factors which trigger the attack. They should avoid foods which have caused them to have migraine though they may later try eating a little bit of these foods at a time to really determine whether the food in question really did cause the migraine. Most sufferers get a lot of relief when they lie down in a dark, quiet room during attacks. Patients may also get good relief when they apply ice or cold, wet towels to their head. Bathing the head with cold water is especially refreshing. In addition, relaxation and meditation have been shown to be beneficial in migraine. Medicines Several medicines are available for treating migraine and a visit to the pharmacy is strongly recommended. Pain killers like paracetamol, aspirin, ibuprofen or diclofenac are very good for the pain which accompanies migraine. Soluble versions of these pain killers (alone or in combination with codeine) are preferred since they work faster. People who suffer from asthma and those who have stomach problems should AVOID aspirin, ibuprofen and diclofenac unless their doctor has specifically prescribed it for them. Patients with severe nausea or those vomiting may opt for pain killers formulated as suppositories (for insertion into the rectum) they work very well and are not unreasonably priced. Sometimes, the pharmacist or doctor may add a medicine to prevent vomiting for example promethazine theoclate (Avomine), domperidone (Motilium) or metoclopramide (Maxolon). These medicines also help speed up the rate at which pain killers get into the body. Stronger migraine medicines (called TRIPTANS) are available but they can only be prescribed by a doctor following proper assessment. Frequent sufferers may need to take regular medication to prevent future attacks. The medicines include propranolol (also used to treat high blood pressure), pizotifen (Sanomigran) and amitriptyline (used to treat depression as well). Patients should note that a combination of medicines may sometimes be tried before the best one for each individual patient can be identified. Talking to your pharmacist or doctor is therefore strongly recommended. If migraine occurs very frequently, it is extremely important to see a doctor immediately since the signs and symptoms of serious conditions like meningitis may resemble those of migraine. Migraine is literally a pain. Fortunately, pharmacists and doctors are well trained to manage the condition. However, if any medicine prescribed for migraine or any other illness causes any unwanted reaction, do inform the Centre for Pharmacovigilance at the University of Ghana Medical School on 021-675885 (daytime) or 021-668219. Pharmacist Dr Alex Dodoo is a Senior Research Fellow at the University of Ghana Medical School. Email: alexooo@yahoo.com