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Migraine

Migraine Headache Treatment in Delhi, India

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Overview

Migraine is a type of headache that presents with a moderate to severe throbbing, pulsating pain on one side of the head. It usually has triggering factors such as missing or delaying a meal, caffeine, monosodium glutamate, cheese, inadequate sleep, and more. The headache episode may last for 4-72 hours. It may interfere with routine activities and worsen with sound, light, and strong smells.

Types of Migraines

Migraines are of many types. But most commonly, migraine is divided into two types:

  1. Migraine without aura/ Common Migraine: In this condition, the person does not experience an aura before an episode, accounting for about 75-80% of migraine cases.
  2. Migraine with aura

Other types include:

  1. Menstrual migraine: When migraine headaches develop predominantly preceding or during the menstrual cycle. It is the one that occurs as a premenstrual symptom or due to hormonal changes in the body.
  2. Chronic migraine: When a patient experiences migraine headaches for over 15 days a month for over three months, it can be categorised as chronic migraine.
  3. Abdominal migraine: Mainly seen in children characterised by episodes of moderate to severe abdominal pain, mainly periumbilical or diffuse, associated with headache, nausea and vomiting.
  4. Basilar migraine: Also known as migraine with brainstem aura includes slurring of speech, giddiness, tinnitus and diplopia along with migraine headaches.
  5. Vestibular migraine: It is associated with vertigo.

Migraine Headache Symptoms

Migraines progress through four stages:

Prodrome

These warning signs appear a day or two before a headache:

  • Craving for specific foods
  • Constipation
  • Fluid retention
  • Yawning excessively
  • Neck stiffness
  • Changes in mood

Aura

Some people experience an aura or visual disturbances in the form of flashes of light or coloured zig-zag lines before an episode of migraine. They progress gradually and may last for about an hour. Instances of aura include:

  • Loss of vision
  • Sometimes a feeling of weakness or numbness in the face or on one side of the body.
  • Pricking sensation in the extremities
  • Difficulty in speaking
  • Visual disturbances include flashes of light, bright spots, or seeing various shapes

Attack

A migraine attack may last from a few hours to three days. Intervals between episodes differ from person to person. Associated symptoms are:

  • Unilateral or bilateral headache
  • Throbbing or pulsating in character
  • High sensitivity to light, sound, rarely smell and touch
  • Nausea and /or vomiting
  • Increases with routine activities like walking, climbing stairs

Post-drome

Once the migraine attack resolves, the person may feel confused and drained.

Migraine Headache Causes

The cause behind the occurrence of migraine has not been fully understood. Migraine pain may be associated with specific chemical imbalances in the brain and changes in the interaction between the brainstem and the trigeminal nerve. The role of CGRP and migraine pathogenesis has been well established and has led to the development of specific anti-CGRP medications as treatment for migraine.

Some factors that may trigger migraine attacks are:

  • Drinking alcohol
  • Smoking
  • Food additives
  • Hormonal imbalances
  • Irregular eating patterns
  • Avoiding food for a longer duration
  • Stress
  • Inadequate sleep
  • Intense physical exertion
  • Certain medicines
  • Changes in weather or pressure

Migraine Headache Diagnosis

Doctors first evaluate symptoms, take a medical and family history, and then advise tests to confirm the diagnosis. Having a family history of migraines is likely the most common factor responsible for causing migraine attacks.

If the condition appears severe, unusual, and complex, tests may be carried out to rule out any underlying medical condition. These include:

  • MRI: This scan produces detailed brain images and associated blood vessels. They help diagnose tumours, strokes, and other neurological conditions.
  • CT scan: This scan is a series of x-rays taken to achieve cross-sectional images of the brain. It helps diagnose underlying tumours, strokes, and other conditions that may cause headaches.

Migraine Headache Treatment

Migraine is not curable, but significant relief can be obtained by lifestyle management, avoiding triggers and adequate treatment. The main aim of the treatment is to reduce or abort headaches and prevent future episodes. Medical management consists of abortive treatment consisting of NSAID, ergotamine or triptans. Those having frequent disabling headaches are prescribed preventive therapy to reduce the frequency and severity of headaches.

Migraine Headache Complications

Overuse of analgesics can cause medication-overuse migraines. The most common medicines that may induce headaches are aspirin, caffeine, and acetaminophen. Migraine is also associated with stroke and heart diseases, especially migraine with aura.

Migraine Headache Risk Factors

Factors contributing to migraine are:

  • Genetic predisposition
  • Migraine attacks tend to peak between 20-40 years of age group
  • Women are more likely to suffer migraine than men
  • Hormonal imbalances may trigger migraine attacks

Prognosis

Migraine headaches become less severe with time. Understanding what triggers the migraine attack can help reduce these headaches.

Reviewed & Updated On

Reviewed by Dr. Vivek Kumar, Senior Director, Neurosciences, Neurology on 22-Mar-2023.


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