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MigraineAlso migraine headache
- Adults between 30 to 40 years of age
- Both men and women but more common in women
- Blood vessels
- Tension-type headache
- Cluster headache
- Cerebral aneurysms
- Chronic paroxysmal hemicrania
- Dissection syndromes
- Subarachnoid/intracranial hemorrhage
- Temporal/giant cell arteritis
- CT Scan (Head) (To rule out other conditions)
- MRI (To rule out other conditions)
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Aspiri, Diclofenac & Ibuprofen
- Triptans: Sumatriptan, Zolmitriptan & Naratriptan
- Ergotns:Ergotamine & Caffeine+Ergotamine+Paracetamol+Prochlorperazine
- Antiemetics:Metoclopramide & Prochlorperazine
- CGRP antagonists: Erenumab & Fremanezumab
- Beta blockers: Propanolol & Metoprolol
- Antidepressants: Amitriptyline & Fluoxetine
- Antiepileptics: Topiramate & Sodium valproate
- Calcium channel blockers: Flunarizine & Verapamil
- General Physician
Symptoms Of Migraine
The main symptom of a migraine is identified as an intense headache, more commonly on 1 side of the head. In some cases, the pain can occur on both sides of your head and may affect your face or neck. The pain is usually a moderate or severe throbbing sensation that gets worse when you move and prevents you from carrying out normal activities. Nausea and vomiting can frequently or infrequently accompany migraine headaches.
Prodromal phase: Also known as the premonitory phase. In this stage, the symptoms tend to occur 24 to 48 hours before the onset of a headache. Some of the common symptoms seen in this stage include increased yawning, irritability, neck stiffness, craving for specific foods, and depression.
Is it a migraine or a headache?
Migraine is more than just a headache. Here’s how to differentiate between a headache and migraine. The most common features that differentiate a migraine from a headache are POUND, where:
- P means Pulsating pain
- O means One-day duration of severe pain if left untreated
- U means Unilateral (one-sided) pain
- N means Nausea and vomiting
- D means Disabling intensity
Causes Of Migraine
The precise cause of migraine is unknown, but it is believed to occur due to abnormal brain activity temporarily affecting nerve signals, chemicals, and blood vessels in the brain.
Types Of Migraine
There are several types of migraine. These include:
1. Migraine without aura (common migraine)
2. Migraine with aura (classical migraine)
3. Status migrainosus
4. Ophthalmoplegic migraine
5. Retinal migraine
Triggers For Migraine
Some of the most common triggers for a migraine headache are:
1. General triggers
- Changing weather (humidity and heat)
- Lack of sleep or oversleeping
- Hormonal changes in women (before or during periods)
- Mental and emotional stress
- Going out in the sun
2. Dietary triggers
- Missing a meal
- Alcohol, especially red wine
- Aged cheese
- An increase or decrease in caffeine
- Monosodium glutamate or MSG
3. Sensory triggers
- Bright or flickering lights
- Loud noises
- Strong smells like perfume or paints
- These triggers can be dealt by using simple tips such as having your meals at the same time every day, not stepping out in unfavorable weather conditions, avoiding certain foods, and sleeping well for at least 7-8 hours.
Risk Factors For Migraine
1. Female sex
2. Family history
3. Lifestyle factors
4. Health conditions
Diagnosis Of Migraine
Clinical history and examination
- On 1 side of the head.
- A pulsating pain.
- Severe enough to prevent you from carrying out daily activities.
- Made worse by physical activity or moving about.
- Accompanied by feeling and being sick.
- Accompanied by sensitivity to light and noise.
Prevention Of Migraine
- Have your meals at the same time every day.
- Track the triggers which start the migraine pain and try to avoid them.
- If weather conditions don’t favor, try to stay at home and fix your schedule accordingly.
- Sleep well for at least 7-8 hours with dim or no lights.
- Avoid using gadgets before going to sleep.
- Avoid bright lights and extreme temperatures.
- Avoid loud music and noisy places.
- Avoid chocolates, cheese, processed food, alcohol, and smoking.
- Avoid stress as much as possible.
Specialist To Visit
- You have migraine episodes more than 3 times a month, even if they can be controlled with medicine.
- You have a migraine which interferes with your daily activities.
- General Physician (Family Doctor)
Treatment Of Migraine
1. Nonsteroidal anti-inflammatory drugs (NSAIDs)
However, some patients may experience gastrointestinal side effects such as dyspepsia, abdominal burning or discomfort, and diarrhea. Some of the common examples of NSAIDs include:
Some of the commonly prescribed drugs in this category include:
As these medicines cause vasoconstriction, these are not advised in people with hypertension and heart disease. Examples include:
Common examples of antiemetics include:
5. CGRP antagonists
7. Prophylactic therapy
- Frequent or long-lasting migraine headaches
- Migraine attacks that cause significant disability or diminished quality of life despite appropriate acute treatment
- Contraindication, failure or serious adverse effect with therapies used for acute attacks
- Risk of medication-overuse headache
- Menstrual migraine
- Beta-blockers such as propanolol, metoprolol, and atenolol
- Antidepressants such as amitriptyline and fluoxetine
- Antiepileptics such as topiramate and sodium valproate
- Calcium channel blockers such as flunarizine and verapamil
- CGRP antagonists like erenumab and fremanezumab (in refractory cases)
Home-care For Migraine
1. Watch what you eat
Food groups: Meat, fish, poultry, & eggs
Use with caution: Sausage, bologna, meats with nitrates or nitrites added.
Avoid: Aged, dried, fermented, salted, smoked, or pickled products. Pepperoni, salami, and liverwurst. Non-fresh meat or liver and pickled herring.
Food groups: Dairy
Use with caution: Yogurt, buttermilk, sour cream
Avoid: Aged cheese: cheddar, Swiss, mozzarella
2. Build a healthy routine
- Get at least eight hours of sleep daily.
- Exercise regularly.
- Avoid skipping meals and eat small frequent meals throughout the day.
- Stay well hydrated. Drink 6-8 glasses of water daily.
- Avoid stress.
- Try muscle relaxation exercises like meditation or yoga.
- Take your medications as advised by your doctor.
- Identify your triggers and try to avoid them.
3. Other home-based solutions
- Take some time off: Do not let the fast-paced life take a toll on your life. Instead, make sure you take a break and relax right away when you feel being hit by a headache.
- Try heat therapy: Place a hot compress such as a towel soaked in warm water on your forehead and relax in a room with dim or no lights.
- Yoga: Yoga asanas that can help relieve the tension and ease headache include seated neck release, viparita karani, adho hastapadasana (standing forward bend), setu bandhasana (bridge pose), shishuasana (child pose), marjariasana (cat stretch), paschimottanasana (two-legged forward bend), adho mukha svanasana (downward facing dog pose), padmasana (lotus pose), shavasana (corpse pose), etc.
- Massage using essential oils: Gently massage the area where the eyebrows meet and the temples, with the knuckles to improve circulation and treat headaches. Use exotic essential oils like peppermint oil, basil oil, and lavender oil.
Alternative Therapies Of Migraine
1. Ayurvedic Remedies
Ayurveda can play a crucial role in managing headaches and improving other symptoms of migraine. You can find all these natural ingredients in your kitchen to help you with migraine. These include:
1. Ginger: A well-known remedy for headaches, it reduces inflammation of the blood vessels of the head, thereby relieving headache. Smash ½ an inch of ginger and brew a cup of tea with it and see the effects. It also aids digestion and reduces the feeling of nausea that occurs during migraines.
2. Lemon: Rich in antioxidants, lemon juice soothes irritated sinuses that helps reduce headaches. Prepare a cup of tea with the juice of a lemon and honey and have it warm. One may also grind the skin of lemons and apply it on the temple for alleviating headaches.
3. Pepper: It will reduce inflammation and decongest the nose that will ultimately help you breathe freely and get rid of the headache. Try a hot bowl of soup with a dash of ground pepper.
4. Cinnamon: Cinnamon reduces the effect of inflammatory markers in blood vessels, thereby reducing the frequency, severity, and duration of pain attacks. Make a thick paste of cinnamon and water and apply to the forehead to get relief from headache.
Check out some of the common herbs whose benefits have been backed by science for migraine relief. Click here to know more!
3. Neuromodulation techniques
Living With Migraine
Moreover, people with migraines do not come out in the open due to the stigma. But one thing you must bear in mind is making simple changes in your routine life to lead a better and happy life. Here are a few tips that people living with migraine can follow to improve their condition and fight migraine attacks.
1. Always be positive
2. Learn about your condition
3. Find the right doctor
4. Join a support group
5. Indulge in self-care
Migraine and comorbidities
Frequently Asked Questions
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- Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015;6(3):115-123.
- Moriarty M, Mallick-Searle T. Diagnosis and treatment for chronic migraine. Nurse Pract. 2016;41(6):18-32.
- Shankar Kikkeri N, Nagalli S. Migraine with Aura. [Updated 2021 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
- Burstein R, Noseda R, Borsook D. Migraine: multiple processes, complex pathophysiology. J Neurosci. 2015;35(17):6619-6629.
- The International Classification of Headache Disorders, 3rd edition. Headache Classification Committee of the International Headache Society (IHS). Cephalalgia. 2018, Vol. 38(1) 1–211.
- Living With Migraine. American Migraine Foundation.
- Kelman L. Migraine changes with age: IMPACT on migraine classification. Headache. 2006 Jul-Aug;46(7):1161-71.
- Esposito M, Pascotto A, Gallai B, et al. Can headache impair intellectual abilities in children? An observational study. Neuropsychiatr Dis Treat. 2012;8:509-513.
- Chowdhury D, Datta D. Managing Migraine in the Times of COVID-19 Pandemic. Ann Indian Acad Neurol. 2020;23(Suppl 1):S33-S39.
- GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018;17(11):954-976.
- Ahmed F, Parthasarathy R, Khalil M. Chronic daily headaches. Ann Indian Acad Neurol. 2012;15(Suppl 1):S40-S50.