What is Migraine?

A Migraine is described as a continuous throbbing headache which affects only one side of the head. It is usually accompanied by a disturbed vision, sensitivity to light & sound and nausea. It can cause extreme throbbing pain which can last from hours to days.

The pain is usually extremely disabling. Warning signs of a Migraine include tingling sensation on your face, leg or arm, blind spots and flashes of light. Taking certain medications can make the Migraines less painful. It usually begins in early adulthood, adolescence or childhood. 

What is the difference between a headache and a migraine?

The main cause of the headache is the contraction of the muscles between the head and neck. It is a dull pain felt across the head, is mild to moderate, and in extreme cases, may last for a few days. More commonly, it lasts for half an hour to a couple of hours.

On the contrary, migraine tends to range from moderate to very severe in intensity. It is a throbbing and severe pain which is felt at the side or in the front of the head. It lasts for a couple of days and is accompanied by a few other symptoms called the aura.

Headaches do not have any warning signs accompanying it. On the other hand, migraine has auras beforehand. These can be visual, auditory, psychological or physiological. These are due to the neurological changes in the brain. For example, ’Basilar’ migraines are characterised with symptoms of fainting, double vision and loss of balance and ‘Familial hemiplegic’ migraines are characterised by reversible paralysis.

Sudden stress, anxiety, depression, poor posture, tiredness, dehydration, hunger, smells, squinting, noise and sunlight could be the triggering agents for headaches. Menstruation, menopause, low blood sugar, hypoglycaemia, a diet high in sugar, anxiety, exercise, contraceptives, medicines, dehydration, alcohol, too much screen time and diet are some of the triggering agents of migraine.

During a headache, the patient may not have many other symptoms. During a migraine attack, a patient faces difficulty in carrying out his day-to-day activities, cannot sleep or rest and may continue to have the aura symptoms.

Headaches rarely start during sleep while migraines usually start during sleep. Also, headaches are often relieved by over the counter medications and with relaxation techniques. For migraines, it is best to avoid them.

What are the stages of migraine?

• Prodrome: Two or three days before you get a Migraine, you can get warned by subtle changes such as constipation, intense mood swings, food cravings, neck stiffness, frequent urination, increase in thirst and frequent yawning. 

• Aura: This usually occurs during or before a Migraine. They usually have signs such as zigzag vision, wavy or light vision and flashes of light. Sometimes, aura can also be characterized by speech disturbances. These symptoms can last for 20 to 60 minutes at a stretch. 

• Attack: In this stage the Migraine usually lasts from 4 to 72 hours if it isn’t treated. The frequency of the occurrence of the headache can vary from person to person. In this stage, you might experience pain on both or just one side of your head, pulsing pain, sensitivity to light, nausea, vomiting and fainting. 

• Post drome: This is known as the final stage of a Migraine. Many people feel washed out and drained. People can also experience confusion, moodiness, dizziness, weakness and sensitivity to light and sound. 

What can trigger a migraine?

A migraine attack can trigger from some particular food or drinks, exercise, stress, too much or too little sleep, bright light, hunger, odours and hormonal disturbances. It can be a difficult task to figure out what triggers migraine in an individual. The best way to deal with it is to make a list of items and keep checking them every once in few weeks to find what triggered an attack. 

Some of the things to avoid order to reduce the number of attacks are Alcohol, Aged cheeses, Chocolate, Artificial sweeteners, Citrus fruits, Cured meats, Dried fish, Dry fruits and Dehydration. 

What are the signs and symptoms of Migraine?

There are a few signs and symptoms in accordance with migraines.

• Pulsatile headaches or throbbing, with moderate pain that intensifies and becomes severe with either movement or physical activity. 

• Localized or unilateral pain in the ocular and frontotemporal area, the pain can be felt around the head or neck.

• Headache lasting for 4-72 hours

• Light-headedness, sensitivity to sound and light, progressive pain built up.

• Sensitivity to sound, light and odours

• Vomiting, feeling sick

• Disturbed vision

What causes migraines?

• Hormonal changes such as estrogen fluctuations trigger headaches in a lot of women. Many women have a tendency to develop acute Migraines during menopause or pregnancy. 

• Foods such as processed food, salty food and aged cheese can also cause Migraine. 

• Alcohol consumptions is a major cause of extreme Migraines in people. 

• Stress at home or work can also cause Migraines. 

How do you stop a migraine before it starts?

1. Keep a check on headache: With this, you can recognise a pattern such as whether you get an episode in the afternoon or over the weekend. 

2. Have consistent lifestyle habits: This means eating meals at the same time, taking proper sleep and regular exercise so as to help the body to set a pattern.

3. Eat natural whole foods: These food helps prevent migraines. Avoid sugars, processed foods, MSG and nitrites as these trigger migraines.

4. Manage Stress: This can prove to be more efficient in preventing an attack than taking a medicine to relieve the symptoms.

5. Consider complementary medicine: Acupuncture, herbal remedies and moxibustion could prove beneficial. Moxibustion is a therapy that involves burning herbs on targeted parts of your body. 

6. Migraine Devices: Neuromodulation devices can reduce attacks. Cefaly, a trigeminal nerve stimulator, sTMS (single-pulse transcranial magnetic stimulator) and the gamma Core which stimulates the vague nerve are a few to name.

7. Natural dietary supplements to prevent migraines: Riboflavin (vitamin B2), magnesium, coenzyme Q10 and melatonin are some of the dietary supplements.

How are migraine headaches treated?

Migraine is a complex medical condition with a range of symptoms. For most people, the main issue is a severe, painful headache. There are several ways to treat migraine headaches including self-care measures, using prescription medications and over-the-counter drugs. Most individuals can take care of mild-to-moderate attacks with the following strategies:

• Applying a cold compress on the areas of pain 

• Resting with pillows supporting the neck and head

• Sleeping in a dark and silent room

• Sipping caffeine

Migraine treatments are helpful to relieve headaches and prevent future attacks. There are several medicines to combat the condition. Medications used to treat migraine can be classified into two broad categories:

Preventive medications:

• Medications for high blood pressure - Beta-blockers, Calcium channel blockers

• Antidepressants - Nortriptyline , Amitriptyline 

• Antiseizure drugs - Valproic acid , Gabapentin , topiramate 

• Some anti-allergy and antihistamines drugs, including cyproheptadine and diphenhydramine 

Over-the-counter medications:

• Nonsteroidal anti-inflammatory drugs : Drugs such as Ibuprofen, Aspirin and Naproxen fall in this category. These kinds of drugs should be avoided by people with a history of stomach bleeding and ulcers.

• Acetaminophen : Taking acetaminophen is quite safe, even if the migraineur has a history of stomach bleeding and ulcers. This medication, however, should be avoided by individuals who have liver issues.

• Combination medications: Some pain relievers such as Excedrin Migraine, which contains acetaminophen and aspirin combined with caffeine, are used to combat migraine.

Who would need a migraine treatment?

If a person has more than 4 exhausting attacks per month and each attack lasts for more than 12 hours, he/she is a perfect candidate for the migraine preventive therapy. People in need of the preventive therapy can experience a prolonged aura or weakness and pain-relieving medications fail to work for them.

Who is not eligible for the treatment?

Cardiovascular drugs are widely used during migraine prevention therapy. So, if the patient is over 60, uses tobacco, or has certain heart conditions, he/she must consult the doctor for some alternate medication.

Which medicine is best for migraine?

If ordinary painkillers are not relieving migraine headaches, a medication termed Triptan may need to be taken in addition to other painkillers and anti-sickness medicines. These are specific drugs for migraine headaches by bringing about some changes in the brain. In migraine, blood vessels widen to cause a specific type of headache and Triptans are known to narrow these vessels. This drug is available as tablets, injections and nasal sprays.

Similarly, anti-emetics can successfully treat migraine even if one did not experience vomiting. They act best when taken immediately after experiencing migraine symptoms. Usually, they come in the form of a tablet but may also be available as a suppository. Side-effects can be drowsiness and diarrhoea.

Combination medicines are also available for managing migraine. However, a disadvantage of this medicine is that the dosages of either the painkiller or the antiemetic may not be high enough in the combination medicine to relieve the symptoms. In such cases, it’s better to take painkiller and anti-emetics separately rather than as a combination so as to be able to relieve the symptoms effectively.

What are the side effects of migraine treatment?

Preventive medication does not always stop the headaches completely and medications may lead to certain side-effects.

• Topiramate may cause diarrhoea, nausea, weight loss, memory difficulties and concentration problems.

• Triptans can cause sleepiness, tingling sensations, tightness in the throat and chest, flushing.

• Ergotamines can cause nausea,

• Beta-blockers can cause depression, fatigue, nausea, low blood pressure, dizziness

• Calcium channel blockers can lead to constipation, weight gain, low blood pressure, dizziness

• Tricyclic antidepressants can cause to dry mouth, weight gain, low libido, sedation

What are the post-treatment guidelines?

It is recommended to lead a relatively stress-free lifestyle as stress is one of the most common factors that can trigger an attack. Also, a regular sleep cycle consisting of an adequate amount of sleep is very crucial for people who have a history of migraines.

How long does it take to recover?

Migraine prevention does not always ensure complete freedom from the ailment; it is more targeted towards reducing the frequency and severity of the attacks. A person suffering from an attack can take from 4 hours to almost 72 hours, in the worst possible cases, to recover.

What is the cost of migraine treatment in India?

The cost of the treatment varies depending on the particular form of treatment the patient opts for. The traditional medications don't cost much; the newly introduced botox treatment costs around Rs.19,200-Rs.38,400.

Are the results of the treatment permanent?

Migraine is often a chronic condition in adults. Prevention therapy can reduce the frequency, severity and longevity of the attacks, but the headaches do not seize to happen completely.

What are home remedies for migraines?

1. Ice packs on forehead, neck or scalp can give relief from pain by reducing the supply of blood. 

2. Over the counter drugs like acetaminophen, ibuprofen or naproxen don’t require any prescription and are well-known painkillers.

3. Caffeine is another ingredient present in the coffee and in many other foods & drinks which not only relieves headache but also helps the body absorb the anti-migraine medications easily. 

4. A dark and quiet environment can help since bright light and loud noises can worsen the headache. 

5. Exercising can prevent episodes of migraine by releasing endorphins that fight pain, relieve stress and make a person sleep well. But this should not be attempted while the episode is on as sudden exercise can worsen the headaches.

6. Magnesium found in green vegetables, nuts and whole grains helps in preventing migraine attack.

7. A good night’s sleep of about 7 to 8 hours help prevent attacks as too much or too little sleep is a trigger factor.

8. Regular yoga sessions reduce the number of attacks and make them less intense when they do occur.

9. Vitamin B2 also called Riboflavin found in milk, cheese, fish and chicken prevent an attack.

10. Finding out what triggers a migraine attack and avoiding it is the best way to reduce the number of episodes. Some of the triggers reported are red wine, aged cheese, cured meats, bright lights, staying at a high altitude and strong odors.

What are the alternatives to the treatment?

If one suffers chronic migraine pains and is not comfortable with medications, he/she can opt for several unconventional ways to fight the headaches. 

Acupuncture is one such option. It has been seen that this treatment, in which a practitioner inserts many thin, disposable needles into several areas of the skin at defined points, has had positive results in the treatment. 

Biofeedback, massage therapy, cognitive behavioral therapy are some other non-traditional ways to treat them. Although studies have shown mixed results, there is some evidence of herbs like feverfew and butter bur somewhat reducing the severity of migraines.