A migraine headache is the most common primary headache syndrome. The term migraine is derived from the ancient Greek word hemikranios which means "half head". Attacks are often recurrent and tend to become less severe as the migraine sufferer ages.
Migraine headaches are more common in females usually before the age of 40 years.
Majority of Migraine cases are without aura, only one third of cases being with aura. Less common types include, Ocular migraine, Menstrual migraine etc.
The cause of migraine is unknown. There is often a family history, in 90 % of cases.
Triggers : Commonly identified migraine triggers include the following:
Alcohol , Foods that contain caffeine (e.g., coffee, chocolate), monosodium glutamate (MSG; found in Chinese food), and nitrates (e.g., processed foods)
Environmental factors (e.g., weather, altitude,) ; Glare, contrasting patterns
Hunger, Lack of sleep , Exertion & Stress ; Hormonal changes in women
Medications (over-the-counter and prescription) ; Perfume
MIGRAINE PHASES :
1. Prodrome: Consist of alterations in mood or energy level, excessive yawning, or food cravings.
2. Aura: It is experienced 10 to 30 minutes before the headache. Most auras are visual (scintillating scotomas, zigzag lines or castles- fortification spectra) in nature.
3. Headache: Migraine headache is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head.
There may be accompanying symptoms such as nausea, vomiting, sensitivity to light, sound or strong smells.
4. Postdrome: Left feeling tired and weak once the headache has passed.
Diagnosis : Diagnosis is mainly based on symptoms with a near normal neurologic examination.
CT/ MRI, CSF Examination, EEG may be performed to rule out other neurological conditions, including meningitis, intracranial bleeds, vascular malformations etc.
TREATMENT : The goals of treatment are to prevent or reduce the number of migraine attacks (prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine attack (abortive treatment).
A. Abortive Treatment : Mild, infrequent migraines may be relieved using over-the-counter medication. During a migraine headache, people often prefer to rest or sleep alone in a dark, quiet room.
1. Analgesics, e.g., aspirin, ibuprofen should be taken at the first sign of a migraine.
2. Ergots ,e.g., Ergotamine maleate (MIGRANIL) along with anti emetics. Not effective if the headache has moved into the throbbing stage.
3. Triptans: Sumitriptan, Ritzatriptan are fast-acting, usually well- tolerated medications commonly used to treat migraines. They are available in oral, injectable (subcutaneous Suminat) and nasal spray forms and can be taken any time during the headache.
4. Steroids: Used in those with severe, refractory or frequent headaches.
B. Prophylactic Treatment : indicated for Frequent headaches (more than 1/ WEEK) or uncommon migraine conditions .
Start with monotherapy), but a combination of medicines may be necessary.
1. Beta blockers (e.g., Propranolol , atenolol) are the preferred medications. To be avoided in asthmatics.
2. Calcium-Channel Blockers prevent spasm of arteries by inhibiting contraction of smooth muscle. Flunarizine ( [FLUNARIN, SIBELIUM] is the most commonly used.
3. Tricyclic antidepressants (TCAs; e.g., Amytriptyline [TRYPTOMER], nortriptyline are also useful for migraine prophylaxis especially in those with associated tension type headaches.
4. Anti Epileptic drugs (AEDs): Valproic acid , Topiramate, Gabapentin.
There are other prophylactic agents to be used selectively like Cyproheptadine in children.
Prevention : There is no cure for migraine but avoiding triggers, managing stress, and taking prophylactic medications can help prevent migraine headaches. Keeping a migraine journal can help identify triggers and gauge the effectiveness of preventive measures.
Stress management techniques (e.g., biofeedback, hypnosis) and stress-reducing activities (e.g., meditation, yoga, and exercise) may help prevent migraines.
Migraine headaches are more common in females usually before the age of 40 years.
Majority of Migraine cases are without aura, only one third of cases being with aura. Less common types include, Ocular migraine, Menstrual migraine etc.
The cause of migraine is unknown. There is often a family history, in 90 % of cases.
Triggers : Commonly identified migraine triggers include the following:
Alcohol , Foods that contain caffeine (e.g., coffee, chocolate), monosodium glutamate (MSG; found in Chinese food), and nitrates (e.g., processed foods)
Environmental factors (e.g., weather, altitude,) ; Glare, contrasting patterns
Hunger, Lack of sleep , Exertion & Stress ; Hormonal changes in women
Medications (over-the-counter and prescription) ; Perfume
MIGRAINE PHASES :
1. Prodrome: Consist of alterations in mood or energy level, excessive yawning, or food cravings.
2. Aura: It is experienced 10 to 30 minutes before the headache. Most auras are visual (scintillating scotomas, zigzag lines or castles- fortification spectra) in nature.
3. Headache: Migraine headache is often described as throbbing or pulsating pain that is intensified by routine physical activity, coughing, straining, or lowering the head.
There may be accompanying symptoms such as nausea, vomiting, sensitivity to light, sound or strong smells.
4. Postdrome: Left feeling tired and weak once the headache has passed.
Diagnosis : Diagnosis is mainly based on symptoms with a near normal neurologic examination.
CT/ MRI, CSF Examination, EEG may be performed to rule out other neurological conditions, including meningitis, intracranial bleeds, vascular malformations etc.
TREATMENT : The goals of treatment are to prevent or reduce the number of migraine attacks (prophylactic treatment) and to alleviate symptoms and shorten the duration of the migraine attack (abortive treatment).
A. Abortive Treatment : Mild, infrequent migraines may be relieved using over-the-counter medication. During a migraine headache, people often prefer to rest or sleep alone in a dark, quiet room.
1. Analgesics, e.g., aspirin, ibuprofen should be taken at the first sign of a migraine.
2. Ergots ,e.g., Ergotamine maleate (MIGRANIL) along with anti emetics. Not effective if the headache has moved into the throbbing stage.
3. Triptans: Sumitriptan, Ritzatriptan are fast-acting, usually well- tolerated medications commonly used to treat migraines. They are available in oral, injectable (subcutaneous Suminat) and nasal spray forms and can be taken any time during the headache.
4. Steroids: Used in those with severe, refractory or frequent headaches.
B. Prophylactic Treatment : indicated for Frequent headaches (more than 1/ WEEK) or uncommon migraine conditions .
Start with monotherapy), but a combination of medicines may be necessary.
1. Beta blockers (e.g., Propranolol , atenolol) are the preferred medications. To be avoided in asthmatics.
2. Calcium-Channel Blockers prevent spasm of arteries by inhibiting contraction of smooth muscle. Flunarizine ( [FLUNARIN, SIBELIUM] is the most commonly used.
3. Tricyclic antidepressants (TCAs; e.g., Amytriptyline [TRYPTOMER], nortriptyline are also useful for migraine prophylaxis especially in those with associated tension type headaches.
4. Anti Epileptic drugs (AEDs): Valproic acid , Topiramate, Gabapentin.
There are other prophylactic agents to be used selectively like Cyproheptadine in children.
Prevention : There is no cure for migraine but avoiding triggers, managing stress, and taking prophylactic medications can help prevent migraine headaches. Keeping a migraine journal can help identify triggers and gauge the effectiveness of preventive measures.
Stress management techniques (e.g., biofeedback, hypnosis) and stress-reducing activities (e.g., meditation, yoga, and exercise) may help prevent migraines.
Dr Rajesh Benny
Consultant Neurologist (DM)
Consultant Neurologist (DM)
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