What is a migraine?

Migraine is a common headache disorder, affecting 12% of the total population globally. Chronic migraine incidence is 1-2% globally. Historically it was also called hemicranial headache as it commonly causes unilateral headache. But it was found that bilateral headache is also equally common in Migraine. Migraine causes throbbing/pulsatile headache associated with some prodromal and aura features.

What type of headache is a migraine headache?

It is a common neurological disorder. It is the primary headache, where all blood tests and imaging tests are normal. Therefore, it is diagnosed mainly clinically, after excluding the secondary causes of headache.

What are the symptoms?

Migraine can attack children, teenagers, and young adults. It can cause the functional limitation of the individuals.

Symptoms are divided into prodromal, aura, attack, and post-attack phases.

Prodromal phase:

The prodromal phase usually occurs 1-2 days before the migraine attack. Patients can experience the following features during the prodromal phase.

• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Constipation
• Increased urination
• Fluid retention
• Frequent yawning

Aura:

Aura might occur just before the migraine attack or during the migraine attack. Aura is the sensory, motor, and speech symptoms that usually warn that a migraine attack is about to begin. About 15-20% of migraine patients have aura features. Aura is reversible symptoms; some people thought it as stroke or epilepsy, but it is actually the aura of a migraine attack. Common Features during aura are,

• Seeing bright flashing dots, sparkles, or lights.
• Blind spots in vision.
• Numb or tingling sensation in the skin.
• Speech changes.
• Feeling of ringing in your ears (tinnitus).
• Vision loss for a short period.
• Seeing wavy or jagged lines.
• Feeling of change in smell or taste.
• Funny Feeling.

Attack:

It usually occurs for 4-72 hours. It is throbbing and pulsatile in nature. The frequency of migraine attacks varies from person to person. It can occur rarely or several times in a month.

• The pain usually occurs in one side of the headache but can occur both sides also
• Pain is throbbing or pulsatile in character
• Nausea or vomiting
• Sensitivity to light, sound but sometimes with touch and smell.

Postdrome:

After a migraine attack period, patients might feel drained, confused, and washed out for up to a day. Some patients report feeling elated. Then, the sudden head movement might cause pain again briefly.

When do we call chronic Migraine Headache?

If a migraine headache occurs for 15 days or more in months, it is called a chronic headache. Migraine symptoms can change frequently and also the severity in chronic Migraine. Chronic migraine patients take medications for more than 10-15 days or more to abort headache episodes.

When to see the doctor?

• Make the migraine headache diary with episodes including prodromal, aura, attack, and postdrome features. Write trigging and relieving factors in each headache period, as it varies from person to person. Then, make an appointment with a neurologist or pain physician for your headache.

When to go to the doctor immediately or emergency?

Suppose the headache is associated with red flag signs. In that case, there might be some deadly things in your brain, so meet the doctor immediately. Red flag signs of headache are,

• An abrupt, severe headache just like a thunderclap
• Headache with fever, neck stiffness, confusion, convulsions, double vision, numbness, or weakness in a part of the body, which might be a sign of a stroke
• Headache after a head injury
• A chronic headache get worse after coughing, exertion, straining, or a sudden movement
• New headache pain after age 50

What are common triggers for migraine headaches?

1. Hormonal fluctuation occurs in women just before menstruation and pregnancy. Hormonal contraceptives pills can trigger headaches and can make it even worse.
2. Drinks: Alcohol, especially wine. And excessive caffeine, such as taking too much coffee.
3. Stress: Stress at the workplace or home can cause headaches.
4. Sensory stimuli. Bright and/or flashing lights can invite migraines, also with loud sounds. Strong smells — like perfume, paint thinner, secondhand smoke, and others — trigger migraines in some people.
5. Sleep changes. Less sleep or sleeping much can trigger migraines in many people.
6. Physical factors. Extreme physical exertion, including sexual activity, might provoke migraines.
7. Weather changes. A change of climate or barometric pressure can provoke Migraine.
8. Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
9. Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skip meals.
10. Food additives: For e.g sweetener aspartame and the preservative monosodium glutamate (MSG).

Risk factors

There are several factors, which might be associated with Migraine,

Family history. If any family members are affected by Migraine, the chances of developing Migraine in other family members are more.

Age. Migraine can occur at any age. Commonly it occurs in adolescents, and it peaks during the 30s. It gradually becomes less frequent and less severe in older age.

Sex. Females are commonly affected with migraine headaches with a female to male ratio of 3:1.

Hormonal changes. Migraine can occur just before menstruation or during the onset of menstruation in women. It can also occur during pregnancy or menopause. However, migraines commonly improve after menopause.

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• What are your specific symptoms?
•  Note hours of sleep you got the night before it happened and your stress level. What’s causing your stress?
• Note the weather.
• Log your food and water intake. Have you eaten something special that triggered your Migraine? Did you skip a meal?
• Describe the type of your pain and rate it based on a 0 to 10 scale, with 0 being absolutely no pain and 10 being the worst pain you’ve ever experienced.
• Mention your location of the pain. One side of your head or in the jaw or in your eye?
• List all of the medications you have taken during headaches, such as any daily prescriptions, supplements, and pain medication you took.
• How did you try to take care of your Migraine, and did it work nicely? What medicine have you taken, at what dosage, at what time?
• Consider other triggers. Maybe you played football /cricket in the bright sunlight? Perhaps you watched a movie with flashing lights? If you’re a woman, are you on your period?

How is Migraine diagnosed?

It is a clinical diagnosis. Unfortunately, no blood test and imaging help diagnose the migraine headache. But the doctor can prescribe some blood tests and imaging to rule out epilepsy and other causes of secondary headache depending upon the age of onset and red flag sign and associated symptoms.

How can it be treated at home?

The patient should know their trigger for headache by keeping a headache diary. It should be avoided. A common trigger for migraine headaches is mentioned above. We should avoid that type of trigger. Keep paracetamol in-home, which is beneficial in aborting headaches in many patients. Take 1 gm of paracetamol at a time, maximum 4gm per day. Avoid going to sunlight. Take a rest in a dark room. Also, sleeping helps in relieving headaches in many patients.

Medical treatments:

Avoid any trigger which is causing you a headache. Common triggers mentioned above.

There are two types of medication treatments:

1. Abortive Medicine: Paracetamol, Ibuprofen, Aspirin are commonly used to abort headaches. If the headache is severe, sometimes triptans group of drugs can be taken like rizatriptan, sumatriptan, etc.

• Preventive Medicine: This medicine will help reduce the frequency and severity of migraine episodes. Commonly used preventive medicines are –propranolol, flunarizine, valproate, topiramate, etc.

The complication of Migraine:

Medicine overuse to abort headache episodes can make it chronic Migraine. Abortive medicine overuse can create a headache worse and chronic. Also, suppose we do not diagnose it timely. In that case, it can convert to chronic headaches and increase severity, which ultimately can disturb daily activities. Also, it can cause psychological features of depression and anxiety in the long term.