Migraine (Headache)

Dr Priya Gupta, MD, DM (Neurology)
Jul 19, 2019
5 min read

Updated: Oct 9, 2023

A migraine is a type of headache which causes severe headache, usually on the one side of the head. The pain of migraine is usually described by patients as throbbing or pulsing type. It is often associated with nausea, vomiting, and sensitivity to light and sound. Pain of migraine can last for few hours to many days and it can be very disabling. Migraines often starts in young ages and migraine onset is unusual after middle age.

Symptoms of Migraine

There are four stages of migraine, all of which are not experienced by every patient. These four stages are: prodrome, aura, headache and post-drome.

Prodrome: It starts usually one or 2 days before a migraine headache, these symptoms may include:

Behavioural changes like depression to euphoria
Constipation and increase urination
Increase hunger and thirst and food cravings
Frequent yawing

Aura: These are the symptoms which occur just before migraine usually last for 20min to 1 hr. Most the migraine headaches are not preceded by auras. These symptoms Symptoms of auras may include:

Visual disturbances: seeing various shapes, bright spots or flashes of light or wavy, zigzag vision. Sometimes patient may experience transient vision loss.
Prickly sensation over skin, feeling of numbness, aching sensation especially one side of the body.
Weakness of arm and leg of one side (hemiplegic migraine).or jerky or movements of body.
Difficulty in speaking, slurred or broken speech
Hearing of noises or music

Migraine Attack: In migraine, headache usually gradually builds up and last for few hours to 72hous if not treated. The frequency of migraine varies from person to person and it could be rare or occur many times a month. Symptoms of migraine may include:

Pain on one side or both sides of head. It may start from one side but as intensity increases it sometime becomes involves whole head. People may also experience pain in eyes and neck. Pain usually throbbing or pulsing type. Physical activity usually worsens the headache.
Pain is usually associated with Nausea and vomiting and sensitivity to light, sounds, and sometimes smells and touch
Sometimes person may feel blurring or vision and Lightheadedness and infrequently followed by unconsciousness /fainting.

Post-drome: this the final stage of a migraine attack and it occurs after the above the symptoms of migraine have subsided. This stage can last for 24 hours and you may feel behavioural changes like moodiness or confusion or dizziness. There may continue to feel Sensitivity to light and sound or weakness

Cause of Migraine

Exact cause of migraine still not very clear but many factors seem to be involved, important one are genetics and environmental factors. Scientists believe that imbalance of brain chemical may be the one of the important cause of migraine.

Migraine triggers

Although the cause of migraine are is not clear but there are several triggering factors which increase the frequency of migraine attacks. These are not common for all persons with migraine, some may develop migraine attacks because these trigger factor but some may not. The important triggering factors are:

Diet: There are several foods and food related habits which can increase migraine attacks.
Processed food, cheese and food with high salt like pickles can precipitate migraine attack.
Fasting or even skipping meals can also trigger migraine attacks.
Preservatives like Aspartame, monosodium glutamate (MSG), found in many food may also trigger migraine.
Alcohol, especially wine, and high caffeine drinks may trigger migraines.
Certain smells including perfume, paint thinner, smoke etc. can trigger migraines in some people. Bright lights, sun glare, loud sounds can also induce migraines.
Stress: Stress is one of the most important factor these days which can triggers migraine
Changes in wake-sleep pattern. Reduced sleep or sleeping too much may trigger migraines in some people.
Hormonal changes in women. Fluctuations in certain hormone in female body may trigger headaches in many women. Many women often have migraine attack immediately before or during their periods. Few may experience increased tendency of migraines during pregnancy or menopause.
Physical Exertion of any kind can also trigger migraine attack.
Change in weather can trigger migraine.
Medications like oral contraceptives and hormone replacement therapy and few other medicines can also trigger migraine attack. However in few women hormonal supplement can lessen the frequency of migraine attack.

Risk factors of migraine

There are several factors which make you make you more prone for having migraines, including:

Family history. Migraine is more common in people if they have a family member with migraine.
Age. Migraines begins usually during adolescence and worsens during 30s and gradually becomes less severe after that.
Sex. Women are more likely to have migraines and during childhood migraine.

Treatment of migraine

Treatment of migraine depends upon the frequency and intensity of headache. Along with medications, life style modification and home remedies are also helpful. Even alternative treatment is also supposed to be effective for migraine.

Medications

There is no fixed drug regime for treatment of migraine, so the choice of medication is always made on the individual basis. The choice of medications depends on the severity of the attacks, associated symptoms such as nausea and vomiting, and associated any other illness. The treatment of migraine does not only include treatment of attack but it requires overall management of conditions which may be contributing to frequent symptoms.

Medications for migraine are of two types: abortive or acute and preventive or prophylactic drugs.

Abortive medications are used during the migraine attack to relieve the symptoms of migraine. The preventive medications are used to reduce the frequency migraine attack.

Abortive or acute Medicines: Acute treatment is most effective when given within 15 minutes of onset of headache and when pain is mild.
Painkillers (Analgesics): many OTC (over the counter) medications are available which can be taken to relieve the headache during migraine. The non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most common group of medication used for acute attack of migraine. Analgesics are more effective when taken in soluble or liquid form because as they are absorbed better and quicker. Paracetamol, Codeine and Caffeine are also commonly used for migraine.
Anti-Vomiting (Anti-emetics): Anti-emetics relieve the nausea and vomiting associated with migraine. Anti-emetics should be taken before or at the same time as painkillers.
Specific anti-migraine drugs: There are two medications in this group: triptans and ergot alkaloids. The most commonly used triptans are, Sumatriptan, Rizatriptan, Zolmitriptan and Naratriptan. The specific ergot alkaloids include ergotamine and dihydroergotamine (DHE.). Triptans are most effective when taken early during a migraine attack. These medications can be repeated if required in 2 hours, should not be taken more than twice. Even any other triptans should not be repeated with in this duration. Triptans should not be used for more than 3 days weekly. Triptans should not be taken by patients with any history of heart disease, stroke or any other vascular problem.
Preventive or Prophylactic Treatment: The patient should consider for preventive treatment if the frequency of migraine attacks is more than 2 per month or the duration of individual attack last for more than 24 hours. It also be considered if acute treatment is not effective or the migraine symptoms disrupt the life of patient. Frequent use of medications used for acute treatment of migraine attack can cause medication-overuse headache in small number of patients. So if you are using abortive treatment for more than four times per month you should consult doctor and consider the use of preventive treatment.

How to Prevent Migraine

The best way to prevent migraine is to avoid the triggering factors which are specific for you. Make a headache diary and note down the factors which precipitate your headache. Many lifestyle modifications will also help in reducing the migraine attack frequency.

Lifestyle modification