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What is Migraine?
Migraine is a mental condition or neurological situation causing prolonged, severe headaches. This is very different from a normal headache due to excess work or once-in-a-while stress.
During migraine, you feel a continuous pulsating and ringing sensation in your head, and especially you feel it at one specific part of the head.
This can last up to 3 to 48 hours or even longer in some cases. Migraine is one of the most common mental disorders globally, due to a multitude of reasons such as chronic stress, hormonal changes, lifestyle, etc.
Untreated migraine is responsible for degrading the nervous system and affecting memory and even personality disorders.
Especially in the current scenario, even teenagers and school children are reporting cases of migraine. Hence, it’s advised to report to a doctor while experiencing initial symptoms of migraine.
Key facts
Disease type: Primary episodic neurological headache disorder
Typical duration of attacks: 4–72 hours
Global prevalence: 11–12% of people worldwide
Sex ratio: More common in women than men
Course: Often lifelong, with episodic or chronic patterns
A migraine is not just a headache; it is a complex neurological disorder involving changes in brain activity, nerve pathways, and blood flow.
Types of Migraine
Migraines are categorized based on their symptoms and frequency:
Migraine Without Aura (Common Migraine): The most frequent type, characterized by pain and nausea without prior sensory warning.
Migraine With Aura (Classic Migraine): Includes the neurological disturbances mentioned above.
Chronic Migraine: Defined as having a headache on at least 15 days per month for more than three months, where at least eight of those days are migraines.
Vestibular Migraine: Primarily involves vertigo and dizziness rather than just head pain.
Hemiplegic Migraine: A rare, severe form that causes temporary weakness or paralysis on one side of the body, mimicking a stroke.
Symptoms of Migraine
Symptoms of migraine are categorized into four phases. It’s not necessary that a migraine patient experience all four phases.
Warning Phase
The warning phase is where you experience some symptoms before the actual migraine. These include frequent urination, stiffness of the neck, sudden hunger, laziness, fatigue, etc.
Aura Phase
This phase includes people experiencing neurological imbalances such as zigzag lines, blind spots, seeing flashing lights, or even visualizing imaginary pain of pins and needles in their hands or feet. This is where imagination sometimes takes over reality.
Attack (Headache Phase)
This is where the main migraine occurs; many people may not experience the visualizing and warning phase and directly experience attacks.
It also includes vomiting, nausea, phobia of direct sunlight or photophobia, or phobia of sound or even smell.
Postdrome
This is also known as the recovery phase, also referred to as “migraine hangover”. Here, the person might experience brain fog, lack of focus or concentration, mood swings, extreme exhaustion, fatigue, etc.
What are the causes of Migraine?
There is no single or exact cause of migraine; it is due to a multitude of factors, including lifestyle, genetics, and many others.
Neurological Changes
Due to certain circumstances, the trigeminal nerve and the brainstem are damaged. This leads to fluctuations in the level of serotonin, the hormone that determines your mood and helps monitor the sensation of pain.
Genetics
Migraines can also occur if your family has a history of people suffering from migraine. Even if one of the parents is a migraine patient, there is 50% probability for the child to also get affected.
Hence, this is one reason where you don’t have control over the situation but one needs to take care of the lifestyle to prevent further worsening.
Common Triggers
- Hormonal Changes: Hormonal changes, such as during puberty, when new hormones get activated, are used to cope with migraine.
- Stress Factor: Excessive stress due to lifestyle, improper sleep cycles, or loneliness can trigger migraines.
- Dietary influence: Your diet also influences your chances of being affected by migraine. Alcoholic beverages, high cholesterol items, adulterated processed foods, and too much caffeine also increase your migraine chances.
- External Issues: Environmental factors such as weather change, pollution, excessive bright light, smoke, or strong perfumes can also trigger migraines.
How is Migraine Diagnosed?
Migraine is diagnosed clinically, based on the pattern of symptoms, using the criteria from ICHD-3.
Physicians (usually neurologists or headache specialists) take a detailed history and conduct a neurological examination.
An imaging (CT or MRI) or blood test is ordered when “red flags” suggest another cause (e.g., sudden onset, change in pattern, neurological deficits).
The headache diary (timing, triggers, symptoms, medications) helps clarify the diagnosis and guide treatment.
Phases of a migraine attack
Many people experience distinct phases, though not everyone gets all of them:
Prodrome (pre-headache):
Mood swings, food cravings, fatigue, stiff neck, frequent urination, and yawning.
Aura:
Reversible neurological symptoms lasting 5–60 minutes: zigzags, flashing lights, blind spots, numbness/tingling, and speech disturbance.
Headache phase:
One-sided throbbing head pain that gets worse with movement, along with nausea, vomiting, photophobia, and phonophobia.
Postdrome:
“Migraine hangover” for up to 48 hours: fatigue, difficulty concentrating, mild head discomfort, light/sound sensitivity.
Symptoms include fatigue, difficulty concentrating, mild head discomfort, and light/sound sensitivity.
Treatment of Migraine
1. Acute or Abortive Treatment
- Ibuprofen: Medications such as ibuprofen or acetaminophen are prescribed to ease pain immediately. These are over-the-counter medications that do not need a prescription for consumption.
- Triptans: Prescription drugs like Triptans are given to ease pain temporarily by blocking the nerve signals.
- Alternative drugs: Advanced medications like Ditans and Gepants are prescribed for patients unable to take Triptans, or where Triptans cannot show the required results.
- Symptoms Fighting Medications: Medications to prevent vomiting and nausea are prescribed, known as antiemetics.
2. Preventive Treatment
- Anti-Symptom Medication: Antidepressant medications to stabilize blood pressure and avoid hypertension are prescribed. Sometimes (after some tests) anti-seizure medicine is also prescribed.
- Protein Blockage: Here, injections are prescribed that block the proteins responsible for migraine pain.
- Botox Control: Botox injections need constant monitoring for chronic migraine patients.
3. Lifestyle Changes
- Regular Practices: Irregular sleep shall be avoided. Regular exercise, including aerobics and cardio.
- Stay Hydrated: Avoiding high cholesterol food items, keep hydrated, and take probiotics.
Avoid irregular sleep. Regular exercise, including aerobics and cardio. Avoid high-cholesterol food items, keep hydrated, and take probiotics.
Limitations of Migraine Treatment
Despite the multitude of treatments available, certain limitations persist that need to be considered:
No Permanent Remedy: The existing treatments mostly give immediate relief and treat superficial symptoms, and do not address the underlying neurological imbalance.
Medication Overuse Headache: is when you start consuming painkillers frequently. This does not solve the problems; it encourages more attacks.
Individual Variation: So, the medications and treatments vary depending on the patient. One set of medications may work for someone but may not for another patient.
Hence, people waste a lot of time trying medicines on their own, rather than checking up with a doctor.
Conclusion
Migraines are a complex neurological condition that goes beyond a simple headache. With the right combination of medical treatment, lifestyle adjustments, and preventive strategies, it is possible to manage symptoms and reduce the frequency of attacks.