MIGRAINE

Overview of migraine – Migraine is a disorder characterized by severe headache and is generally associated with nausea and/or light and sound sensitivity.

Migraine is an episodic disorder which may be caused by genetic and environmental factors. There is an imbalance in the chemicals of the brain including – serotonin, which helps regulate pain in your nervous system.

 

Symptoms of migraine – Migraine attacks occur over the course of several hours to days. A typical attack progresses through four phases – Prodrome, aura, headache, and the postdrome.

  • Prodrome appear 24 to 48 hours prior to the onset of headache. Symptoms may include yawning, neck stiffness, irritability, euphoria, food cravings, depression.
  • Migraine aura – Typical migraine aura is a mix of positive and negative symptoms. Positive symptoms are  auditory (eg, tinnitus, noises, music), visual (eg, bright lines, shapes, objects), somatosensory (eg, burning, pain, paresthesia), or motor (eg, jerking or repetitive rhythmic movements). Negative symptoms may be loss of vision, hearing, feeling, or ability to move a part of the body.
  • Headache – Migraine headache is often but not always on one side of the head and is throbbing or pulsatile in nature. Patients may experience nausea and sometimes vomiting, as the severity of the attack increases over one to two hours. Other symptoms may include photophobia (light sensitivity), or phonophobia (fear of or aversion to loud sounds), or osmophobia (fear, aversion, or hypersensitivity to odors), or cutaneous allodynia (pain from non- painful stimuli such as light touch). An untreated migraine headache can last from four hours to several days.
  • Postdrome – There is weakness and fatigue for up to a day after a migraine attack. Sudden movement of the head can bring in the headache briefly.

 

Migraine triggers –

  • Alcohol, too much caffeine
  • Hormonal changes in women – pregnancy, menopause, before or during menstrual periods, oral contraceptives and hormonal replacement therapy.
  • Bright light, sun glare, strong smells such as perfumes, paint thinners, secondhand smoke.
  • Sleep disturbances – Missing sleep, sleeping too much, jet lag.
  • Intense physical exertion
  • Weather changes
  • Medications such as vasodilators, nitroglycerin, oral contraceptive pills
  • Food additives
  • Skipping meals
  • Sexual activity

 

Complications of migraine –

  • Seizures – Seizure may be triggered by an attack of migraine with aura.
  • Infarction(tissue death because of inadequate blood supply) of the brain area – Infarction may occur in people with migraine with aura.

 

Diagnosis of migraine – Diagnosis of migraine is based on symptoms, signs and physical examination.

Tests such as magnetic resonance imaging, or computerized tomography scan may be used to rule out other causes of pain if headache becomes worse suddenly.

 

Management of migraine –

Lifestyle management –

  • Aerobic exercise such as walking, swimming, and cycling can reduce tension and helps prevent migraines
  • Biofeedback and other relaxation techniques, cognitive behavioural therapy, acupuncture, transcutaneous electrical nerve stimulation can help you deal with stressful situations.
  • Do not oversleep or sleep little. Be consistent with sleep and wake schedule.
  • Keep a record of your migraine attacks. It will help you learn more about what triggers your migraines.
  • Try to eat meals at the same time everyday.
  • Stay hydrated with plenty of fluids.
  • Resting or taking a nap in a quiet and dark room while having an attack.
  • Stay well hydrated with plenty of fluids mostly water.

 

Medical management –

  • Pain relieving medications during an attack – Aspirin; ibuprofen; combination of aspirin, caffeine and acetaminophen; triptans(sumatriptan, rizatriptan); dihydroergotamine; narcotic opioid medications.
  • Antinausea medications – Chlorpromazine, metoclopramide or prochlorperazine

Preventive medications – Blood pressure lowering medications (propranolol, metoprolol tartrate, verapamil), antidepressants (amitriptyline), anti – seizure medications (Valproate and topiramate), botox injections (onabotulinumtoxinA), other newer drugs such as erenumab-aooe, fremanezumab-vfrm and galcanezumab-gnlm.

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