Migraine

Introduction

  • Migraine is a neurological condition characterized by recurrent, moderate-to-severe headaches, often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound.
  • Migraine is more common in women and can significantly impact daily life and productivity.
  • Effective management includes identifying triggers, acute treatments for attacks, and preventive therapies to reduce the frequency and severity of episodes.

Types of Migraine

  1. Migraine Without Aura
    • Most common type.
    • Moderate-to-severe throbbing pain, often on one side of the head.
  2. Migraine With Aura
    • Visual or sensory disturbances (e.g., flashing lights, zigzag lines, or tingling) precede the headache.
  3. Chronic Migraine
    • Headache on 15 or more days per month, with at least 8 days having migraine features.
  4. Hemiplegic Migraine
    • Rare type causing temporary paralysis or weakness on one side of the body.
  5. Menstrual Migraine
    • Linked to hormonal changes during the menstrual cycle.

Causes and Triggers of Migraine

  1. Triggers
    • Stress, lack of sleep, dehydration.
    • Dietary factors: Alcohol, caffeine, processed foods.
    • Environmental changes: Bright lights, loud sounds, strong odors.
    • Hormonal fluctuations in women.
  2. Underlying Mechanisms
    • Overactivation of the trigeminovascular system.
    • Cortical spreading depression leading to aura.
    • Imbalances in neurotransmitters, particularly serotonin.

Symptoms of Migraine

  1. Prodrome (Warning Phase)
    • Fatigue, mood changes, cravings, or yawning hours to days before the headache.
  2. Aura (In Some Cases)
    • Visual disturbances: Zigzag lines, blind spots.
    • Sensory symptoms: Tingling or numbness.
  3. Headache Phase
    • Throbbing or pulsating pain, often unilateral.
    • Nausea, vomiting, and sensitivity to light (photophobia) or sound (phonophobia).
  4. Postdrome (Resolution Phase)
    • Fatigue, confusion, and body aches after the headache subsides.

Complications of Migraine

  • Medication Overuse Headache: Frequent use of pain relievers can worsen headaches.
  • Stroke Risk: Slightly increased in migraines with aura, particularly in women using hormonal contraceptives.
  • Chronic Migraine: Conversion from episodic to chronic headaches.
  • Quality of Life Impact: Missed work or school and emotional distress.

Diagnosis of Migraine

  1. Clinical Assessment
    • History of recurrent headaches with associated symptoms.
  2. Diagnostic Criteria (ICHD-3)
    • At least five attacks fulfilling specific criteria for migraine without aura or two for migraine with aura.
  3. Exclusion of Other Causes
    • Imaging (MRI or CT) to rule out structural brain issues in atypical cases.
  4. Headache Diaries
    • Track frequency, duration, triggers, and associated symptoms.

Treatment Options for Migraine

1. Acute (Abortive) Treatment

MedicationBrand NameManufacturerCost Range
TriptansSumatriptanImitrexGSK
RizatriptanMaxaltMerck
NSAIDsIbuprofenAdvilPfizer
NaproxenAleveBayer
Anti-Nausea MedicationsMetoclopramideReglanTeva
  • Triptans: First-line treatment for moderate-to-severe migraines.
  • NSAIDs: Effective for mild-to-moderate attacks.
  • Ergotamines: Used for severe, refractory cases.

2. Preventive (Prophylactic) Treatment

MedicationBrand NameManufacturerCost Range
Beta-BlockersPropranololInderalPfizer
AntidepressantsAmitriptylineElavilAstraZeneca
AnticonvulsantsTopiramateTopamaxJanssen
CGRP Monoclonal AntibodiesErenumab (Aimovig)Amgen$600–$700 per month
  • Beta-Blockers and Antidepressants: Common first-line preventive options.
  • CGRP Monoclonal Antibodies: Effective for chronic migraines but costly.

3. Non-Pharmacological Approaches

  • Lifestyle Modifications
    • Regular sleep patterns and stress management.
    • Avoid known dietary triggers.
  • Behavioral Therapies
    • Cognitive Behavioral Therapy (CBT) to manage stress and emotional triggers.
  • Acupuncture and Biofeedback
    • May reduce migraine frequency in some individuals.

Monitoring Parameters

  • Frequency, intensity, and duration of migraine episodes.
  • Effectiveness and side effects of treatments.
  • Medication adherence and avoidance of overuse.

Patient Counseling Points

  • Educate on the importance of avoiding known triggers.
  • Emphasize early treatment during the onset of a migraine attack.
  • Discuss the risks of medication overuse and how to manage chronic migraines.
  • Encourage lifestyle changes such as regular exercise, hydration, and stress management.

Use in Children

  • Use age-appropriate doses of NSAIDs or triptans; avoid adult prophylactic medications.

Use in Pregnancy

  • Limit medications; paracetamol is preferred, and triptans may be used with caution.

Use in Elderly

  • Consider age-related comorbidities and potential drug interactions.

FAQs About Migraine

Q1: What causes migraines?

  • Triggers like stress, hormonal changes, or certain foods, combined with genetic predisposition.

Q2: How is a migraine different from a regular headache?

  • Migraines are often more severe, one-sided, and accompanied by nausea or aura.

Q3: Can migraines be cured?

  • There is no cure, but symptoms can be managed, and frequency reduced with treatment.

Q4: What are common triggers for migraines?

  • Stress, lack of sleep, hormonal changes, and certain foods or drinks.

Q5: Are migraines hereditary?

  • Yes, genetics play a significant role in migraine susceptibility.

Q6: Can exercise trigger migraines?

  • Intense physical activity may trigger migraines, but moderate exercise can help prevent them.

Q7: How long does a migraine last?

  • Typically 4–72 hours without treatment.

Q8: Can migraines cause permanent damage?

  • Rarely, but severe migraines with aura may slightly increase the risk of stroke.

Q9: What is the role of diet in migraines?

  • Certain foods like aged cheese, processed meats, and alcohol can trigger attacks.

Q10: Are there natural remedies for migraines?

  • Magnesium, riboflavin (vitamin B2), and coenzyme Q10 may help reduce frequency.

Q11: What is a migraine aura?

  • Visual or sensory disturbances that occur before or during a migraine.

Q12: Can weather changes trigger migraines?

  • Yes, barometric pressure changes are a common trigger.

Q13: What is the best medication for migraines?

  • Triptans are the most effective for acute attacks; preventive therapy depends on individual needs.

Q14: When should I see a doctor for migraines?

  • If migraines are frequent, severe, or significantly impact daily life.

Q15: Can lifestyle changes alone manage migraines?

  • For some people, avoiding triggers and maintaining a healthy lifestyle is enough; others may need medication.