What is Migraine

Dr Foram Bhuta

Dr Foram Bhuta

BDS (Bachelor of Dental Surgery), 10 years of experience

November 20, 2020 Brain Diseases 1726 Views

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What is the meaning of Migraine?

A migraine is a neurological (brain-related) disorder that causes several symptoms like a pulsing, throbbing headache, usually on one side of the head. Migraine is often accompanied by nausea, vomiting, and extreme sensitivity to sound and light. Migraine attacks can last for many hours or days and the pain can be extremely severe, affecting one’s daily activities. In some cases, an aura or a warning symptom is seen before the onset of migraine. The symptoms of an aura include visual disturbances, like blind spots and flashes of light; or tingling sensation on one side of the face, arm, or leg; and difficulty in speech.

In this article, we will be discussing in detail migraine.

  • What are the types of Migraines?
  • What are the causes of Migraine?
  • What are the risk factors for Migraine?
  • What are the symptoms of Migraine?
  • How to diagnose a Migraine?
  • What is the treatment for Migraine?
  • What are the complications of Migraine?
  • How to prevent Migraine?
  • What is the cost of Migraine treatment in India?

What are the types of Migraines?

The different types of migraines include:

  • Complicated migraine: Migraine with an aura is known as complicated migraine.
  • Common migraine: This type of migraine occurs without any aura.
  • Silent migraine or Acephalgic migraine: This type of migraine includes the aura symptom, but is not followed by the headache that typically follows it.
  • Hemiplegic migraine: This type of migraine causes temporary paralysis (hemiplegia) or sensory or neurological changes on one side of the body.
  • Retinal migraine or Ocular migraine: One may experience temporary, partial or complete vision loss in one of the eyes in this condition. It may be accompanied by a dull ache behind the eye that spreads to the rest of the head.
  • Chronic migraine: This type of migraine occurs for at least 15 days in a month.
  • Migraine with brainstem aura: This type of migraine is accompanied by slurred speech, vertigo, loss of balance, or double vision, which normally occurs before a headache. This may be followed by vomiting, ringing in the ears, and inability to speak properly.
  • Status migrainosus: This is a severe and rare form of migraine that may last for more than 72 hours.

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What are the causes of Migraine?

  • The exact cause of migraine is not understood fully, but it is thought to occur due to certain genetic and environmental factors.
  • Migraine starts when the overactive nerve cells send out signals that may trigger the trigeminal nerve, which gives sensation to the head and face.
  • This signals the body to release chemicals known as serotonin and calcitonin gene-related peptides (CGRP).
  • These chemicals make the blood vessels that line the brain swell up. The neurotransmitters (the chemical messengers of the body) then lead to pain and inflammation.

Certain factors trigger migraine. The different migraine triggers may include:

  • Pregnancy
  • Menopause (stopping of the menstrual cycle)
  • Just before or soon after a menstrual cycle
  • Use of oral contraceptives
  • Excessive consumption of alcohol
  • Excessive consumption of caffeine
  • Stress
  • Getting too little or too much sleep
  • Flashing lights
  • Loud sounds
  • Strong smell
  • Secondhand smoke
  • Physical exertion
  • Change of weather
  • Certain medications like vasodilators (uses to open the blood vessels)
  • Eating processed and salty food
  • Eating food loaded with artificial sweeteners and preservatives

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What are the risk factors for Migraine?

Certain factors may increase the risk of developing migraine. These factors may include:

  • Family history of migraine
  • More common in women
  • Can occur at any age, but most commonly starts in adolescence, peaks during the ‘30s, and gradually becomes less frequent and less severe with age
  • Hormonal changes in women like the onset of menstrual cycle, menopause, or pregnancy

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What are the symptoms of Migraine?

Migraine usually progresses through four stages. The different stages of migraine and their symptoms include:

  • Prodrome: One or two days prior to a migraine, you may notice the following symptoms:
    • Mood changes
    • Depression
    • Euphoria
    • Constipation
    • Food cravings
    • Stiffness of the neck
    • Retention of fluid
    • Increase in urination
    • Frequent yawning
  • Aura: In some cases, an aura may occur before or during a migraine attack. An aura consists of reversible symptoms of the nervous system. The symptoms usually start gradually and can last for about 60 minutes. The symptoms may include:
    • Loss of vision
    • Visual disturbances, like seeing bright spots, flashes of light, or various shapes
    • Needle-like sensation in an arm or leg
    • Difficulty in speech
    • Numbness or weakness in the face or one side of the body
  • Attack: A migraine normally lasts for 4 to 72 hours if it is not treated. A migraine can occur sometimes or may occur several times in a month. The symptoms associated with a migraine attack include:
    • Pain that normally occurs on one side of the head, but may occur on both the sides
    • Pain in the head that throbs or pulses
    • Extreme sensitivity to sound, light, smell, and touch
    • Nausea
    • Vomiting
  • Post-drome: This is the stage following a migraine attack and can last for up to a day. The symptoms seen during this stage include:
    • Feeling tired or drained
    • Feeling confused
    • Recurrence of pain on sudden movement of the head for a brief period

One should immediately contact a doctor in the following cases:

  • Headache after an injury to the head
  • A severe, sudden headache
  • A chronic or long-term headache that gets worse on exertion, coughing, or a sudden movement
  • Headache pain which is new and is seen after the age of 50
  • Headache accompanied by a stiff neck, fever, seizures, confusion, double vision, weakness or numbness in my part of the body (these symptoms could indicate a stroke)

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How to diagnose a Migraine?

  • Physical examination: The doctor will examine the patient and ask about the medical history and family history of the patient, along with the symptoms of the patient.
  • Neurological examination: This is a test done by the doctor to check the sensory neuron and motor responses, especially reflexes of a person to diagnose any disorders associated with the nervous system (brain and spinal cord).
  • Blood tests: This test may be recommended to rule out any other underlying medical conditions or infections that may cause headaches.
  • Imaging tests: Imaging tests like computerized tomography (CT) scan and magnetic resonance imaging (MRI) scans are done to obtain clear images of the brain and the blood vessels. These tests help to rule out other conditions like strokes, tumors, infections, bleeding in the brain, brain damage, and other neurological conditions.
  • Electroencephalography (EEG): This test is done to check the electrical activity of the brain and to detect abnormalities in the brain waves. It helps to rule out other neurological conditions that may be causing a headache.

What is the treatment for Migraine?

The goal of migraine treatment is to treat the symptoms and prevent future migraine attacks.

The different medications that can be used to treat migraine include:

  • Medications for pain relief: These medicines help in relieving the symptoms associated with migraine and should be taken as soon as any symptoms of migraine appear. These medications include:
  • Pain relievers:
    • Examples include ibuprofen and aspirin.
    • When used for too long, these medicines may cause medication-overuse headaches, bleeding, and ulcers in the gastrointestinal tract.
    • A combination of aspirin, acetaminophen, and caffeine may be effective against mild pain caused due to migraine.
  • Triptans:
    • Sumatriptan and rizatriptan are medications used for the treatment of migraines.
    • They block the pain pathways in the brain.
    • They may be taken in the form of nasal sprays, injection shots, or pills.
  • Lasmiditan (Reyvow):
    • This is a new oral tablet that is approved for migraine treatment, with or without aura.
    • Side-effects may include dizziness.
  • Dihydroergotamine (D.H.E 45, Migranal):
    • It is available in the form of an injection or nasal spray.
    • It is effective when taken immediately after noticing the symptoms of migraine.
    • It is effective in cases of migraine that last for more than 24 hours.
    • Side-effects include nausea and vomiting.
  • Ubrogepant (Ubrelvy):
    • This is an oral calcitonin gene-related peptide receptor antagonist which can be used for acute (sudden and short-term) migraine with or without an aura in adults.
    • Side effects may include nausea, dry mouth, drowsiness.
  • CGRP antagonists:
    • Ubrogepant and rimegepant are oral CGRP antagonists that can be used for treating acute migraine, with or without an aura in adults.
    • Side effects may include nausea, sleepiness, and dry mouth.
  • Opioid medications:
    • For individuals who cannot take other migraine medications, narcotic opioid medicines may be used.
    • They are addictive in nature and are therefore used only if no other treatment methods are effective.
  • Anti-nausea drugs:
    • These medications can be taken when a migraine with aura is accompanied by nausea and vomiting.
    • These are usually taken along with pain medicines.
    • Examples are metoclopramide and chlorpromazine.

Preventive medications: These medicines help in preventing frequent, long-lasting, or severe migraines that do not respond well to treatment. The different types of preventive medications include:

  • Blood pressure-lowering medications
    • Examples include beta-blockers like propranolol and metoprolol tartrate.
    • Calcium channel blockers like verapamil also prevent migraine with aura.
  • Antidepressants:
    • A tricyclic antidepressant like amitriptyline can help in preventing migraine.
    • The side effect of amitriptyline is sleepiness.
  • Botox injections:
    • Injections of botulinum toxin every 12 weeks can prevent migraines in some adults.
  • Anti-seizure drugs:
    • Topiramate and valproate prevent migraines that may be less frequent.
    • Side effects include weight fluctuations, nausea, and dizziness.
    • It is not recommended in case of pregnancy.
  • CGRP monoclonal antibodies:
  • These are newly approved drugs given monthly or quarterly in the form of injections.
  • Side effects may include a reaction at the site of injection.

Devices for migraine: Some medical tools have been approved to lessen migraine attacks by increasing or decreasing nervous system activity. These are known as neuromodulation treatments and may include:

  • Single-pulse transcranial magnetic stimulator: It is a handheld device that produces magnetic impulse which affects the electrical signals in the brain.
  • Transcutaneous vagus nerve stimulator: It is a non-invasive, small medical tool that targets the vagus nerve situated in the neck region by electrical stimulation.
  • Transcutaneous supraorbital neurostimulator: It is a device that stimulates the supraorbital nerves by electrical stimulation.
  • Multi-channel brain neuromodulation system: It is a type of headset that can target several nerves in the head.

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What are the complications of Migraine?

The complications associated with migraine are:

  • Status migrainosus (severe migraine that lasts for more than 3 days)
  • Stroke (when the blood supply to the brain is cut off)
  • Migrainous infarction (migraine associated with a stroke)
  • Persistent aura without infarction (if the aura lasts for more than a week)
  • Migralepsy (migraine triggers an epileptic seizure, which is an abnormal behavior or movements due to the sudden rush of electrical activity in the brain)
  • Mental health disorders like depression, anxiety, panic disorder, post-traumatic stress disorder
  • Motion sickness
  • Sleep talking
  • Sleepwalking
  • Grinding of teeth
  • Vomiting
  • Abdominal (stomach) pain
  • Vertigo (a sudden spinning sensation caused due to a quick movement of the head)

Complications due to overuse of pain medications like:

  • Abdominal pain and bleeding
  • Medication overuse headache or rebound headache
  • Serotonin syndrome: It is caused due to excessive serotonin in the brain that occurs when a combination of some migraine medications like antidepressants and triptans are taken. Symptoms of this syndrome include confusion, agitation, diarrhea, excessive sweating, muscle twitching, and rapid heart rate.

If you notice any of the above complications, contact your doctor immediately.

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How to prevent Migraine?

Migraine can be prevented by:

  • Avoid migraine triggers by keeping track of the symptom patterns in a diary
  • Try to get about seven to nine hours of sleep every night
  • Drink plenty of fluids
  • Maintain a healthy weight
  • Avoid packaged food
  • Exercise regularly
  • Manage stress by yoga, meditation, relaxation training
  • Take preventive medications as prescribed by the doctor
  • Take help from a therapist or counselor to help you manage stress
  • If the migraine is linked to the menstrual cycle of a woman, talk to your doctor about hormone therapy (treatment done for boosting the levels of female hormones and relieving the symptoms of menopause)
  • Use a battery-powered electrical stimulator (like the transcutaneous supraorbital nerve stimulation device)

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What is the cost of Migraine treatment in India?

The total cost of migraine treatment in India can range from around INR 2000 to INR 50,000, depending on the type of treatment done. However, the cost of the procedure may vary across different hospitals. There are many big hospitals and specialized doctors in India for migraine treatment. The cost varies across different hospitals. 

If you are coming from abroad, in addition to the expenses of migraine treatment, there will be a cost of staying in a hotel, cost of living, and cost of local travel. So, the total cost of migraine treatment in India will be around INR 4000 to INR 90,000. 

We hope that we were able to answer all your questions regarding migraine through this article.

If you want more information and treatment for migraine, you can contact a Neurologist.

We only aim to give you information through the article and do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan. 

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