Migraine is a disorder of episodic headaches, with or without associated symptoms (aura)
How common is this disorder?
About 12 to 15% of the population will be affected by this disorder at least once in their lifetime. It is one of the most common diagnoses amongst people with headaches.
Few facts about Migraine:
- This disorder is genetic, i.e. it runs in your family. Patients with migraine have at least one other family member with similar symptoms
- The bad news is that this disorder is not curable since it is your genetic tendency. However, the good news is that it is treatable!
- Simple lifestyle modifications and basic medication can make your life comfortable
- This is not a life-threatening disease. It does not worsen with age or culminate into some other dangerous disorder
What are the symptoms of Migraine?
- Headache is quite disabling. It is usually moderate to severe in intensity. It may be
- Usually unilateral
- Aggravated on movement like bending forward, jerking Usually lasts between 15 mins to 2 hours. However there have been reports of headaches lasting for up to 24hours and sometimes even days together.
- Other symptoms, which are common but not always present include:
- Nausea and rarely vomiting
- Increased sensitivity to light and sound. Normal light seems too bright.
- Photophobia may be present in extreme cases. Normal conversation may seem too loud. It may be impossible to converse over phone. Even insignificant sounds like ticking of the clock or chirping of birds outside may be irritating. Some patients may have so much of heightened sensitivity that they prefer to lie down alone in a quiet, dark room to avoid precipitation of a headache.
- A few triggers have been identified, in response to which headaches are commonly precipitated. These include:
- Oversleeping / Sleep deprivation
- Skipping meals
- Travelling / Change of environment
- These triggers may be different in different individuals. However, the common factor is change. These individuals are less tolerant to change of any kind.
What is the treatment of migraine?
- Lifestyle Modification: As stated earlier, these individuals are less tolerant to change. Thus, developing a regularity in day to day activities ie a daily routine is key to successful management.
- Healthy diet
- Regular exercise
- Avoidance of caffeine, alcohol, smoking
- Maintenance of a “Headache Diary”
- Identification of stressors and consciously avoiding them as far as possible
As the name suggests, preventive treatment is given in order to prevent further attacks of migraine.
This should be started very cautiously, bearing in mind the chronicity of the disease and adverse effects of long term medication.
Preventive treatment is not considered if one is having less than 2 attacks per month. May be considered in patients having 3 to 5 attacks in a month. It is indicated if one suffers more than 5 attacks per month or has an increasing frequency of attacks.
Treatment of Acute attacks:
Acute attacks usually respond well to paracetamol and even better to NSAIDs like Ibuprofen which are readily available over the counter. One must bear in mind that treatment is best initiated at the first hint of a headache rather than waiting for it to worsen until it is unbearable. It then becomes difficult to manage.
Specific drugs like Sumatriptan are available, which are very effective. However these drugs should be taken only on advice of your pain physician as they have adverse effects and interactions with few common medications.
Interventional Pain Management for Migraine: Interventional techniques are not commonly used, however few modalities like Occipital nerve block, Sphenopalatine ganglion blockade, Botox trigger point injections are used in exceptional cases.