Migraine

While migraines can occur with or without the following risk factors, having more of these factors increases the likelihood of experiencing migraine headaches:

1. Female sex: Women are more prone to migraines than men, though the precise reasons for this are not well understood.
2. Family history: Migraines tend to run in families. If one parent has migraines, a child has a 50% chance of inheriting them. If both parents are affected, the likelihood increases to 75%.
3. Lifestyle factors: Factors like stress, poor sleep, lack of exercise, smoking, excessive caffeine consumption, and medication overuse can all elevate the risk of migraines.
4. Health conditions: Conditions such as obesity and depression are commonly associated with an increased risk of migraines.

While female gender and family history are non-modifiable risk factors, lifestyle changes and medical treatment can help reduce the likelihood of experiencing migraines.

There is no single test available to diagnose migraines. To determine if you have a migraine, your doctor will examine the recurring patterns of headaches and any related symptoms. The diagnosis process may require some time as the doctor carefully assesses your condition.

Clinical History and Examination

During your initial consultation, your doctor will gather a detailed medical history and check your vision, coordination, reflexes, and sensations. These tests help rule out or confirm other possible underlying causes of your symptoms or conditions responsible for your headaches.

Your doctor may ask if your headaches:

• Occur on one side of the head.
• Feel like a pulsating pain.
• Are intense enough to disrupt your daily activities.
• Worsen with physical activity or movement.
• Are accompanied by nausea or vomiting.
• Cause sensitivity to light and sound.

Note: If your headaches are unusual, your doctor may recommend a CT scan or MRI to eliminate other conditions that may cause headaches similar to migraines.

The most effective way to avoid migraine attacks is by identifying and steering clear of triggers. Here are some preventive tips:

• Eat meals at the same time every day.
• Track your migraine triggers and try to avoid them.
• If the weather is unfavorable, stay indoors and adjust your schedule accordingly.
• Get 7-8 hours of restful sleep, ideally in a dimly lit or dark room.
• Avoid using gadgets before bedtime.
• Stay away from bright lights and extreme temperatures.
• Avoid noisy environments and loud music.
• Limit or avoid foods like chocolates, cheese, processed foods, alcohol, and smoking.
• Try to manage and reduce stress as much as possible.

When to See a Specialist

Consult your doctor if you frequently experience severe migraines that cannot be managed with occasional over-the-counter painkillers. Regular use of pain medications may lead to medication-overuse headaches, which can make treatment more difficult.

You should also seek preventive treatment if:

• You have migraine attacks more than three times a month, even if they can be controlled with medication.
• Your migraines interfere with daily activities. For migraine-related concerns, you can consult:
• General Physician (Family Doctor)
• Neurologist

Various medications are used to treat and prevent migraines. Natural treatments can also complement medical treatments.

The choice of treatment depends on the severity of your migraine and associated symptoms. For mild to moderate migraines, non-specific drugs like analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment. For more severe cases, specific drugs such as ergot derivatives and triptans may be recommended. Newer medications, like CGRP antagonists and lasmiditan, are available for acute attacks.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

NSAIDs are typically the first line of defense against migraines. They help relieve pain by inhibiting the production of prostaglandins, which are chemicals responsible for triggering inflammation.

Common NSAIDs include:

• Aspirin
• Diclofenac
• Ibuprofen
• Naproxen

Some people may experience side effects like stomach upset, abdominal discomfort, or diarrhea.

1. Triptans Triptans are often prescribed when NSAIDs are ineffective, or if the migraine is severe. These drugs work by narrowing the blood vessels in the brain, blocking pain signals, and preventing nausea.

Examples include:

• Sumatriptan
• Zolmitriptan
• Naratriptan
• Rizatriptan
• Eletriptan
• Almotriptan

Ergots Ergots function similarly to triptans by constricting blood vessels in the head and blocking pain signals. However, these are not recommended for people with high blood pressure or heart disease.

Examples include:

• Ergotamine
• Caffeine + Ergotamine + Paracetamol + Prochlorperazine

Antiemetics If your migraines are accompanied by nausea or vomiting, your doctor may prescribe antiemetics. These can be used alongside NSAIDs or triptans or as standalone treatment.

Examples include:

• Metoclopramide
• Prochlorperazine
• Metoclopramide + Paracetamol

CGRP Antagonists CGRP antagonists are a newer class of medication used to both treat and prevent migraines. They work by blocking the protein CGRP, which contributes to migraine pain and inflammation. These are available in injection form.

Examples include:

• Erenumab
• Fremanezumab

Lasmiditan A newly approved medication, Lasmiditan helps treat acute migraines without constricting blood vessels, making it a safer option for those with heart conditions. It is available as a tablet.

Prophylactic Therapy Prophylactic medications are used to prevent future migraine attacks in individuals who experience frequent, long-lasting migraines or those that severely impact their quality of life.

Common preventive drugs include:

• Beta-blockers like propranolol, metoprolol, and atenolol
• Antidepressants like amitriptyline and fluoxetine
• Antiepileptics like topiramate and sodium valproate
• Calcium channel blockers like flunarizine and verapamil
• CGRP antagonists like erenumab and fremanezumab (for resistant cases)

Note: Always consult your doctor before starting any medication as these treatments may have side effects. Overuse of painkillers can lead to medication-overuse headaches, making treatment more difficult.

1. Ayurvedic Treatments Ayurveda offers a range of natural remedies that can help manage migraines. Many of these remedies use everyday ingredients found in your kitchen, including:

• Ginger: Known for its anti-inflammatory properties, ginger can help reduce the inflammation of blood vessels in the head, alleviating headache pain. To use, crush about ½ inch of ginger and brew a cup of tea. Ginger also helps with nausea, a common symptom during migraines.
• Lemon: Rich in antioxidants, lemon juice helps soothe irritated sinuses, which can reduce headache pain. You can prepare a warm tea by mixing lemon juice and honey, or you can grind lemon peel and apply it to your temples to ease the headache.
• Pepper: Pepper helps reduce inflammation and clear nasal congestion, which can relieve headache pressure. A hot soup with a sprinkle of ground pepper can be a helpful remedy.
• Cinnamon: Cinnamon reduces inflammation in blood vessels, which can decrease the frequency and severity of migraines. You can make a paste by mixing cinnamon with water and apply it to your forehead for relief.

For more herbs backed by science that help with migraine relief, click here for more information!

1. Acupuncture Acupuncture is a traditional Chinese medicine practice where fine needles are inserted into specific points on the body (acupoints) to relieve pain. While the exact mechanism is not fully understood, it is believed that acupuncture reduces nerve activity to modulate pain response. A form of acupuncture called ear acupuncture has shown to relieve migraine pain, particularly in those who experience migraines without aura.
2. Neuromodulation Techniques This therapy uses electrical stimulation to alter nerve activity and relieve pain. One popular non-invasive technique is transcranial magnetic stimulation (TMS), which delivers single-pulse magnetic stimulation to the brain and is commonly used to treat migraine pain.

Watch Your Diet Foods containing tyramine can trigger migraines. Some foods that are rich in tyramine include:

• Aged cheese, nuts, chicken livers, and processed meats like sausages.

Foods to limit or avoid:

• Aged, dried, fermented, salted, or pickled products such as pepperoni and salami.

Build a Healthy Routine

• Get at least eight hours of sleep each night.
• Exercise regularly.
• Eat small, frequent meals and avoid skipping meals.
• Stay hydrated by drinking 6-8 glasses of water daily.
• Minimize stress and practice relaxation techniques such as yoga or meditation.
• Track your migraine triggers and avoid them.

Tip: Keeping a headache diary can help you identify patterns and effective treatments.

Other Home-Based Solutions

• Take Breaks: Step away from stressful situations and rest when you feel a headache coming on.
• Heat Therapy: Apply a warm compress to your forehead or relax in a dimly lit room.
• Yoga: Certain yoga poses can relieve tension and alleviate headaches, such as seated neck release, child pose, and downward-facing dog.
• Massage with Essential Oils: Gently massage areas where headaches are commonly felt, like the temples or between the eyebrows. Use soothing essential oils like peppermint, basil, or lavender to enhance relaxation.

Living with migraine can be challenging, especially since many people do not fully understand the daily struggles of those affected. While it’s normal to feel frustrated or defeated, developing a positive mindset can improve your ability to manage migraines and enhance your overall quality of life.

Additionally, many people with migraines remain silent about their condition due to stigma. However, by making simple adjustments in your daily routine, you can lead a more comfortable and fulfilling life. Here are a few tips for managing migraines:

1. Stay Positive Migraine pain can lead to feelings of anger and helplessness, but these negative emotions only make things worse. Train yourself to focus on positive thoughts and actions to improve your well-being.
2. Educate Yourself Instead of blaming yourself for your migraines, take the time to understand the condition. Talk to your doctor about your symptoms, triggers, and medications to better manage your migraines.
3. Choose the Right Doctor Having a skilled and empathetic doctor is essential for managing migraine pain. Whether you need guidance during a migraine attack or help adjusting medications, a trusted healthcare provider can significantly improve your ability to handle the condition.
4. Join a Support Group Talking to others who share similar experiences can be incredibly helpful. Joining a support group or online community allows you to connect with others suffering from migraines, share your concerns, and gain insights into effective management strategies.
5. Practice Self-care Constantly thinking about your migraine can wear you down mentally. Instead of stressing over your condition, try engaging in activities that help take your mind off your pain, such as spending time with loved ones, listening to music, or going for a walk.

It’s important not to frequently change doctors. While there is no cure for migraines, medications can help reduce the frequency and intensity of episodes. A consistent treatment approach can make a big difference.

Migraine and Comorbidities

1. Migraine and Stress: While stress is not classified as a type of migraine, it is a well-known trigger. Techniques like deep breathing, meditation, or yoga can help reduce stress and alleviate migraine symptoms.
2. Migraine and Nausea: Nausea is a common symptom associated with migraines. Anti-nausea medications (antiemetics) can help, but if vomiting occurs alongside the headache, it’s important to seek medical advice. Natural remedies like ginger and lemon can also provide some relief.
3. Menstrual-related Migraine: Over 50% of women who suffer from migraines experience them in relation to their menstrual cycle. Hormonal fluctuations during menstruation are believed to trigger these attacks.