Migraine is a severe and disabling neurological disorder. It is the sixth most disabling illness affecting One billion people worldwide. An estimated 18% of women and 6% of men experience it but many go undiagnosed and undertreated.
Migraine is a complex neurological disorder having recurrent episodes of headache, most often unilateral and in some cases associated with visual or sensory symptoms collectively known as an aura. Aura arises most often before a headache but it may occur after or even during a headache. It is common in females and has a strong genetic component.
The headache is usually unilateral, Occular or in front or sides of the head but may occur anywhere in the head and neck region. Pain is usually throbbing and except few exceptions, it doesn’t last for more than 3 days. Migraine headache is associated with nausea, vomiting, yawning, watering eyes, intolerance to light and sound and aura. The aura may occur before, after or during headache. Aura is usually visual symptom sensory or motor symptoms, vertigo and dysarthria. Aura lasts not more than 60 minutes leaving few exceptions.
Diagnosis is based on history mainly. International headache society has given various clinical criteria to diagnose. Imaging modalities are rarely required to diagnose migraine with typical clinical scenarios.
Various factors trigger headache. Some of the factors are listed here:
- Hormonal changes like in the premenstrual period
- Fasting or skipping meals
- Bright light
- Sleep excess or deficiency
- Change of daily routine
- Sudden change in temperature
- Weather changes
- Drugs e.g. Vasodilators
- Lack of exercise
- Red wine
- Strong odour like perfume or deodorant
- Foods containing tyramine like Cheese
- Monosodium glutamate
- Artificial sweetener
Migraine treatment involves acute (abortive) and preventive (prophylactic) therapy. Severe migraine requires both. Effective management of migraine also needs reducing trigger factors as far as possible. The aim of acute treatment is to reverse or at least stop the progression of headache. Early treatment gives better results. If the patient has already been diagnosed he can recognise it in the initial phase in most of the cases. A tablet of paracetamol can abort a mild attack if given within 15 minutes of starting the attack. Prophylactic treatment reduces the severity, duration, and frequency of migraine attacks and improves responsiveness to treatment of acute attack. Prophylactic or preventive treatment is given to a small group of patients with frequent attacks or any problem with acute therapies.
Exercise, avoidance of trigger factors, and yoga reduce severity, frequency and duration of attacks. Deep inspiration exercises and pranayam(especially anoolom vilom) may even abort the attack if done early in the attack.
Migraine is a common neurological illness and people must be educated about this problem as migraine is responsible for the loss of man-days. Migraine also causes numerous psychological problems when the headache is not diagnosed or undertreated.