MIGRAINE & HEADACHE DISORDERS

Overview: Migraines are severe, recurrent headaches often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines are a neurological condition affecting approximately 12% of the population, with higher prevalence in women. Migraines can significantly impact quality of life and work productivity.

Types of Headaches

• Migraine with Aura: Visual or sensory disturbances precede the headache
• Migraine without Aura: Headache without preceding symptoms (most common)
• Chronic Migraine: 15 or more headache days per month
• Status Migrainosus: Migraine lasting > 72 hours

Migraine Phases

• Prodrome (24 hours before): Mood changes, food cravings, fatigue
• Aura (20-60 minutes): Visual disturbances, numbness, tingling
• Headache Phase (4-72 hours): Throbbing pain, usually one-sided
• Postdrome (24 hours after): Fatigue, mood changes, difficulty concentrating

Symptoms

• Throbbing or pulsating headache
• Pain usually on one side of head
• Nausea and vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Sensitivity to smell
• Blurred vision
• Dizziness

Triggers (Common)

• Hormonal changes (menstrual cycle, oral contraceptives)
• Stress and anxiety
• Sleep changes
• Skipped meals
• Caffeine withdrawal
• Certain foods (aged cheese, processed meats, chocolate, citrus)
• Alcohol (especially red wine)
• Environmental factors (bright lights, strong smells, weather changes)
• Physical exertion

Risk Factors

• Family history (70% of migraine patients have family history)
• Female gender (3:1 ratio)
• Age (typically start between 10-40 years)
• Hormonal factors
• Stress
• Sleep disorders
• Obesity

Diagnosis

• Detailed history of headache characteristics
• Neurological examination
• Headache diary to identify patterns and triggers
• Brain imaging (MRI or CT) if symptoms are atypical or progressive
• Blood tests to rule out other conditions

Treatment Options

• Acute Treatment (for individual migraines):
  • Triptans (sumatriptan, rizatriptan, naratriptan)
  • NSAIDs (ibuprofen, naproxen)
  • Combination medications
  • Anti-nausea medications
  • Rest in dark, quiet room
• Preventive Treatment (for frequent migraines):
  • Beta-blockers (propranolol)
  • Tricyclic antidepressants (amitriptyline)
  • Anti-seizure medications (topiramate, valproic acid)
  • CGRP antagonists (newer class of preventive medications)
  • Botox injections (for chronic migraine)
• Lifestyle Modifications:
  • Identify and avoid triggers
  • Regular sleep schedule
  • Stress management techniques
  • Regular exercise
  • Healthy diet
  • Limit caffeine and alcohol
  • Stay hydrated
  • Relaxation techniques (yoga, meditation)

Prognosis

With appropriate treatment, migraine frequency and severity can be significantly reduced. Many patients achieve 50% or greater reduction in migraine days with preventive treatment. Some patients may experience remission, especially if triggers are identified and avoided.