Break Free from Migraines: From Symptoms to Solutions

Migraine is a neurological condition characterized by recurrent episodes of moderate to severe headaches, often accompanied by symptoms such as nausea, vomiting, and sensitivity to light and sound.

These headaches typically last from a few hours to several days and can significantly impact an individual’s quality of life. It is much more than a bad headache.

It can cause debilitating, throbbing, one-sided head pain that can leave you in bed for days. A healthcare provider can help you manage symptoms so migraines don’t take over your life.

Why your Headache is / is not migraine?

Classically if you have a family history of migraine and are having hemicranial (headache occurring in half the head) which is very severe and last for many hours/days AND you become aware even before the headache starts that you are going to have this headache are classical points in favor of migraine.

Causes of Migraine

The exact cause of migraine is not fully understood, but it is believed to involve a combination of genetic, environmental, and neurological factors. Some common triggers for migraine attacks include:

Hormonal changes: Fluctuations in estrogen levels, particularly in women, can trigger migraines. This is often experienced during menstruation, pregnancy, or menopause.
Certain foods: Foods high in tyramine, such as aged cheeses, chocolate, and processed meats, as well as foods containing additives like monosodium glutamate (MSG), can trigger migraines in susceptible individuals.
Environmental factors: Bright lights, loud noises, strong odors, and changes in weather patterns can trigger migraines.
Stress: Emotional stress and anxiety are common triggers for migraine attacks.
Sleep disturbances: Lack of sleep or changes in sleep patterns can trigger migraines in some people.

Who is More Likely to Have Migraine?

Migraine affects people of all ages, races, and genders, but certain factors may increase the risk of developing migraines, including:

Family history: Migraine tends to run in families, suggesting a genetic predisposition.
Gender: Women are more likely than men to experience migraines, particularly during reproductive years.
Age: Migraine often begins in adolescence or early adulthood and tends to peak in frequency during the 30s and 40s.

Other medical conditions

Individuals with certain medical conditions, such as depression, anxiety, bipolar disorder, epilepsy, and sleep disorders, may have a higher risk of migraines.

What triggers a migraine?

A trigger is something that causes symptoms to start. Some of the most common migraine triggers include:

Stress.
Hormonal changes.
Certain medications.
Changes to your sleep.
Weather conditions change.
Too much physical activity (overexertion).
Addictive substances like caffeine or tobacco.
Missing a meal.
Exposure to bright lights, loud noises or strong odors.
Your healthcare provider can help you identify your triggers. They might recommend keeping a migraine journal to track similarities between migraine attacks.

What foods trigger migraines?

Your body may have a sensitivity to specific chemicals and preservatives in foods. This sensitivity makes a migraine more likely to happen, especially if combined with other triggers.

Some of the most common food triggers include:

Aged cheese.
Beverages containing alcohol.
Chocolate.
Food additives like nitrates and MSG.
Processed or cured foods (hot dogs, pepperoni).
Fermented or pickled foods.
Are migraines hereditary?
Yes, migraines tend to run in biological families. Up to 80% of people with migraines have a first-degree biological relative with the condition.

Types of Migraine

There are several types of migraine, including:

Migraine without aura: This is the most common type of migraine, characterized by moderate to severe throbbing headaches without the presence of aura (visual disturbances or other sensory changes).
Migraine with aura: Some people experience specific warning signs or symptoms, known as aura, before the onset of a migraine attack. Aura may include visual disturbances (such as flashes of light or blind spots), sensory changes, or difficulty speaking.
Chronic migraine: Chronic migraine is defined as experiencing migraine headaches on 15 or more days per month for at least three months, with at least eight of those headaches having migraine features.
Hemiplegic migraine: This rare type of migraine is characterized by temporary paralysis or weakness on one side of the body, which can mimic symptoms of a stroke. Symptoms such as vertigo, a pricking or stabbing sensation, and problems seeing, speaking, or swallowing may begin prior to the headache pain and usually stop shortly thereafter. When it runs in families the disorder is called familial hemiplegic migraine (FHM). Though rare, at least three distinct genetic forms of FHM have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate.

Other types of migraine include

Abdominal migraine: Abdominal migraine mostly affects young children and involves moderate to severe pain in the middle of the abdomen lasting one to 72 hours, with little or no headache. Additional symptoms include nausea, vomiting, and loss of appetite. Many children who develop abdominal migraine will have migraine headaches later in life.
Basilar-type migraine: Basilar-type migraine mainly affects children and adolescents. It occurs most often in teenage girls and may be associated with their menstrual cycle. Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance, poor muscle coordination, slurred speech, a ringing in the ears, and fainting. The throbbing pain may come on suddenly and is felt on both sides at the back of the head.
Menstrual migraine: Menstrual migraine affects women around the time of their period, although most women with menstrually-related migraine also have migraines at other times of the month. Symptoms may include migraine without aura, pulsing pain on one side of the head, nausea, vomiting, and increased sensitivity to sound and light.
Migraine without headache: Migraine without headache is characterized by visual problems or other aura symptoms, nausea, vomiting, and constipation, but without head pain.
Ophthalmoplegic migraine is an uncommon: Ophthalmoplegic migraine is an uncommon form of migraine with head pain, along with a droopy eyelid, large pupil, and double vision that may last for weeks, long after the pain is gone.
Retinal migraine: Retinal migraine is a condition characterized by attacks of visual loss or disturbances in one eye. These attacks, like the more common visual auras, are usually associated with migraine headaches.
Status migrainosus: Status migrainosus is a rare and severe type of acute migraine in which disabling pain and nausea can last 72 hours or longer. The pain and nausea may be so intense that people need to be hospitalized.

Symptoms of Migraine

Common symptoms of migraine include:

Throbbing or pulsating headache, often on one side of the head
Sensitivity to light, sound, and odors
Nausea and vomiting
Blurred vision or visual disturbances
Lightheadedness or fainting
Sensory changes, such as tingling or numbness in the face or extremities
Food cravings or lack of appetite . You may crave a particular food like sweets or feel hungrier in general. Or you might not feel much like eating.

Diagnosis of Migraine

Diagnosing migraine involves a thorough medical history, physical examination, and sometimes additional tests to rule out other potential causes of headaches. Healthcare providers may also use criteria established by the International Classification of Headache Disorders (ICHD) to confirm a diagnosis of migraine.

Management and Treatment of Migraine

While there is no cure for migraine, several treatment options are available to help manage symptoms and reduce the frequency and severity of attacks. These may include:

Lifestyle modifications: Identifying and avoiding migraine triggers, maintaining a regular sleep schedule, staying hydrated, and managing stress through relaxation techniques or therapy can help reduce the frequency of migraine attacks.
Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen may provide relief for mild to moderate migraines. For more severe or frequent migraines, prescription medications such as triptans, ergots, or anti-nausea medications may be recommended.
Preventive medications: For individuals with frequent or severe migraines, daily medications such as beta-blockers, anticonvulsants, or antidepressants may be prescribed to reduce the frequency and severity of attacks.
Biofeedback and relaxation techniques: Techniques such as biofeedback, progressive muscle relaxation, and mindfulness-based stress reduction may help individuals manage migraine symptoms and reduce the frequency of attacks.

Prevention and Remedies

In addition to medication and lifestyle modifications, several preventive measures and home remedies may help reduce the frequency and severity of migraine attacks, including:

Maintaining a regular sleep schedule
Eating regular meals and staying hydrated
Practicing relaxation techniques such as deep breathing exercises or yoga
Applying cold packs to the head or neck during a migraine attack
Using over-the-counter headache relief products containing caffeine, aspirin, or acetaminophen

Investigations

When you have migraines, your doctor needs to check if you have any other issues with your brain or nerves. They’ll look for things like changes in reflexes, loss of feeling, or weakness, which could indicate serious problems like a stroke or multiple sclerosis (MS).

They will also examine your eyes to see if your optic nerve (which helps you see) is swollen. This can be a sign of serious conditions like a brain tumor or aneurysm.

If your migraine symptoms are new, changing, or unusual, your doctor may run some tests to rule out other problems.

Blood Tests

Complete Blood Count (CBC): Checks for anemia, infections, inflammation, or certain cancers, which can cause headaches and tiredness.
Electrolyte Levels: Detects issues with your kidneys, liver, or nutrition, which can cause fatigue and headaches.
Thyroid Tests: Checks for thyroid problems that might be causing fatigue and headaches similar to migraines.

Other Tests

Encephalogram (EEG): Measures brain activity to tell the difference between migraines and seizures.
Electrocardiograph (EKG/ECG) and Echocardiogram: Checks your heart’s rhythm and structure to see if heart issues are causing your symptoms.
Lumbar Puncture (Spinal Tap): Collects spinal fluid to check for inflammation or infections in your brain.

Imaging Tests

Brain CT Scan: Looks for bleeding, large strokes, infections, or big tumors in your brain.
MRI Brain / Contrast MRI Brain with Venogram: Always get see for the venous sinuses with venogram should be done to rule out any other lesions or Venous Sinus Thrombosis. MRI Brain detects small strokes, MS, tumors, inflammation, or infections in your brain.
Cervical Spine CT or MRI: Checks for issues in your spine that might cause pain.
Magnetic Resonance Angiogram (MRA): Visualizes blood vessels to detect problems like aneurysms or blockages.

These tests help ensure that your symptoms are due to migraines and not something more serious.

Which Doctor to show if you are having symptoms of migraine or you are diagnosed with it?

You should visit a neurologist if any kind of symptoms are shown or if you are diagnosed with migraine. Also if the neurologist has said the patient will undergo some surgical procedures or if you want to talk about surgical treatments, then you show a neurosurgeon.

Non-Surgical Treatments for Migraine

Non-surgical treatments for migraine focus on managing symptoms, preventing attacks, and improving overall quality of life without the need for invasive procedures. These treatments can be broadly categorized into lifestyle modifications, medications, alternative therapies, and preventive strategies. Here’s a closer look at each:

Lifestyle Modifications

Identifying Triggers: Keeping a migraine diary to track potential triggers such as certain foods, stress, sleep patterns, and environmental factors can help individuals identify and avoid triggers that may precipitate migraine attacks.
Maintaining Regular Sleep Patterns: Establishing a consistent sleep schedule and ensuring adequate sleep hygiene can help reduce the frequency and severity of migraine attacks.
Managing Stress: Stress management techniques such as relaxation exercises, mindfulness meditation, deep breathing, and yoga can help reduce stress levels and alleviate migraine symptoms.
Regular Exercise: Engaging in regular physical activity, such as walking, swimming, or cycling, can help reduce the frequency and severity of migraine attacks and improve overall well-being.
Hydration and Diet: Staying well-hydrated and maintaining a balanced diet rich in fruits, vegetables, whole grains, and lean proteins while avoiding known trigger foods can help manage migraine symptoms. Strong caffeine can also help in reducing migraine pain.

Medications

Over-the-Counter (OTC) Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, and naproxen sodium can provide relief for mild to moderate migraine attacks.
Triptans: Prescription medications such as sumatriptan, rizatriptan, and zolmitriptan are commonly used to relieve moderate to severe migraine pain and associated symptoms.
Preventive Medications: For individuals with frequent or severe migraines, preventive medications such as beta-blockers, anticonvulsants, antidepressants, and CGRP inhibitors may be prescribed to reduce the frequency and severity of attacks.
Anti-nausea Medications: Medications such as metoclopramide or prochlorperazine may be prescribed to alleviate nausea and vomiting associated with migraine attacks.

List of few neuro drugs commonly used in allopathic medicine, as well as some homeopathic remedies for migraines, along with their potential side effects:

Allopathic Medications

Sumatriptan (Imitrex):

Side effects: Nausea, dizziness, drowsiness, muscle weakness, chest discomfort.

Rizatriptan (Maxalt):

Side effects: Dizziness, drowsiness, nausea, dry mouth, tingling sensations.

Zolmitriptan (Zomig):

Side effects: Tingling or numbness, dizziness, drowsiness, nausea, throat discomfort.

Ergotamine (Ergomar):

Side effects: Nausea, vomiting, muscle pain, numbness or tingling, chest pain.

Propranolol (Inderal) (a beta-blocker sometimes used for migraine prevention):

Side effects: Fatigue, dizziness, slow heart rate, cold extremities, depression.

Topiramate (Topamax) (an anticonvulsant also used for migraine prevention):

Side effects: Nausea, fatigue, dizziness, cognitive difficulties, weight loss.

[NOTE: These are a few medications given during migraine. Only take medicines as advised by your concerned doctors/neurologists as medications vary from person to person. These need to be taken continuously as they may reduce the frequency & the duration of the migraine. Also these drugs cannot be given for an extended period of time due to the side effects.]

Homeopathic Remedies

Belladonna:

Side effects: May cause dry mouth, blurred vision, rapid heartbeat, and sensitivity to light.

Gelsemium:

Side effects: Can induce dizziness, drowsiness, and weakness.

Iris Versicolor:

Side effects: Possible nausea, vomiting, and diarrhea.

Natrum Muriaticum:

Side effects: May exacerbate dryness, particularly in the mouth and throat.

Sanguinaria Canadensis:

Side effects: May cause gastric irritation, nausea, and vomiting.

Alternative Therapies:

Acupuncture: Acupuncture involves the insertion of thin needles into specific points on the body to restore balance and alleviate migraine symptoms. Some studies suggest that acupuncture may help reduce the frequency and severity of migraine attacks.
Biofeedback: Biofeedback techniques involve using electronic monitoring devices to teach individuals how to control physiological processes such as muscle tension, heart rate, and skin temperature to reduce migraine symptoms.
Herbal Supplements: Certain herbal supplements such as feverfew, butterbur, and magnesium may be used as complementary treatments for migraine, although evidence supporting their effectiveness is limited.

Preventive Strategies:

Botulinum Toxin Injections: Botulinum toxin (Botox) injections may be recommended for individuals with chronic migraine to prevent migraines by temporarily paralyzing specific muscles and preventing migraine triggers.
Occipital Nerve Blocks: Injections of local anesthetics or steroids into the occipital nerves at the base of the skull may provide temporary relief for some individuals with migraine.

Surgical treatments

Surgical treatments for migraine are considered as a last resort for individuals who have not responded to other conservative treatments and medications. These procedures aim to reduce the frequency, severity, or duration of migraine attacks by targeting specific nerves or structures believed to be involved in migraine pathophysiology. While surgical options exist, they are generally reserved for severe cases of migraine that have not responded to other therapies. Here are some surgical treatments that have been explored for migraine:

Deep Brain Stimulation for Migraine

There are probably a number of different treatments available for headache which might not be helpful for many. This deep brain stimulation is a surgical procedure which works by targeting an area of the brain that is part of the pain pathway involved in headaches. A small amount of electrical current to the area is introduced, which helps to block the pain signals and reduce level of pain.

Non-Invasive Vagus Nerve Stimulation (nVNS)

Non-invasive vagus nerve stimulation (nVNS) is a treatment that involves using a handheld device to deliver electrical impulses to the vagus nerve through the skin on the neck. This stimulation can modulate pain pathways and inflammatory responses, helping to reduce the frequency, duration, and severity of migraine attacks. It is generally well-tolerated, with minimal side effects such as mild discomfort or tingling at the stimulation site.

Gamma Knife Radiosurgery

Gamma Knife radiosurgery is a form of stereotactic radiosurgery that uses focused beams of gamma radiation to target specific brain regions involved in migraine pathophysiology. This non-invasive outpatient procedure aims to disrupt pain pathways and neural circuits contributing to chronic migraines. While it is still experimental and primarily used for brain tumors, some studies suggest it may benefit patients with treatment-resistant chronic migraines, although potential risks include radiation-induced damage to surrounding tissues.

Occipital nerve stimulation (ONS)

Occipital nerve stimulation involves the implantation of electrodes near the occipital nerves, which are located at the back of the head. These electrodes deliver electrical impulses to the nerves, modulating their activity and potentially reducing migraine symptoms. While ONS has shown promise in some studies, its effectiveness can vary, and the procedure carries risks such as infection, lead migration, and device malfunction.

Peripheral nerve decompression surgery

This type of surgery involves identifying and releasing entrapment sites along peripheral nerves thought to be involved in migraine pathogenesis. Common sites targeted include the supraorbital, supratrochlear, and auriculotemporal nerves. By decompressing these nerves, surgeons aim to alleviate pressure and reduce migraine symptoms. However, the evidence supporting the efficacy of peripheral nerve decompression surgery for migraine is limited, and the procedure carries risks such as nerve damage and surgical complications.

Botulinum toxin (Botox) injections

While not a surgical procedure in the traditional sense, botulinum toxin injections are sometimes used as a treatment for chronic migraine. Botox is injected into specific muscle groups, typically in the forehead, temples, and neck, to prevent muscle contractions and reduce migraine frequency and severity. While Botox injections have been approved by regulatory agencies for the treatment of chronic migraine, their effectiveness can vary, and some individuals may experience side effects such as muscle weakness or injection site pain.

Surgical decompression of the trigeminal nerve

Some surgeons advocate for decompression of the trigeminal nerve, a major cranial nerve involved in sensory perception, as a treatment for migraine.

This procedure involves identifying and releasing sites of compression along the trigeminal nerve, which is thought to reduce migraine symptoms by alleviating pressure on the nerve and modulating its activity.

However, the evidence supporting the efficacy of trigeminal nerve decompression surgery for migraine is limited, and the procedure carries risks such as nerve damage and surgical complications.

In conclusion,

It’s important to note that surgical treatments for migraine are not considered first-line options and are typically reserved for individuals with severe, refractory migraine who have not responded to other treatments.

These procedures carry risks, and their effectiveness can vary from person to person. Individuals considering surgical treatment for migraine should discuss the potential benefits and risks with their healthcare provider and seek out a qualified surgeon experienced in performing these procedures.

Also individuals with migraine to work closely with their healthcare providers to develop a personalized treatment plan made to their specific needs and preferences. This may involve a combination of lifestyle modifications, medications, alternative therapies, and preventive strategies to effectively manage migraine symptoms and improve quality of life.