Overview#
Migraine is a neurological condition characterised by recurrent episodes of moderate-to-severe throbbing headache, usually on one side of the head, often accompanied by nausea, vomiting, and sensitivity to light and sound. It affects approximately 15-20 % of the Indian population, with women being three times more likely to suffer than men. Migraine is the second leading cause of disability globally, yet it remains underdiagnosed and undertreated in India, often dismissed as "just a headache."
Causes & Risk Factors#
- Neurovascular mechanism – abnormal brain activity affects nerve signalling, blood flow, and chemical balance, particularly serotonin and CGRP (calcitonin gene-related peptide).
- Genetic predisposition – if one parent has migraine, there is a 50 % chance the child will too.
- Hormonal fluctuations – menstrual migraine is common; oestrogen drops before periods trigger attacks.
- Triggers – stress, sleep deprivation, skipping meals, bright lights, strong odours, weather changes, and specific foods.
- Common food triggers in India – aged cheese, chocolate, citrus fruits, fermented foods (idli/dosa batter if over-fermented), MSG (ajinomoto), alcohol (especially red wine).
Signs & Symptoms#
- Intense, throbbing or pulsating headache – typically one-sided
- Nausea and/or vomiting
- Sensitivity to light (photophobia) and sound (phonophobia)
- Visual aura (in 25-30 % of patients) – flashing lights, zigzag lines, or temporary vision loss appearing 20-60 minutes before the headache
- Neck stiffness and pain
- Fatigue and difficulty concentrating
- Tingling or numbness in the face or hands (sensory aura)
- Episodes lasting 4-72 hours if untreated
Diagnosis#
Migraine is a clinical diagnosis based on symptoms and history. There is no specific blood test for migraine.
- ICHD-3 Criteria – at least 5 attacks with headache lasting 4-72 hours, with at least 2 of: unilateral, pulsating, moderate-severe intensity, aggravated by activity; plus at least 1 of: nausea/vomiting or photophobia/phonophobia.
- Brain MRI – ordered only if atypical features are present (sudden onset, focal neurological deficits, first migraine after age 50) to rule out secondary causes.
- Blood tests – to rule out thyroid disorders, anemia, or vitamin deficiencies that may worsen headaches. Book Thyroid Profile, Book CBC
Treatment Options#
Acute treatment (during an attack):
- Triptans (sumatriptan, rizatriptan) – the most effective migraine-specific treatment. Take at the first sign of headache.
- NSAIDs (ibuprofen, naproxen) – effective for mild-moderate attacks.
- Anti-emetics (domperidone, ondansetron) – for associated nausea.
- Avoid overusing painkillers (> 10 days/month) – this causes medication-overuse headache.
Preventive treatment (if ≥ 4 attacks/month):
- First-line: Propranolol, amitriptyline, topiramate, flunarizine (widely used in India).
- CGRP monoclonal antibodies (erenumab, fremanezumab) – newer, highly effective targeted therapies.
- Botox injections – for chronic migraine (≥ 15 headache days/month).
Lifestyle management:
- Maintain a regular sleep schedule – both too little and too much sleep trigger migraine.
- Stay hydrated and eat regular meals; do not skip breakfast.
- Practice stress management through yoga, pranayama, and progressive muscle relaxation.
Prevention#
- Keep a headache diary to identify personal triggers and patterns.
- Sleep 7-8 hours at consistent times – avoid sleeping late on weekends.
- Exercise regularly (30 minutes, 5 days/week) – exercise reduces migraine frequency by 40-50 %.
- Limit screen time and use blue-light filters, especially in the evening.
- Stay well-hydrated, especially in hot Indian summers – dehydration is a common trigger.
When to See a Doctor#
Consult a neurologist if you have more than 4 headache days per month, if headaches are worsening in frequency or severity, or if over-the-counter painkillers are not providing relief. Seek emergency care for "thunderclap headache" (worst headache of life with sudden onset), headache with fever and stiff neck, headache after head injury, or headache with weakness, vision loss, or speech difficulty.