Migraine is one of the most common neurological illness in the world. It often goes underdiagnosed, under-recognized and undertreated. Patients suffering from migraine compromise on the good quality of life associated with decreased work productivity. So, it becomes necessary to have an idea whether the frequent headaches that you get is migraine or not/should you be consulting a Neurologist or not?
Migraine is defined as an episodic disorder with a severe headache associated with nausea and/or light and noise sensitivity. Many theories have been flouted in Neurology for the etiology of Migraine like genetic factors, Vascular factors, Migraine generator, cortical spreading depression, the involvement of trigeminocervical system and hyperexcitable brain.
There are 2 types of migraine-Acute and Chronic Migraine. Acute migraine lasts anywhere between 4 -72 hours. Chronic migraine is having a headache for 15 days in a month for more than 3 months.
Migraine typically presents with prodromal symptoms which include fatiguability, irritability, noise & light sensitivity, excessive yawning and thirst. This is followed by the migraine aura which includes visual, motor, sensory, language and brainstem manifestations. All the symptoms felt during aura are fully and completely reversible in a span of 60 minutes. Visual aura is seeing wavy lines and flashing lights. Sensory aura is usually unilateral, involves the hand, arm, shoulder and face.
It can be felt as a tingling sensation or benumbed sensation in the aforementioned body parts. Language aura is of mild severity and includes the wrong usage of a word or using a word that does not exist commonly called paraphasic errors. Motor aura involves transient weakness of the hand and arm mostly. Migraine with brainstem aura consists of a combination of visual, sensory, and language symptoms with at least two brainstem symptoms including Slurring of speech, vertigo, ringing or buzzing sensation in the ears, double vision, imbalance and decreased level of consciousness. Some patients do not present with aura and end up directly with a headache. On the other hand, few patients present only with the aura, without the headache. The aura is followed by unilateral throbbing headache in the majority of patients through bilateral headache may also be present. After the post dromal period patients usually have a migraine hangover wherein, they feel extremely tired and wrung out.
Many patients can identify their migraine triggers. Exposure to a trigger ends up precipitating a migraine attack. Triggers can be sunlight, weather factors, coffee, chocolate, missed meals, emotional stress, menstruation, sleep disturbances, strong odors, alcohol, visual stimuli, muscle tension and physical exercise.
Management of migraine involves lifestyle modification, abortive and preventive treatment. Lifestyle modifications include maintaining a headache diary, timely food intake, adequate sleep, identifying and avoiding migraine triggers. Headache diary includes frequency of headaches in a week, nature of pain, duration of headache, precipitating and relieving factors. Abortive treatment is to give immediate relief of headaches and includes the usage of paracetamol, NSAIDs and triptans.
Preventive treatment reduces the frequency of migraine attacks and gradually prevents them. Triptans, beta-blockers, anti-depressants and anti-epileptics are some of the drugs used to prevent migraine attacks. In order to achieve better patient compliance triptans are available as nasal sprays and orally disintegrating strips. Botox injections are another mode of treatment for chronic migraines. Recently monoclonal antibodies were introduced as a form of treatment for migraines.
Dr. Shubha Subramanian, MBBS, MD, DM (Neurology), is an associate consultant, Neurology, Dr. Rela Institute & Medical Centre, Chennai