“I don’t want that explosion in my head as my father used to have,” says RameshN, 18-year-old BE student when he came to my OPD after a severe headache of 5-6 hours. He was upset since he had his exams in a few days and he was not able to concentrate due to the throbbing pain. We all have visited physicians many times with the complaint of a headache. Out of all the primary and secondary causes, migraine is the 2nd common cause of a headache.
A migraine is common in childhood, adolescence and early adulthood. It is ignored many times by parents citing it as a reason to avoid studies. A migraine is benign episodic, syndrome of a headache associated with other symptoms of neurological dysfunction. Most of the people have a positive family history of a migraine.
Classic triad seen in a migraine are
- Premonitory visual scotoma or scintillations, sensory or motor symptoms or
- Unilateral throbbing headache
A migraine attack lasts for around 4-7 hours & is relieved after a good sleep. It is difficult to predict as to when a migraine attack will occur. However one can predict the pattern of each attack as there are well-defined stages. Once you the know the stages of a migraine, and if a proper history is given to the doctor, a proper diagnosis can be reached and medication can be taken to reduce this effect.
Pre-motory Stage/ Aura: It includes certain physical or mental changes like mood changes, feeling thirsty, tiredness etc. It may last a few minutes or hours.
Aura: It includes a wide range of neurological symptoms like changes in the sight like dark spots, coloured spots, zigzag lines, Numbness, weakness, dizziness, vertigo, speech changes, confusion might also occur before a headache.
A headache: a headache is severe sometimes unbearable. Typically it is throbbing. It is unilateral but can be bilateral as well. One may feel nauseated or might vomit in this stage. Some people also become sensitive to light or sound.
Resolution: most of the attacks slowly fade away but some stop suddenly after crying or sleeping for some time. It can take hours for many people to restore or days for that feeling to disappear. It is like a hangover.
Simplified diagnostic criterion: Photphobia Repeated attacks of headaches lasting for 4-7 hours without physical examination & neurological investigation and no other cause found
- Unilateral pain
- Aggravated by movement
One can never be sure as to when the next episode would occur. However non- pharma many things can be done-
- Identify triggering factors and avoid those
- Some researches show avoidinghot, spicy food, fermented, sour foods helps
- One should avoid sun light as much as possible. If this cannot be stopped, one can wear glasses and hat to protect one’s self
- Certain yoga postures are extremely beneficial for migraine. Some of these are moon salutation, boat pose, bow pose (dhanurasan), spiral twist (matsyendrassana), tree pose and standing on toes
- Meditation reduces stress levels and brings a balance in one’s being.
- Pranayam (breathing exercises) has a long term impact in maintain good health
- 5 drops of brahmi ghee in each nostrils sometimes help relieve the pain