Introduction
Migraine is a medical condition that involves severe, recurring headaches and other symptoms. Before the headache, there may be sensory changes that are known as an aura. A migraine episode is different from a headache unrelated to migraine. An episode usually occurs in stages and can last for several days. It can affect a person’s daily life, including their ability to work or study. A person may experience physical and sensory symptoms before a migraine episode starts. How migraine affects people can also vary. There is a range of triggers, severity, symptoms, and frequency. Some people have more than one episode each week, while others have them only occasionally.
Signs & symptoms
Symptoms of migraine tend to occur in stages:
Before the headache: According to older research, around 20-60% of people experience symptoms that start hours, or possibly days, before the headache. These include physical and sensory symptoms, such as aura.
During the headache: Alongside a mild to severe throbbing or pulsing headache, symptoms may include nausea, vomiting, and nasal congestion.
Resolution: Tiredness and irritability may last another 2 days, and this period is sometimes called the “migraine hangover.”
Other common features are:
- head pain that worsens during physical activity or straining
- an inability to perform regular activities due to pain
- increased sensitivity to light and sound that lying quietly in a darkened room relieves
Other symptoms may include sweating, temperature changes, a stomach-ache, and diarrhoea.
Causes
Experts do not know what causes migraine episodes. They may begin from changes in the brain that affect the:
- way nerves communicate
- balance of chemicals
- blood vessels
Genetic factors play a role, as having a family history of migraine is a common risk factor.
Migraine triggers vary but include:
- Hormonal changes, for example, around the time of menstruation.
- Emotional triggers, such as stress, depression, anxiety, and excitement.
- Dietary factors, including alcohol, caffeine, chocolate, cheese, citrus fruits, and foods containing the additive tyramine.
- Medications, such as sleeping pills, hormone replacement therapy (HRT), and some birth control pills.
- Environmental factors, including flickering screens, strong smells, second hand smoke, loud noises, stuffy rooms, temperature changes, and bright lights.
Some other possible triggers include:
- tiredness
- a lack of sleep
- shoulder and neck tension
- poor posture
- physical overexertion
- low blood sugar
- jet lag
- irregular mealtimes
- dehydration
Risk factors
Anyone can develop migraine, but it is more common in people with any of the following:
- depression
- bipolar disorder
- fibromyalgia
- irritable bowel
- an overactive bladder
- sleep disorders
- obsessive-compulsive disorder
- anxiety
Migraine is an inherited, episodic disorder involving sensory sensitivity. Patients complain of throbbing type of headache, but there is no reliable relationship between vessel diameter and the pain, or its treatment. They complain of discomfort from normal lights and the unpleasantness of routine sounds. Some mention that otherwise pleasant odours are unpleasant. Normal movement of the head causes pain, and many mention a sense of unsteadiness. The ophthalmic division of the trigeminal nerve subserves sensation within the cranium and perhaps underpins why the top of the head is headache, and the maxillary division is “facial pain.” The convergence of cervical and trigeminal afferents explains why neck stiffness or pain is so common in primary headache. The genetics of channelopathies is opening up a plausible way to think about the episodic nature of migraine. Perhaps, electrophysiological changes in the brain have been mislabelled as “hyperexcitability,” whereas dishabituation might be a simpler explanation.
Surrounding the large cerebral vessels, pial vessels, large venous sinuses and dura mater is a plexus of largely unmyelinated fibres that arise from the ophthalmic division of the trigeminal ganglion and in the posterior fossa from the upper cervical dorsal roots. Trigeminal fibres innervating cerebral vessels arise from neurons in the trigeminal ganglion that contain substance P and calcitonin gene-related peptide (CGRP), both of which can be released when the trigeminal ganglion is stimulated. Stimulation of the cranial vessels, such as the superior sagittal sinus (SSS), is certainly painful. Human dural nerves that innervate the cranial vessels largely consist of small diameter myelinated and unmyelinated fibres that almost certainly subserve a nociceptive function. Some studies say it seems likely that the trigemino-vascular system and its cranial autonomic reflex connections, the trigeminal–autonomic reflex, act as a feed-forward system to facilitate the acute attack, the fundamental problem in migraine is in the brain.
Types
There are various types of migraine. According to whether aura, or sensory changes.
Migraine with aura
Aura is a disturbance of the senses in the early stages of an episode. It can act as a warning that a migraine headache is approaching.
Aura can involve:
- having confusing thoughts or experiences
- seeing strange, sparkling, or flashing lights that are not there
- seeing zig-zagging lines of light
- having blind spots or blank patches in the vision
- feeling pins and needles in an arm or leg
- having difficulty speaking
- having weakness in the shoulders, neck, or limbs
- seeing things that are not there out of one eye, such as transparent strings of objects
- not being able to see part of something clearly
- having part of the field of vision disappear, then reappear
Aura may feel similar to the sensation that follows exposure to a very bright camera flash, but the visual changes can last for several minutes or up to an hour.
Migraine without aura
More commonly, a person experiences no sensory disturbances before an episode.
According to the Migraine Trust, 70–90% of episodes occur without aura.
Other types
Other types of migraine include:
- Chronic migraine:Â This involves having an episode on more than 15 days per month.
- Menstrual migraine:Â This occurs in a pattern that follows the menstrual cycle.
- Hemiplegic migraine:Â This type causes temporary weakness on one side of the body.
- Abdominal migraine:Â This involves migraine episodes linking with irregular function in the gut and abdomen, often with nausea or vomiting. It mainly affects children under 14 years of age.
- Vestibular migraine: Severe vertigo is a symptom of this form of migraine.
- Basilar migraine: This rare type is also known as migraine with brainstem aura, and it can affect neurological functions, such as speech.
There is the international “5, 4, 3, 2, 1” criteria to diagnose migraine without aura. This number series stands for:
- having five or more attacks, each with a duration of 4 hours to 3 days
- the headache having at least two of the following qualities:
– occurring on one side
– pulsating
– causing moderate-to-severe pain aggravated by activity - having at least one additional symptom, such as:
– nausea
– vomiting
– sensitivity to light
– sensitivity to sound
Imaging tests to rule out other causes, such as a tumour.
Treatments
There is no cure for migraine.
Medications can help reduce the symptoms.
Also, preventive measures can help reduce the frequency and severity of episodes.
Medications
Pain relief and other types of medication can often help. Taking medication as soon as symptoms start may keep them from becoming severe.
Some over-the-counter pain relief medications that may benefit people with migraine include:
- naproxen
- ibuprofen
- acetaminophen
Other options include:
- triptans, such as sumatriptan, to help reverse the brain changes that cause migraine
- antiemetics to manage any nausea and vomiting
- gepants, which block a protein involved in inflammation and pain called calcitonin gene-related peptide (CGRP)
- ditans, which interact with 5-HT1F receptors on the sensory nerves and blood vessels
It is important not to overuse medication, as it can cause a rebound headache. So, it is important to use safe and effective medication.
Prognosis
Migraine is a chronic disease with a variable and long-term prognosis. In many, migraine may have a very benign (complete remission) or relatively benign (partial remission) prognosis. In some, migraine persists and in others, it progresses.
Complications
- Chronic migraine.
- Migraine-triggered seizures.
- Cerebral infarction related with migraine (stroke with migraine)
- Persistent aura (e.g., 30–60 minutes) without infarction.
- Migraine can also bring on episodic syndromes including motion sickness, sleepwalking, sleep talking, night terrors, and teeth grinding.
- Abdominal pain, cyclical vomiting, and vertigo.
- Medicine overuse headache (Rebound headache)
- Serotonin syndrome
Disease & Ayurveda
Ardhavabhedaka
Nidana
Dry food intake & excessive food intake
Wind from east side
Causative factors for the vitiation of Vaata
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors, the vitiated Vaata travels in abnormal paths in the body. When it gets lodged in the head along with any obstruction inside the channels in the head and vitiated Kapha, the headache on that area manifests.
Lakshana
Severe cutting or stabbing type of pain in one side of the head
Happens in every ten or fifteen days
The headache can develop at any time
After some hours or a day, it subsides on its own.
Divisions
Not mentioned
Prognosis
Yaapya in chronic cases
Chikithsa
Samana
Lepanam with Soolahara dravyas
Swedanam
Aamapachanam
Agnideepanam
Intake of jeernaghrutam
Sodhana
Avapeedanasyam
Uttamammtrasnehapanam with Chatu:sneham
Sirovirechananasyam
Kaayavirechanam
Upanaha
Sirovasti
Nadeeswedam
Asthapanavasti
Anuvasanavasti
Commonly used medicines
Varanadi kashayam
Pathyakshadhatryadi kashayam
Sirasoolari vajrarasam
Dadimashtaka Churna
Chitrakadi Kashayam
Triphala Churna
Rasnadi choornam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There is no cure for migraine at home but some measures can be helpful to lessen the suffering due to migraine.
- using flexible cold packs or masks
- staying in a quiet, darkened room
- sleeping, when necessary
- herbal extracts, like jatipatri, karpoora and turmeric
- acupuncture
- neck exercises
A migraine episode is often a response to a trigger. To figure out the culprit, a person might try keeping a diary and recording what they did, ate, and drank before an episode.
It may be particularly helpful to avoid:
- low blood sugar
- physical overexertion
- stress
- certain foods, such as chocolate and any that contain tyramine
- certain medications, like some birth control pills
- bright lights and flickering screens
The following strategies can also help reduce the frequency of migraines:
- getting enough rest and sleep
- reducing stress
- drinking plenty of water
- improving posture
- avoiding dietary triggers, such as caffeine, alcohol, and cheese
- exercising daily
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, cause obstruction in channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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