DR. MOHIT MATHUR Reader (Dept. of Medicine)
NHMC&H
What is Migraine?Repeated attacks of headache
Moderately or severely painfulFrequent or infrequentLast a few hours to a couple of days
Often only one side of the head hurtsOften experience loss of appetite, nausea,
and vomiting
World Federation of Neurology
What You Might Experience During an Attack
NauseaVomitingDiarrheaSweatingCold handsSensitivity to light
Sensitivity to soundScalp tendernessPale colorPulsating templePressure pain
Migraine headaches are often triggered by specific things
Triggers: Changes in Daily Cycles
Triggers: Environment or Diet
Triggers: Mental
DEACTIVATORS OF MIGRAINE
1.Sleep2.Exhiliratio
n3.Pregnancy 4.Sumatripta
n
1.2% 18.4%
47.2%
33.2%
Mild
Moderately severe
Severe
Extremely severe
National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
52%39%
9%
Need bed restCan work with some difficulty
Can work as normal
National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
In the past 3 months...
9 million
14 million
21 million
18 million
16 million Missed family or leisure activity
Functioned less than half as well at household chores
Were unable to do chores/household work
Functioned less than half as well at work/school
Missed Work or School
Migraine Takes Time Out From Your Life
Unnecessary SufferingMore than half of people with migraine suffer
for at least a year before they are diagnosed with migraine
38% suffer for 3 or more years
National Headache Foundation. American Migraine Study II: Migraine in the United States: Burden of Illness and Patterns of Treatment
MigraineMajor Forms:Migraine without aura (common) 70%Migraine with aura (classical) 25%Migraine variants and complicated migraine
5% Hemiplegic Migraine Basilar type migraine Ophthalmoplegic Migraine Retinal Migraine
Migraine without auraNo focal neurological disturbance precedes
the episodes of headache.Headache is of pulsating quality, unilateral
location and aggravated by walking stairs or similar routine activity.
Concomitant nausea, vomiting, photophobia and phonophobia.
Each episode last for 4 to 72 hrs.
Migraine with aura (classic migraine)Headache is associated with premonitory
sensory, motor, or visual symptoms.Most common premonitory symptoms are
visual: Scotomas in central portion of visual fieldHallucinations Fortification spectrum (paracentral scotoma
which expands into a “C” shape with luminous angles at the enlarging outer border)
1Migraine originates deep within the brain
2Electrical impulses spread to other regions of the brain.
3Changes in nerve cell activity and blood flow may result in visual disturbance, numbness or tingling, and dizziness.
4Chemicals in the brain cause blood vessel dilation and inflammation of the surrounding tissue
5The inflammation irritates the trigeminal nerve, resulting in severe or throbbing pain
Chronic Daily HeadacheAbout 4% of Americans have this condition20% to 40% of primary care headache
patients are affectedDefined as 15 or more headache days each
month
Chronic Daily HeadacheSome contributing factors:Frequency and duration of migraine attacksOveruse or misuse of certain medicines Other diseases (for example, depression or
anxiety)Life style or life events
Some Medications May Cause Migraine to Become ChronicMay cause chronic
headaches:OpiatesCombination
analgesicsCaffeineBarbiturate-containing
medicationsErgotamine tartrate,
isomethepteneTriptansOthers
Not clearly associated with chronic headaches:
AcetaminophenAspirinDihydroergotamineOthers
MANAGEMENT OF MIGRAINE
Self Treatment Efforts:What You Can Do For Your Migraines
RestBiofeedbackIce/heatMassageExerciseAvoid triggers
Seek treatment earlyKeep a headache
diaryTake medications as
directed by your doctor
Many options are available for migraine relief – ask your doctor what’s right for you
Protective FactorsRegular sleepRegular mealsRegular exerciseBiofeedbackHealthy lifestyle
The National Headache FoundationFor more information on headache causes
and treatments visit the National Headache Foundation (NHF) Web site at:
www.headaches.org
Acknowledgement: My sincere thanks to my friend Dr. Parduman Singh [MD, MRCP (I, UK), ABPN (USA), FLEX (USA), ABQEEG (USA), FAAN (USA),FAADEP (USA) CLINICAL PROFESSOR OF NEUROLOGY (OHIO UNIVERSITY COLLEGE OF MEDICINE, ATHENS, OHIO (USA)]