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)]