The headache can be associated with nausea, vomiting, dizziness and often it associates with stimuli or a precursor like bright light, loud sounds, movement, food patterns and certain food varieties (Skipping meals, alcohol, cashew, chocolates), stress, sleep(less or too much),hormonal factors(menstrual migraine, oral contraceptive use, menopause),changes in weather etc.
Frequent episodes can be very stressful and can transform into chronic daily headache. Genetic factors also play a part in causing this migraine.
According to clinical features migraine can be divided in to migraine with aura and migraine without aura. Aura is the feeling and some focal neurological signs of someone who is about to get a migraine episode. It can be a visual aura like flashing of lights, seeing zigzag lines, fragmentation of images, patches of loss of vision or other sensory symptoms like tingling sensation, deficiency of generation of words (dysphasia) or loss of motor functions etc. The aura can be varying from person to person. Aura is typically resolves over 5-20 minutes. There are diagnostic criteria based on clinical features of migraine that can be used as an aid when diagnosing the disease.
Diagnostic criteria of migraine
Headache lasting 4 hours to 3 days
At least 2 of:
- Unilateral pain(may become generalized later in the attack)
- Throbbing type pain
- Moderate to severe intensity
- motion sensitivity(headache worse with head movement or physical activity)
At least one of:
- Nausea/vomiting
- Photophobia/phonophobia
- Normal examination and no other cause of headache
Sleep usually helps with relieving the pain. In some patients scalp may be painful to touch during episodes and most of the patients prefer a dark, quite environment during an episode.
Hemiplegic migraine is a rare autosomal dominant type of migraine which can cause hemiparesis and/or coma with recovery within 24 hours. Some will have permanent residual cerebellar signs.
Management
- Avoidance of triggers of headache
- Life style modifications-Go to sleep and wake up at the same time of the day, aerobic exercises, regular meals, proper hydration, healthy diet, live in a calm environment, meditation, listning to soothing music
- Analgesics(pain killers)-High dose dispersible aspirin, paracetamol, non-steroidal anti-inflammatory drugs
- Antiemetic-metoclopramide
- Triptans-sumatriptan, zolmitriptan, rizatriptan
Acute medications (analgesics, antiemetic) should be taken as soon as possible but overuse of analgesics can cause medication overuse headache. When migraine episodes are more frequent (more than 1-2 episodes per month), massively impact on quality of life the migraine suppression drugs are considered. 3-6 month period of migraine suppression drugs are usually sufficient to reduce the headache frequency and intensity.
