Migraines are no ordinary headaches. In fact, while the terms 'headache' and 'migraine' are sometimes used interchangeably, they aren't synonymous. In an interview with HT Lifestyle, Dr Shivananda Pai, consultant, neurology, KMC Hospital, Ambedkar Circle, Mangalore said that the hallmarks of migraines include symptoms such as blurred vision, eye pain and much more. 

What is migraine?

Dr Pai said, “A migraine is a common headache often accompanied by nausea, vomiting, and sensitivity to light. It typically causes throbbing pain on one side of the head. Some people experience an aura — vision disturbances or other warning signs — before the headache begins.”

Dr Nitika Mahajan, MD (medicine), DM (neurology), consultant neurologist, Livasa Hospital, Khanna further told HT Lifestyle, “Migraine episodes can persist for several hours to days, and the severity of the pain can significantly disrupt daily activities.”

Dr Pai added that migraines occur more often in women than men, and may run in families. In fact, according to Dr Pai, some women, but not all, may have fewer migraines when they are pregnant.

According to Dr Vamsi Chalasani, consultant, neurology, Manipal Hospital, Vijayawada, migraine 'is the most common neurological disorder characterised by recurrent, often severe headaches, typically on one side of the head'.

Dr Chalasani told HT Lifestyle, “It may be accompanied by nausea, vomiting, photophobia, and phonophobia. It is triggered by hormonal changes, stress, lack of sleep, and weather changes. Migraine pain is a neuroinflammatory pain involving neuronal hyperexcitability, trigeminal nerve activation, CGRP-mediated vasodilation, and brain sensitisation.”

What causes migraine pain?

According to Dr Mahajan, there are several known triggers for migraines. She said, “Hormonal changes, particularly fluctuations in estrogen levels, can lead to migraines in women, especially before or during menstrual periods, during pregnancy, and around menopause. While hormonal medications like oral contraceptives may worsen migraines for some, others find that these medications reduce their frequency. Certain beverages, particularly alcohol (especially wine) and excessive caffeine intake, such as from coffee, can also trigger migraines.”

Moreover, sensory stimuli like bright or flashing lights, loud noises, and strong odours — such as perfumes, paint thinner, and secondhand smoke — can provoke migraines in some individuals, she added. Irregular sleep patterns, whether due to insufficient sleep or oversleeping, may also lead to migraines.

Dr Mahajan said, “Physical exertion, including intense activities and sexual activity, can provoke migraines as well. Lastly, food additives and preservatives, including monosodium glutamate (MSG) found in various foods, can also be migraine triggers. Most importantly, stress not only triggers migraines but can also exacerbate them.”

On an emotional level, stress contributes to negative thinking, anxiety, and tension, all of which can intensify migraine pain, she said. “This creates a vicious cycle: stress triggers migraines, and the resulting migraines lead to increased stress, resulting in more frequent and severe attacks. Understanding these triggers can help individuals manage their migraine symptoms more effectively,” Dr Mahajan said.

Dr Pai added that migraine attacks may be triggered by the following:

* Alcohol

* Allergic reactions

* Bright lights

* Certain odors or perfumes

* Changes in hormone levels (which can occur during a woman's menstrual cycle or with the use of birth control pills)

* Changes in sleep patterns

* Exercise

* Loud noises

* Missed meals

* Physical or emotional stress

* Smoking or exposure to smoke

What are the symptoms of migraine aura?

Dr Mahajan said that some individuals experience a warning sign known as an aura, which may occur before or during the headache: “An aura manifests as visual disturbances, like flashes of light or blind spots, or other sensations, such as tingling on one side of the face or in an arm or leg, and difficulties with speech.”

Dr Pai added, “Vision disturbances, or aura, are considered a 'warning sign' that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following: a temporary blind spot, blurred vision, eye pain, seeing stars or zigzag lines, tunnel vision.”

In addition to taking medication, doctors recommend avoiding bright lights, noises, and certain smells, which can exacerbate migraine symptoms. When migraine symptoms begin, Dr Pai suggests you:

* Drink water to avoid dehydration, especially if you have vomited

* Rest in a quiet, darkened room

* Place a cool cloth on your head

How to knock out a migraine attack?

Dr Chalasani said that migraine treatments are broadly divided into abortive and preventive treatments. Abortive therapy includes treatment with NSAIDs, Triptans, and Ergot medicines. Asked about what are the most effective migraine treatments, Dr Mahajan said there is no universal treatment for migraines, but various strategies can help prevent and alleviate symptoms.

“Common treatment options include over-the-counter medications, which should be taken under the guidance of a healthcare professional to help reduce pain,” she said, and added, “Additionally, relaxation techniques like meditation and yoga promote relaxation and are known to help relieve pain. Staying well-hydrated by drinking plenty of fluids, including herbal teas, can also assist in managing migraine symptoms. It is important to identify and avoid specific triggers, such as certain foods, strong odours, and bright lights, to help prevent migraine episodes.”

Here's what Dr Pai suggests:

* Antidepressants such as amitriptyline

* Blood pressure medicines such as beta-blockers (propanolol) or calcium channel blockers (verapamil)

* Seizure medication such as valproic acid, gabapentin, and topiramate

* Selective norepinephrine uptake inhibitor (SNRIs) such as venlafaxine

* Botulinum toxin (Botox) injections may also help reduce migraine attacks

Can migraine attacks be prevented?

Dr Mahajan said, “A major new study released by The Lancet Neurology shows that, in 2021, more than 3 billion people worldwide were living with a neurological condition. One of the top 10 neurological conditions contributing to loss of health in 2021 was migraine. Thus, one must take measures to prevent this condition. Stay away from migraine triggers, such as particular meals, potent smells, and bright lights, to prevent migraines.”

She added: Keep a regular sleep schedule and drink lots of water to stay properly hydrated. “Frequent exercise can enhance general well-being and assist in lowering stress. To control your stress levels, try deep breathing exercises, yoga, or meditation. To keep track of trends and triggers, think about maintaining a migraine journal. For individualised guidance and possible preventive medicine, speak with a healthcare provider as well. The frequency and intensity of migraine attacks can be considerably decreased by adopting these lifestyle changes,” Dr Mahajan said.

Dr Chalasani shared that preventive therapy includes options like beta-blockers, antiepileptics, and antidepressant drugs. “Now, there are newer options like monoclonal antibodies, which act against CGRP and are very effective in the treatment of migraine. In cases of refractory migraine, Botox can be used for the relief of migraine. Migraine treatment requires a holistic approach in reducing the burden along with lifestyle modification to prevent migraine,” Dr Chalasani said.

Here's what Dr Pai suggests:

* Avoid smoking

* Avoid alcohol

* Avoid artificial sweeteners and other known food-related triggers

* Get regular exercise

* Get plenty of sleep each night

* Learn to relax and reduce stress- some patients have found that biofeedback and self-hypnosis help reduce the number of migraine attacks

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