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Migraine- What? When? How to manage?

Dr. Sreenivas U.M.,MD (Int. med.), DM (Neuro), FEBN, SCE (UK), Consultant Neurologist, Arunai Neuro Centre and Research Foundation, Saligramam, Chennai

Migraine is a common type of headache which is classified as primary headache, i.e., a headache which occurs without any specific cause. It can affect anyone at any one at any age, from children to elderly, and both men and women. It is extremely common with 1 in 5 women and 1 in 16 men suffering from migraine.

There is a distinct inherited element to migraine, with at least one family member affected, but there is no recognised gene for migraine. If one parent is affected, there is a 50% risk of a child having migraine, and if both parents are affected, this risk increases to 75%.

Migraine presents as a headache, which can present anywhere over the head, typically with a pulsating quality and associated with nausea, photophobia, and photophobia. Some people can have preceding neurological symptoms, lasting up to an hour, called “aura.” This is commonly with flashing lights or blurring of vision. Migraine attacks can last anywhere from 4 hours to 72 hours at a time and improves with sleep. Common triggers of migraine include lack of sleep, hunger, sun exposure and excessive screen time.

There are certain ways to improve quality of life in migraine without resorting to medication, including changes to lifestyle. Regular exercise, regular sleep and reduced screen time has been shown to reduce frequency of attacks.

Certain foods such as cheese contain a compound called tyramine, which can be a trigger for migraine. Other foods which can trigger migraine include alcohol, cured meats, chocolate, and caffeine. Avoiding high sodium processed foods is an effective way to reduce frequency of migraine attacks. Unfortunately, fasting can be a trigger for migraine as well. Eating regular small meals or healthy snacks is a clever way to avoid migraines.

Anxiety and stress are known triggers for migraine. Many people with migraines also suffer from depression. This makes behavioural therapy a key component of migraine management. Psychologists can help with migraine prevention by various methods such as cognitive behavioural therapy, relaxation training and biofeedback training.


Migraine presents differently in children and can be easily misdiagnosed. It can present as just vomiting and is one of the causes of poor scholastic performance. Early recognition and proper treatment can aid in the cognitive, physical, and psychological development of children.

Women suffer from more severe attacks than men. Hormonal imbalance during perimenopause leads to an increase in frequency of attacks. This can be managed by hormone replacement therapy. A healthier lifestyle can be helpful in reducing the frequency of attacks at any age. There are treatment options which are safe for women of childbearing age. There are newer modalities of treatment which do not use medications and work by neuromodulation for management of migraines. These have been proven to be safe in pregnancy and lactation.

Many of us can suffer from migraine without being aware of the diagnosis. If you have ever had to take a day off work due to headache, it is time for you to


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