Description

• Neurobiologically based, common clinical syndrome characterized by recurrent episodic attacks of head pain
• The core features of migraine is headache, which is usually throbbing and often unilateral, and associated with nausea, vomiting, sensitivity to light, sound, and exacerbation with head movement
• Migraine has long been regarded as a vascular disorder because of the throbbing nature of the pain
• Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes, they begin earlier or later. Migraines may run in families. It occurs more often in women than men
• In approximately 25% of cases, patients experience an aura preceding the headache, which involves reversible focal neurologic abnormalities, e.g., visual field defects (scotomas) or paresis lasting less than an hour

Types

• Migraine is characterized by recurrent attacks and may occur with aura or without aura. A typical migraine attack passes through four stages, and the aura (if present) typically occurs before the headache. However, migraine patterns may differ and do not follow the characteristic stages

Prodrome (facultative)

• 24–48 hours before the headache starts
• Excessive yawning
• Difficulties with writing or reading
• Sudden hunger or lack of appetite
• Mood changes

Aura

• Paroxysmal, focal, neurologic symptoms that precede (or, in some cases, occurring during) the headache

Typical aura

• Visual disturbances, sensory and/or speech symptoms
• Scintillating scotoma : an arch-shaped scotoma that starts centrally and shifts peripherally (appears for 15–30 minutes)
• Central scotoma
• Flashing lights
• Distorted colour perception
• Fortification spectra: star-like, zigzag figures
• Impaired sensibility, paresthesia
• Aphasia
• No motor symptoms
• Develops gradually
• Completely reversible
• Symptoms last ≤ 60 minutes each

Atypical aura

• Dizziness
• Paresis
• Persistent or long-lasting symptoms

Headache

• Typically unilateral, but bilateral headache is possible
• Especially frontal, frontotemporal, retro-orbital
• Duration: usually 4–24 hours
• Progression of pulsating, throbbing, or pounding pain exacerbated by physical activity
• Accompanying symptoms: photophobia, phonophobia, and nausea/vomiting

Postdrome (facultative)

• Feeling of exhaustion or euphoria
• Muscle weakness
• Anorexia or food cravings

Investigation

• Clinical diagnosis based on history and clinical examination
• Exclude red flags that suggests a secondary headache (infection, haemorrhage, intracranial mass)
• Brain CT or MRI scan - if there is unusual symptoms with migraine, including weakness, memory problems, or loss of alertness
• EEG - to rule out seizures

Treatments

• There is no specific cure for migraine headaches. The goal is to treat migraine symptoms right away, and to prevent symptoms by avoiding or changing triggers

Lifestyle changes include

• Better sleep habits
• Better eating habits
• Not skipping meals and avoiding food triggers
• Managing stress

Medicines include:

• Antidepressants
• Beta blockers
• Anti-seizure medicines

Ayurvedic Treatment

Internal medicines

• Pathyashadanga Kashaya
• Drakshadi kashaya
• Varanadi Kashaya
• Saptasara kashaya
• Ashtavarga kashaya
• Vaiswanara Choorna
• Varanadi Gritha
• Sirasooladi vajra rasa
• Agni kumara rasa
• Trivrut lehya

Procedures

• Lepa – Rasnajambeera ,Vidanga + Krishna Tila + Bringaraja leaves, Marma gulika
• Jaloukavacharana - forehead
• Virechana - Gandharvaeranda
• Nasya - Varanadiksheera Gritha, Shadbindhu Taila ,Anutaila
• Shirodhara - Dhanwanthara Taila , Vatasini Taila
• Oil for head – Balahatadi, Asana vilwadi, Triphala Keram, Vilwampachottyadi

Department

Salakya - ENT