Migraine is characterized by moderate to severe headache accompanied by other signs such as nausea, vomiting, visual disturbances and sensitivity to light and sound

Migraine is a neurological phenomenon involving a wave of unusual nerve activity and altered blood flow in the brain

Pathophysiology

Definition

Genetic factors

• Almost 90% of patients have a positive family

history of migraine

Age

• Migraine may begin at any age as early as

adolescence

Gender

• Females are more likely to have migraine

than males after puberty

A number of Factors may trigger a Migraine attack

Hormonal changes

Some women experience migraine just before or during menstruation. Migraine generally improve after menopause. Although migraines may improve or aggravate variably during pregnancy

Food & Drinks

Cheese, salty , processed foods, chocolates. Skipping meals or fasting may also trigger attacks.

Alcohol, wine , caffeinated drinks may trigger attacks.

Stress Physical exertion or mental stress may also be triggers

Sleep deprivation

Sleep deprivation or any change in sleep pattern, oversleeping

MedicationsOral contraceptives , vasodilators are known to aggravate symptoms of migraine

Other FactorsExposure to bright flickering light, bright sunlightStrong odors, perfumes

typically described as throbbing /pulsating in character

moderate to severe in severity

often but not always confined to one side/part of the head

recurrent

self limiting

known to last for hours to days

associated with autonomic signs

preceded by “aura” in about 30% of patients

Headache which is..

Prodrome

•Some patients experience premonitory symptoms before the onset of aura or pain. These include depression ,

hyperactivity, constipation, irritability, neck stiffness, excessive yawning, sleepiness, excessive thirst, frequent

urination, craving for certain foods

Aura

•A spectrum of transient neurological phenomena that occur before or during headache. Visual changes such as flickering

lights, bright spots, jagged lights, visual loss. Sensory aurae such as sensation of pins and needles on arm or leg ,

numbness, spreading to one side of body. Speech and language difficulties and motor difficulties such as weakness of one

side of body may also occur. Auditory hallucinations or delusions may also occur. Migraine may occur without Aura

Pain•Pulsating pain usually begins over the eyes, spreading to one side of the head. Although at times the entire head

may be involved. Undue sensitivity to light, smell, and sound. physical activity, leaning forward may aggravate the

pain. Nausea and vomiting may also occur

Postdrome

•Weakness, tiredness may persist for a few days after headache though some patients may experience a sense of

euphoria

Migraine is known to progress through in four phases. Although not all the phases may necessarily be experienced by a particular patient

Migraine lasting

for 15 days or

more in a month

Migraine attack

lasting for more

than 72 hours

Persistent aura

without

infarction- Aura

lasting for more

than 7 days after

the attack has

passed

Risk of brain

infarct when

aura lasts for

more than one

hour

Chronic Migraine Status migrainosus Persistent aura Migrainous infarct

Beta blockers-dizziness, cold extremities, decreased libido, asthma aggravation

Tricyclic antidepressants-drowsiness, dry eyes, dry mouth

Serotonin antagonists-drowsiness, weight gain

Anti seizure drugs-nausea , tremor, weight gain, dizziness

NSAIDs-Gastrointestinal bleeding, ulcers

Triptans-nausea, dizziness, drowsiness, muscle weakness. contraindicated for people at risk for stroke and heart attacks

Opioids- habit forming

Preventive drugs and side effects

Pain relieving medication and side effects

Biofeedback-Patient is trained to gain awareness and

control over the body’s reaction to stress using

instruments to measure changes in muscle activity,

heart rate, temperature, sweat gland activity

accompanying changes in thoughts, emotions and

behaviour

Neurofeedback/EEG feedback- using sophisticated

equipment to measure brain electrical activity and re-

training it to practice healthier patterns of mood

regulation

Remedy Indications

GLONOINE Throbbing pain, from exposure to sun, heat., during menopausehead feels large, sensation as if skull is too small for brain

BELLADONNA Throbbing, pulsating headache worse from light, noise, jar, lying down, in afternoon

IRIS VERSICOLOR Headache accompanied by nausea, vomiting, heartburn. Nausea not relieved by vomiting .headache begins with blurring of vision,with visual disturbances. Headache in frontal area and right temple ,comes on after patient relaxes from a mental strain

EPIPHEGUS Affinity for left side of the head, headache settles over left eye, headache comes on due to mental exertion, exposure to sun, undue exertion, overwork, unaccustomed activity, profuse viscid salivation, pain better by sleep

NUX VOMICA gastric migraine, constipation, , bloating, flatulence, headache after eating rich fatty food, drinking alcohol

CIMICIFUGA Throbbing headache, associated with menstrual period, stiffness of neck, feeling of gloom, and despair, depression, ears sensitive to noise.

1Homoeopathic Management of Migraine

Remedy Indications

COCCULUS INDICUS Headache from loss of sleep, travelling, pain nape of neck, vertigo, nausea, visions, colors, shapes , black spots in front of eyes

CYCLAMEN Migraine accompanied by sparks before eyes

COFFEA Headache brought on after loss of sleep, or following excitement

PULSATILLA Headache associated with digestive upsets, after eating warm, rich, or fatty foods or ice cream. Nausea and vomiting frequently accompany headache. headaches with menstrual periods (before, during, or especially when the period ends) or those that result from a frightening experience. The pain is most often felt in the forehead or on one side of the head and may change location frequently. Throbbing accompanies the headache. Although walking briskly may make the pain worse, generally there is relief from gentle motion, especially walking about slowly in the open air

GELSEMIUM headaches begin at the back of the head, often extending to the rest of the head or to the forehead. The person may feel as though a band or hood were bound tightly around their head. But Gelsemium is also one of the fairly few homeopathic medicines that clearly suit headaches preceded by dimness of vision or other visual disturbances, symptoms of migraines. Localized pain on the right side of the head is also covered by this remedy. The Gelsemium headache is not much affected by changes of temperature, but other environmental factors (light, noise, motion, jarring) aggravate it. Napping or, curiously, urinating relieves the pain. The person feels dull, tired, heavy, and apathetic. exhausted. wants to be left alone.

2Homoeopathic Management of Migraine

Remedy Indications

SANGUINARIA headaches begins in the back of the head but extend to and soon settle over the right eye or in the right side of the head. . The pain is sharp, splitting, knifelike, and sometimes throbbing. Nausea and vomiting occur at the height of the pain, but unlike Iris headaches, those of Sanguinaria are relieved after vomiting. Motion aggravates the pain, whereas sleep and firm pressure relieve it., Sanguinaria suits headaches that recur with periodicity

SPIGELIA Headache in frontal or left side of the head increased by shaking and jarring ,movement, stooping, temporary relief by washing with cold water

NATRUM MUR. Headache semi-lateral, chiefly on left side, sensation as if hammers are knocking on brain, from grief, fright, anger , from sunrise to sunset, noise, warm room, mental exertion, relieved by sleep, open air, cold application. Patient is depressed, irritable, wants to be alone.

ONOSMODIUM headache with pain in eyeballs, vision affected , blurred objects seem distorted

3Homoeopathic Management of Migraine

1. Scutellaria Laterifolora Q Migraine, worse over right eye; aching in eyeballs.

Explosive headache of school teachers with

frequent urination.

2. Usnea Barbata Q Congestive headache. Bursting feeling, as if

temples would burst, or the eyes burst out of

sockets.

3. Epiphegus Q, 6C Migraine, pressing pain in temples from without

inwards; worse left side.

Viscid salivation, constant inclination to spit. Sick

headache when deviating from ordinary pursuits.

Headache preceeded by hunger.

4. Chionanthus Q Dull frontal headache, over root of nose, over eyes,

through temples, worse stooping, motion, jar.

5. Iris Versicolor Q, 6C Frontal headache, with nausea.

Right temples especially affected.

Sick headache worse rest; begins with a blur before

eyes, after relaxing from a mental strain.

Few Mother Tinctures which are very useful during Acute Migraine attacks

Regular sleep

Regular meals

Regular exercise

Avoidance of triggers such as dietary, caffeine, alcohol

Stress management with relaxation techniques

Dr Jithesh T.K, C.M.O

Dr Shirin Balan,C.M.O

Dr Pradip Kumar Roy, S.M.O

Dr K.N. Rama, S.M.O

Dr Anubha Sikka, M.O

Dr Deepti Chawla

C.M.O, Dte. of AYUSH

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