Migraine: Causes, Types & Effects

What is a Migraine?

A migraine is a headache often characterised by severe, throbbing pain or a pulsating sensation on one side of the head. In addition to the headache, the patient often experiences nausea, vomiting, and acute sensitivity to light and sound. A migraine episode may last for many hours or even days, significantly impacting a person's day-to-day life and activities.

What are the Types of Migraine?

Migraines can be classified by frequency and the symptoms they present alongside the headache.

Migraine with Aura In this type of migraine, certain migraine symptoms, such as visual problems, speech difficulties, and altered sensations, begin before the actual headache.
Migraine Without Aura No symptoms appear before the headache, and the attack may last for a few hours to 3 days. The frequency of these attacks may vary, with episodes occurring a few times a week or once a year.
Chronic Migraine Chronic migraine refers to a condition in which a person experiences long-lasting episodes of headache. In this condition, symptoms vary daily and may even change every hour.
Basilar-Type Migraine This type of migraine develops gradually and occurs before or with a typical headache. This type of migraine is also known as migraine with brainstem aura.
Abdominal Migraine This type of migraine usually affects children and some adults. The condition is characterised by severe abdominal pain, with no headache. Abdominal migraine subsides as the child grows, and there may be a chance that an individual experiences migraines as an adult.
Hemiplegic Migraine In this condition, during a migraine attack, the person experiences temporary weakness on one side of their body.
Menstrual Migraine In this condition, during a migraine attack, the person experiences temporary weakness on one side of their body.

How Common is Migraine in India?

Migraine is a common neurological disorder in India and have been affecting the lives of many people. The global prevalence of the condition is estimated at 14.7%, but studies from India show a range of 14.12% to 28.99%. This accounts for almost 213 million cases every year. Further, research suggests that the total economic burden in India, accounting for the large number of migraine cases, is ₹18,674 crores. These figures not only highlight the commonality of migraine in India, but also the socio-economic burden it puts on the country.

Symptoms of Migraine

Migraine is a recurring neurological condition that can cause moderate to severe headaches, often accompanied by other symptoms. A migraine attack typically lasts 4 hours to 3 days. Symptoms may begin hours or even up to two daysbefore the headache and, in some cases, continue after the pain subsides. However, not everyone experiences every phase or symptom of a migraine attack.

Head Pain and Sensory Symptoms	Aura and Associated Symptoms
Recurrent headache lasting 4-72 hours, often on one side of the head, with a pulsating or throbbing quality Pain that is moderate to severe in intensity and worsens with routine physical activity such as walking or climbing stairs Nausea and vomiting that can make eating, drinking, or taking oral medicines difficult Sensitivity to light that causes a strong preference for a dark room during an attack	Visual disturbances before or during the headache, such as flashing lights, zig-zag patterns, blind spots, or temporary vision loss Sensory symptoms, speech or language difficulties, motor symptoms, brainstem symptoms, or retinal symptoms, depending on the migraine subtype Feeling very tired or other premonitory symptoms in the hours before head pain begins In some people, aura symptoms occur without any headache, sometimes called silent migraine

Head Pain and Sensory Symptoms

Aura and Associated Symptoms

Recurrent headache lasting 4-72 hours, often on one side of the head, with a pulsating or throbbing quality
Pain that is moderate to severe in intensity and worsens with routine physical activity such as walking or climbing stairs
Nausea and vomiting that can make eating, drinking, or taking oral medicines difficult
Sensitivity to light that causes a strong preference for a dark room during an attack

Visual disturbances before or during the headache, such as flashing lights, zig-zag patterns, blind spots, or temporary vision loss
Sensory symptoms, speech or language difficulties, motor symptoms, brainstem symptoms, or retinal symptoms, depending on the migraine subtype
Feeling very tired or other premonitory symptoms in the hours before head pain begins
In some people, aura symptoms occur without any headache, sometimes called silent migraine

Related Diseases Comparison

Migraine can look similar to other types of headaches, like tension headaches or cluster headaches. Knowing the differences can help you get the right treatment.

Migraine vs Tension-Type Headache vs Cluster Headache

Basis of Comparison	Migraine	Tension-Type Headache	Cluster Headache
When it Happens?	Recurrent attacks lasting 4-72 hours; chronic migraine involves headache on at least 15 days per month for more than 3 months.	Episodes may last from 30 minutes to 7 days and are not usually worsened by routine activity.	Attacks last 15-180 minutes and may occur from once every other day to 8 times per day during cluster periods.
Location	Often one-sided with pulsating, moderate-to-severe pain that may vary between attacks.	Usually felt on both sides of the head, with a pressing or tightening quality that is mild to moderate.	Strictly one-sided pain centred around the eye, above the eye, or at the temple.
Associated Symptoms	Nausea, vomiting, sensitivity to light and sound, and sometimes aura symptoms such as visual disturbances.	Photophobia or phonophobia may occur, but not both together; nausea and vomiting are absent.	Ipsilateral eye redness or watering, nasal congestion or runny nose, eyelid swelling, sweating, miosis, ptosis, or restlessness and agitation.
Severity	Moderate to severe pain that is aggravated by routine physical activity, often interrupting daily activities.	Mild to moderate pain that is not aggravated by routine activity such as walking or climbing stairs.	Severe or very severe pain, frequently accompanied by restlessness or agitation during attacks.
Can it be Reversed?	Not cured in most recurrent cases, but attacks can be treated and preventive therapy aims to reduce frequency and severity.	Symptoms are usually managed with appropriate acute care and prevention when frequent.	Attacks can be aborted and cluster periods may remit, but the disorder may recur episodically or become chronic.

Medicines Used to Treat Migraine

There is no permanent cure for migraine, but it can be managed. Treatment can help control attacks and prevent them from returning as often.

Simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), such as paracetamol, aspirin, ibuprofen, and naproxen
Triptans, such as sumatriptan, rizatriptan, and zolmitriptan
Antiemetics, such as metoclopramide and prochlorperazine
Beta-blockers, such as propranolol
Antiseizure medicines, such as topiramate, sodium valproate, and divalproex
Tricyclic antidepressants, such as amitriptyline
Calcium-channel blockers, such as flunarizine
Botulinum toxin type A

Living with Migraine in India: Daily Challenges, Work, and Well-being

Living with migraine in India can affect your work, family life, and mental health. But with the right treatment and support, you can manage daily life better.

Daily Challenges Migraine attacks can make it hard to work, study, or do household chores. The pain, nausea, and sensitivity to light or sound can last for hours or days. On these days, it is difficult to do your usual activities or be productive. For working adults in India, how often and how severe the attacks are, and how easy it is to get healthcare, can affect how much you can work.
Financial Considerations Migraine does not just cost money for treatment. It can also lead to missed work, reduced productivity, and even job loss. Some people also spend more because of depression linked to migraine.
Attack Planning and Follow-up If you use pain medicines for migraine often, regular check-ups are important. Using these medicines too much can make headaches worse in the long run. It is also important to know what type of headache you have and watch for warning signs like sudden severe pain or changes in movement or speech.

Migraine Treatment Cost in India

People with frequent or long-lasting migraine often have to spend money on treatment. Costs can go up if you need to see a specialist, get tests, or use preventive or advanced medicines.

Treatment	Cost Range
Neurologist Consultation	₹500 to ₹2,000 per consultation
CT Brain Scan	₹2,000 to ₹4,000 per scan
MRI Brain Scan	₹4,000 to ₹8,000 per scan
Sumatriptan Tablet	₹58.89 to ₹59.48 per tablet
Sumatriptan plus Naproxen Tablet	₹42.25 to ₹78 per tablet
Botulinum Toxin Injection for Chronic Migraine	₹35,000 to ₹68,000 per procedure package

Disclaimer: The above costs are indicative and may vary depending on the city, hospital, diagnostic lab, doctor consultation fees, medicines prescribed and the general health of the patient.

What Causes Migraine?

During a migraine, certain nerves in the brain send pain signals that may cause inflammation and changes in blood vessels, leading to headache and other symptoms. However, certain triggers may bring on a migraine:

Hormonal Changes: Many individuals have headaches when their oestrogen levels change. It might happen before or during menstruation, during pregnancy and during menopause. Hormonal medications, such as oral contraceptives, may potentially increase migraines.
Alcohol and Caffeine: Having alcohol or too much caffeine also triggers migraines in some individuals.
Stress: Stress at work or home might bring on migraines.
Sensory Inputs: Migraines may be set off by bright or flashing lights or loud noises. Strong fragrances such as those from perfume, paint thinner, and passive smoke might also provoke headaches in certain individuals.
Changes in Sleep: Some individuals experience migraines when they do not get enough sleep.
Physical Exertion: Sexual activity and other physical activity may cause migraines in some individuals.
Weather Changes: Changes in weather or barometric pressure might trigger a migraine.
Medications: Oral contraceptives and vasodilators, such as nitroglycerin (Nitrostat, Nitro-Dur, others), may worsen migraines.
Food: Aged cheese and salty processed foods may trigger migraines in some people. Skipping meals might also trigger a migraine.
Food Additives: Consuming food additives such as aspartame and the preservative monosodium glutamate, or MSG may also trigger migraine in some people.

What are the Complications of Migraine?

Along with the continuous headache, migraines may have other complications as well, which are as follows:

Status Migrainosus It refers to a migraine attack lasting more than three days, and during this period, the patient experiences extreme tiredness and dehydration due to the pain, vomiting, and nausea.
Migraine Stroke It refers to a rare complication where the migraine aura is accompanied by the effects of a stroke. Reduced blood supply can cause several symptoms, including visual disturbances, tingling, numbness, and weakness. It is more commonly seen in younger women who smoke or use oral contraceptives.
Persistent Aura Without Infarction In some cases, migraine aura may persist beyond one week following a migraine attack. Such a condition may mimic the effects of a stroke without causing any damage or bleeding in the brain tissue. The symptoms may persist for several months or, in rare cases, years.
Migraine-Triggered Seizure In some cases, a seizure may occur in patients with a migraine with aura. Although rare, it appears to occur at the end of the attack and may resemble a seizure caused by epilepsy. The two conditions appear to share unknown mechanisms.
Depression and Anxiety Migraine sufferers are likely to suffer from anxiety or depression since the condition significantly affects their quality of life. Pain and repeated attacks are likely to influence psychological well-being, while stress and anxiety may make the condition worse.
Vertigo Patients suffering from migraines may experience vertigo even when stationary. It may result in loss of balance and increased risk of falling or discomfort. Vertigo is more common in patients with motion sickness.
Sleep Problems (Insomnia) Due to the effects of migraine attacks, sleep problems such as insomnia may occur. Patients may find it hard to fall asleep or remain asleep, wake up too early, or experience morning tiredness. Lack of adequate sleep may increase the risk of future migraine attacks.
Nausea and Vomiting Nausea and vomiting are the most common issues associated with migraine attacks. In addition to causing pain, they may result in an inability to eat or drink, leading to weakness and fatigue. Severe vomiting may lead to dehydration in some cases.
Serotonin Syndrome Serotonin syndrome may develop in cases where migraine medications are taken together with certain antidepressants. Symptoms include hallucinations, restlessness, diarrhoea, muscle twitching, and rapid heart rate. If the symptoms develop, patients need to seek medical attention immediately.
Stomach Problems The use of analgesics regularly may lead to stomach irritation and ulcers. In addition, if there is an overdose of medicines, there may be bleeding within the stomach walls. Therefore, it is important to follow the prescription strictly.
Rebound Headaches Overuse of medications to treat migraines may lead to rebound headaches occurring frequently. Therefore, it is important to follow the prescribed dosage and frequency.

When Should I See My Healthcare Provider?

It is important to consult a healthcare provider if the following symptoms appear:

A headache that seems like a thunderclap.
Any new neurological issue (seizure, balance problems, vision issues, confusion)
A headache after a head injury.
If new or unusual symptoms develop along with the headache.

How is Migraine Diagnosed?

For the correct diagnosis of migraine, a neurologist is consulted. The process begins with the neurologist asking a few questions regarding the patient's medical history and symptoms. For a complete diagnosis, the following tests may be recommended:

Neurological Examination
This examination checks how well the different parts of your nervous system are working. During this test, one or more of these tests may be conducted:
- Mental Status Exam - Checks memory, thinking, orientation and mood by solving simple problems. Questions like the current date and location may be asked.
- Cranial Nerve Test: Checks how well a person can control their senses. May be asked to move fingers with eyes or name different sounds and smells.
- Reflex Testing: Checks how well nerves and the spinal cord respond to certain actions. The examiner might tap elbows, knees and ankles to watch reflexes.
- Coordination and Balance Tests: The person is asked to walk or touch their nose with their finger, keeping their eyes closed.
- Gait and Stance Tests: This test is done to assess any issues with walking or standing, which may point to nerve or muscle conditions.
MRI An MRI scan is used to create detailed images of the brain and blood vessels. It helps identify conditions such as tumours, stroke, brain bleeding, infections, and other nervous system disorders.
CT Scan A CT scan is used to create detailed cross-sectional images of the brain. It helps detect tumours, infections, brain injuries, bleeding in the brain, and other medical conditions that may be contributing to headaches.

How is Migraine Managed?

Migraine management and treatment focus on two things: relieving symptoms during an attack and preventing future migraines from happening too often.

The right treatment depends on how often migraines occur, how severe they are, and whether symptoms like nausea or vomiting are present. The following medications and practices are usually recommended to manage migraine effectively.

Medication The best time to take migraine medicine is as soon as the headache starts. Pain killers like aspirin and ibuprofen may help with mild migraines, but using them too often can sometimes make headaches worse. Triptans are medicines that help stop pain messages in the brain and may be prescribed for mild to severe headaches. For long-lasting headaches, medicines like dihydroergotamine may be needed. Newer drugs, called gepants, can help ease the pain and other symptoms of migraines, like feeling sick and being sensitive to light and sound.
Neuromodulation Therapy
Some people may benefit from devices that help control migraine pain without medicine. These devices work by gently stimulating nerves to change how the brain responds to pain. They help reduce the number of migraines or make them less severe.
Lifestyle Modifications
- Keep a consistent sleep schedule
- Exercise daily
- Drink plenty of water
- Keep a diary to identify patterns
- Manage stress

When Should I See My Healthcare Provider?

There is currently no permanent cure for migraine, but the good news is that the condition can be managed with a few lifestyle changes and the right treatment.

Some people get migraines once in a while, while others have frequent episodes; therefore, the outlook varies from person to person.

Frequency of attacks, the symptoms and identification of triggers play a vital role in its prognosis. Habits such as, getting enough sleep, rest, staying hydrated, and reducing stress may help manage the condition in some people.

Also, regular medication and proper follow-ups help lessen the frequency of migraine attacks.

How Can I Prevent Migraine?

If migraine happen often or are severe, doctors may recommend preventive treatment, which may include:

Taking medication as prescribed
Getting enough sleep
Eating well and staying hydrated
Exercising regularly
Relaxing and managing stress
Tracking triggers and avoiding them

Does Health Insurance Cover Migraines?

Yes, health insurance can cover migraines, but the extent of coverage depends on the condition's severity and the type of treatment required. In most cases, health insurance policies cover migraines only when they lead to hospitalisation or require emergency medical care. However, routine outpatient consultations and regular follow-ups are generally not covered under standard health insurance plans unless the policy includes OPD (Outpatient Department) benefits.

However, if migraines are diagnosed before buying the policy, they are treated as a pre-existing condition, and coverage is usually available only after a waiting period of 2 to 4 years, depending on the insurer and plan.

How Much Health Insurance Coverage Is Needed for Migraine Treatment?

For migraine treatment, a health insurance policy with a coverage range of ₹5 lakh to ₹10 lakh is generally recommended. This amount can help manage expenses related to specialist consultations, diagnostic tests, medicines, emergency care, and occasional hospitalisation if symptoms become severe.

For the elderly, especially those living in metro cities or with recurring migraines, a higher cover of ₹10 lakh to ₹15 lakh is a better option.

FAQs

Q1. What are the main reasons for migraines?

Ans: Migraines can occur due to a variety of triggers, which differ from person to person. Common triggers include stress, lack of sleep, hormonal changes, skipping meals, dehydration, certain foods, bright lights, strong smells, and genetic factors.
Q2. How do you prevent migraines?

Ans: Preventing migraines often starts with identifying and avoiding personal triggers. Maintaining a regular sleep schedule, staying hydrated, eating meals on time, managing stress, and avoiding trigger foods may help. In some cases, doctors may prescribe preventive medications.
Q3. What are the symptoms of a migraine?

Ans: Migraines are commonly characterised by throbbing or pulsating pain, often on one side of the head. Other symptoms may include nausea, vomiting, and sensitivity to light, sound, and certain smells.
Q4. How do I deal with a migraine?

Ans: If you experience a migraine, resting in a quiet, dark room, staying hydrated, avoiding screens and loud noises, and taking prescribed medications early may help relieve symptoms more effectively.
Q5. What is migraine stage 4?

Ans: Stage 4 of a migraine is called the postdrome phase, often referred to as a "migraine hangover." Although the headache has subsided, you may still feel tired, weak, confused, or emotionally drained for up to a couple of days.
Q6. What is 4 Head Migraine Relief?

Ans: For quick migraine relief, resting in a dark room, drinking fluids, applying a cold compress, and taking migraine medication as recommended by your doctor may help. The effectiveness depends on the trigger and severity of the attack.
Q7. What is a migraine stage 3?

Ans: Stage 3 is known as the headache phase. This is when migraine pain is typically at its most intense and may last anywhere from a few hours to several days.
Q8. Is migraine 100% cured?

Ans: There is currently no permanent cure for migraines. However, many people successfully manage them with the right combination of medications, lifestyle adjustments, and trigger avoidance strategies.
Q9. How do you confirm a migraine?

Ans: Migraine diagnosis is usually based on symptoms, medical history, and headache patterns. There is no specific diagnostic test, although imaging or blood tests may sometimes be performed to rule out other conditions.
Q10. What foods should be avoided during migraines?

Ans: Certain foods may trigger migraines in some individuals, including aged cheese, processed meats, chocolate, alcohol, excessive caffeine, and foods containing artificial additives. Keeping a food diary can help identify personal triggers.
Q11. How long do migraines last?

Ans: Migraine attacks can last anywhere from a few hours to several days. Most episodes typically resolve within 4 to 72 hours, although fatigue and mental exhaustion may persist afterwards.
Q12. What does silent migraine mean?

Ans: A silent migraine occurs without the typical headache pain. Instead, symptoms such as visual disturbances, dizziness, numbness, or sensory changes may occur, often resembling a migraine aura.
Q13. Is migraine dangerous?

Ans: Migraines are generally not life-threatening, but they can significantly affect quality of life. Seek immediate medical attention if you experience a sudden severe headache, weakness, difficulty speaking, or symptoms that are unusual for you.
Q14. Does lack of sleep trigger migraines?

Ans: Yes, lack of sleep is a common migraine trigger. Changes in sleeping patterns, including sleeping too little or too much, may increase the likelihood of a migraine attack.
Q15. What are the causes of migraine?

Ans: The exact cause of migraines remains unclear. Researchers believe they are linked to changes in brain activity, nerve signalling, and blood vessel function, combined with genetic and environmental factors.
Q16. How do you end a migraine fast?

Ans: Treating a migraine early offers the best chance of quick relief. Resting in a calm environment, staying hydrated, avoiding triggers, and taking prescribed medications promptly may help shorten the duration and reduce symptom severity.

References
- https://www.apollo247.com/specialties/neurologists?page=1
- https://ichd-3.org/1-migraine/1-1-migraine-without-aura/
- https://www.nhs.uk/conditions/Migraine/