Migraine

Overview:

It is a headache that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Its attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help. [3]

Indian epidemiology then other

Causes and Triggers:

Though migraine causes aren’t fully understanding, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might involve.

So, might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

Migraine triggers: – There are a number of migraine triggers, including:

• Hormonal changes in women- Fluctuations in oestrogens, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.
• Drinks–These include alcohol, especially wine, and too much caffeine, such as coffee.
• Stress-Stress at work or home can cause migraines.
• Sensory stimuli–Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, second-hand smoke trigger migraines in some people.
• Sleep changes- Missing sleep or getting too much sleep can trigger migraines in some people.
• Physical factors-Intense physical exertion, including sexual activity, might provoke migraines.
• Weather changes– A change of weather or barometric pressure can prompt a migraine.
• Medications- Oral contraceptives and vasodilators, such as nitro-glycerine, can aggravate migraines.
• Foods- Aged cheeses and salty and processed foods might trigger migraines. [3]

TYPES:

1. Migraine with aura or classic migraine i.e.:

• Here the episode begins with prominent neurologic symptoms (auras) such as visual disturbances like dazzling zig-zag lines, homonymous hemianopia, field defects or rarely total blindness, sensory disturbances affecting one-half of the body, disturbances of speech or hemiparesis.
• These neurologic symptoms last for 15-30 minutes and generalized throbbing headache with nausea and vomiting, all of which may last even for 1 to 2 days. [4]

2. Migraine without aura or common migraine i.e.:

• There is onset of headache, nausea and vomiting following the same sequence.
• Migraine has differentiated from other organic disorders such as raised intracranial tension, subarachnoid haemorrhage and arteriovenous malformations.[4]

3. Migraine without head pain i.e.:

• “Silent migraine” or “acephalgic migraine,” as this type also known as, includes the aura symptom but not the headache that typically follows.

      4. Hemiplegic migraine i.e.:

• You’ll have temporary paralysis (hemiplegia) or sensory changes on one side of your body.
• The onset of the headache may associate with temporary numbness, extreme weakness on one side of your body, a tingling sensation, a loss of sensation and dizziness or vision changes.

     5. Retinal migraine (occular migraine) i.e.:

• You may notice temporary, partial or complete loss of vision in one of your eyes, along with a dull ache behind the eye that may spread to the rest of your head.
• That vision loss may last a minute, or as long as months.

6. Chronic migraine i.e.:

• A chronic migraine is when a migraine occurs at least 15 days per month.
• The symptoms may change frequently, and so may the severity of the pain.

7. migraine with brainstem aura i.e.:

• With this migraine, you’ll have vertigo, slurred speech, double vision or loss of balance, which occur before the headache.
• The head pain may affect the back of your head.

• These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in ears and vomiting.

8. status migraneous :

• This is a rare and severe type of migraine that can last longer than 72 hours.
• The headache and nausea can be extremely bad. [5]

Risk Factors:

• Family history- If you have a family member with migraines, then you have a chance of developing them too.
• Age-Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
• Sex-Women are three times more likely than men to have migraines.[3]

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology:

• Though the exact mechanism is unknown, it is the consensus that an attack of migraine consists of a neurovascular disorder of the intracranial as well as the extracranial vessels.
• Sequential studies of cerebral blood flow show an initial reduction which may localize or generalize followed by increase in blood flow (35-50%) later. The basic cause of this circulatory disturbance is not knew.
• It  found that the blood levels of histamine, serotonin, and norepinephrine increase during the attacks. There is also increase in platelet aggregability.
• This may account for strokes which sometimes complicate migraine. The headache has attributed to excessive pulsation of extracranial arteries, and possibly intracranial ones also.[4]

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• It can progress through four stages: prodrome, aura, attack and post-drome.
• Not everyone who has migraines goes through all stages.

Prodrome: –

One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:

• Constipation
• Mood changes, from depression to euphoria
• Food cravings
• Neck stiffness
• Increased urination
• Fluid retention
• Frequent yawning

Aura: –

For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system.

Its auras include:

• Visual phenomena, such as seeing various shapes, bright spots or flashes of light
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness in the face or one side of the body
• Difficulty speaking

Attack: –

During a migraine, you might have:

• Pain usually on one side of your head, but often on both sides
• Pain that throbs or pulses
• Sensitivity to light, sound, and sometimes smell and touch
• Nausea and vomiting

Post-drome: –

After a its attack, you might feel drained, confused. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.[7]

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If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose it based on your medical history, symptoms, and a physical and neurological examination.

If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:

• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) [3]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Medications used to relieve pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:

 Pain relievers:

• Pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others).

Triptans:

• Prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt, Maxalt-MLT) are used to treat migraine because they block pain pathways in the brain.

Dihydroergotamine (D.H.E. 45, Migranal):

• Available as a nasal spray or injection, this drug is most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours.
• People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydroergotamine.

Lasmiditan:

• This newer oral tablet is approved for the treatment of migraine with or without aura.
• Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours.

Ubrogepant:

• This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without aura in adults

CGRP antagonists:

• Ubrogepant and Rimegepant are oral CGRP antagonists recently approved for the treatment of acute migraine with or without aura in adults.
• Drugs from this class were more effective than placebo in relieving pain and other related symptoms such as nausea and sensitivity to light and sound two hours after taking it.

Anti-nausea drugs:

• These can help if your migraine with aura is accompanied by nausea and vomiting.
• Anti-nausea drugs include chlorpromazine, metoclopramide or prochlorperazine.[3]

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Homeopathic Treatment:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines select after a full individualizing examination and case-analysis.

which includes;

• the medical history of the patient,
• physical and mental constitution,
• family history, presenting symptoms,
• underlying pathology, possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often take into account for the treatment of chronic conditions.

What Homeopathic Doctors Do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus usually on what cause the disease condition? Why ‘this patient’ is sick ‘this way’?. The disease diagnosis is important but in homeopathy, the cause of disease is not just probing to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic.

Homeopathic Medicines

The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advance, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not directly relate to this disease because in homeopathy general symptoms and constitutional indications are also taking into account for selecting a remedy.

Homoeopathic medicine:

1. Belladonna – 

• Belladonna is a helpful for migraine headaches with intense throbbing, pulsating headaches.
• It is also indicated when there is an extreme fullness in the head. Light seems to worsen the headache.
• Noise is unbearable. Some cases have, exposure to cold air can trigger a its episode.
• In others, a head bath with cold water can bring on migraine headaches.
• Belladonna has sensation of fullness with a throbbing headache.
• It is also used for headaches resulting from high blood pressure.

2. Glonoinum – 

• Glonoinum is helpful in treating migraine with excessive congestion in the head.
• The head feels very large, as if it would burst. In such a migraine attack, patients in pain are seen holding their head in hands.
• The eyeballs seem protruded.
• Extreme heaviness in the head is felt. Also, heat around the head is unbearable. Uncovering the head relieves the headache.
• The migraine gets better with sleep while walking worsens the migraine headache.
• Glonoinum most suitable medicine for migraine headache triggered by sun exposure.

3. Iris Versicolor – 

• Iris Versicolor is a medicine for migraine when attending with intense nausea, vomiting or acidity.
• Burning may note in any part of the alimentary canal.
• Vomiting of acidic, sour, bitter nature is observed.
• Bitter, acrid, belching with intense burning behind the sternum and in the throat is well marked.
• Acidic stomach reflux leads to headaches.
• Headache with diarrhoea.
• It is also useful where migraine begins with a blur before the eyes.

4.  Epiphegus – 

• Epiphegus is a medicine for migraine where exhaustion – mental or physical.
• It is used where the slightest deviation from routine work brings on a migraine attack.
• Although it works for both sided migraine, yet comparatively better results are seen in left-sided headaches with Epiphegus.
• A peculiar attending symptom increase saliva with constant inclination to spit.

5. Kali Phos – 

• In case of a migraine attack triggered by stress, Kali Phos proves extremely useful.
• The unique indication for use of Kali Phos is that stress, tensions and worry lead to migraine headaches.
• Migraine headaches are common among students who suffer school or college related stress.
• Exhaustion and weakness usually accompany the migraine.

6. Natrum Muriaticum – 

• Natrum Muriaticum is the best prescription for migraine attacks that worsen around the menstrual cycle.
• The headache may be triggered before, during or at the close of the menstrual cycle.
• Migraine headache that starts with sunrise, continues through the day and vanishes after sunset. This is popularly known as the “sunrise to sunset headache”.
• Migraine headache feels like little hammers knocking on the brain, Natrum Muriaticum will help.
• It is also the most suitable prescription for migraine headaches in school girls or in girls who are anaemic.
• Natrum mur is also a very effective medicine for headache caused by eye strain.

7. Nux Vomica – 

• Nux Vomica is a very effective remedy for migraine with gastric troubles.
• Migraine due to indigestion, flatulence, constipation also piles.
• Nux Vomica also helps where migraine headaches get worse after taking coffee, spicy food also alcoholic drinks.
• The headache may be located in any part of the head.
• The person specifically feels the need to press the head against something hard for relief.

8. Gelsemium – 

• It works well when dim sight occurs with a headache. In some cases, temporary blindness precedes onset of headache.
• Moreover, In most cases the pain is felt in the back of the head.
• With this a sensation of band around the head may be present.
• Besides this, Heaviness of eyelids can also there. is also made when
• Headache worsens especially, from mental exertion. Pressure may give relief in pain when it need.

9. Spigelia – 

• Generally, Spigelia is a most effective medicine for left-sided migraine.
• It indicate when the headache is locating over the left temporal region, forehead and eyes.
• In most cases, the pain begins in the occipital region of the head, extends upward and settles over the left eye.
• The pain is violent, throbbing and pulsating in nature. In detail, There is a sensation of a tight band around the head.
• Stooping seems to worsen the headache. All in all, Severe pain in the eyeballs may attend. Eye movement worsens this pain.

10. Sanguinaria Canadensis – 

• Sanguinaria Canadensis is a good medicine for right-sided migraine.
• The pain starts from the back of the head i.e. occiput, ascends and settles over the right eye. Lying down quietly in a dark room brings relief.
• In some cases, sleep may relieve pain.
• Fasting often triggers a migraine headache in persons prescribed Sanguinaria Canadensis.
• It is also the medicine to prescribe when the headache starts in the morning, increases during the day and lasts until sunset.
• Sanguinaria Canadensis is a significant for migraine in women during menopause.

• Develop a sleeping and eating routine: – Don’t sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day.
• Drink plenty of fluids: – Staying hydrated, particularly with water, might help.
• Exercise regularly: – Regular aerobic exercise such as walking, swimming and cycling, Warm up slowly reduce tension and can help to prevent it.
• Meditation and yoga: – Meditation may relieve stress, which is a known trigger of migraines. Done on a regular basis, yoga may reduce the frequency and duration of migraines.[3]
• Magnesium-rich foods: – Foods rich in magnesium include dark leafy greens, avocado, and tuna.
• Omega-3 fatty acids: – Research indicates that increasing omega-3 fatty acid may help people with migraine. Food rich in omega-3 fatty acid include fish such as mackerel and salmon, and seeds and legumes. [7]

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[1] Davidson’s foundations of clinical practice (2009)

[2] Harrison’s Manual of Medicine: Nineteenth Edition

Frequently Asked Questions

What is Migraine?

Recurrent headaches which are throbbing in nature, associated with nausea, vomiting, light or sound sensitivity and which get worse with physical exertion are likely to be migraine headaches.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Migraine?

• Belladonna
• Glonoinum
• Iris Versicolor
• Kali Phos
• Natrum Muriaticum
• Nux Vomica
• Gelsemium
• Spigelia

What causes Migraine?

• Hormonal changes in women
• Drinks
• Stress
• Sensory stimuli
• Sleep changes
• Physical factors
• Weather changes
• Medications- Oral contraceptives
• Foods

What are the symptoms of Migraine?

• Visual phenomena
• Vision loss
• Pins and needles sensations in an arm or leg
• Weakness or numbness
• Difficulty speaking
• Pain usually on one side of your head
• Pain that throbs or pulses
• Sensitivity to light, sound, smell and touch
• Nausea and vomiting

Give the types of Migraine?

• Migraine with aura or classic migraine
• Migraine without aura or common migraine
• Migraine without head pain
• Hemiplegic migraine
• Retinal migraine
• Chronic migraine
• Migraine with brainstem aura