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.
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Migraine with Aura In this type of migraine, certain symptoms, such as visual problems, speech difficulties, and altered sensations, begin before the actual headache.
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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.
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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.
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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.
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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.
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Hemiplegic Migraine In this condition, during a migraine attack, the person experiences temporary weakness on one side of their body.
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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.
What are the Symptoms of Migraine?
A migraine attack may progress through 4 stages, and not everyone experiences all of them. Here is a quick overview of the stages and the symptoms they showcase:
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Prodrome
These symptoms appear a day or two before the actual migraine attack begins. They usually serve as a warning sign before the attack.
- Mood changes
- Food cravings
- Stiffness in the neck
- Increased frequency of urination
- Fluid retention
- Constipation
- Frequent yawning
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Aura
An aura refers to reversible symptoms related to the nervous system. These symptoms may appear days before the actual migraine attack or go alongside it.
Symptoms of migraine aura are:
- Loss of vision
- Visual changes, seeing shapes and bright spots
- Feeling like pins and needles in the arm or leg
- Weakness or numbness in one side of the body
- Trouble speaking
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Attack
This is when the headache begins, and the episode may last for several hours to days. During this time, a person may feel:
- Pain on one side of their head
- Throbbing and pulsing pain
- High sensitivity to light, sound and sometimes even smell and touch
- Vomiting and nausea
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Postdrome When the migraine attack subsides, the person may feel worn out, drained and confused.
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:
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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.
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Alcohol and Caffeine: Having alcohol or too much caffeine also triggers migraines in some individuals.
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Stress: Stress at work or home might bring on migraines.
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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.
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Changes in Sleep: Some individuals experience migraines when they do not get enough sleep.
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Physical Exertion: Sexual activity and other physical activity may cause migraines in some individuals.
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Weather Changes: Changes in weather or barometric pressure might trigger a migraine.
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Medications: Oral contraceptives and vasodilators, such as nitroglycerin (Nitrostat, Nitro-Dur, others), may worsen migraines.
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Food: Aged cheese and salty processed foods may trigger migraines in some people. Skipping meals might also trigger a migraine.
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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:
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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:
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A headache that seems like a thunderclap.
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Any new neurological issue (seizure, balance problems, vision issues, confusion)
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A headache after a head injury.
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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:
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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.
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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.
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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.
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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.
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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.
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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:
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Taking medication as prescribed
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Getting enough sleep
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Eating well and staying hydrated
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Exercising regularly
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Relaxing and managing stress
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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
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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.
