Migraine Headache

Migraine Headache: Introduction,Clinical Features, Trigger factors,Diagnosis,management and Prophylaxis


Migraine is the 2nd most common cause of headache affecting 15% of women and 6 % of men worldwide. It is an episodic headache associated with certain features like sensitivity to light light, sound or movement . Nausea vomiting often accompany the headache.

Triggers for Migraine Headache:

Hormonal Changes:- Changes during menses, pregnancy, menopause, and effect of OCP
Changes in daily schedule:- over sleeping, inadequate sleep, skipping meal and a rest after a hectic schedule.
Weather:- Rapidly rising barometric pressure, rise in pressure, temperature and humidity
Foods:- food rich in tyramin like aged cheese, chocolate,banana, soya sauce and citrus fruits
Environmental triggers like cigarette smoke, perfumes, petrol and fresh paint

Migraine Headache

Pathogenesis of Migraine ( PDF format)

Variants Of Migraine:

  1. Hemiplegic migraine-  weakness which is usually reversible
  2. Basilar Migraine- dizziness,ataxia,tinnitus, vomiting
  3. Retinal Migraine- recurrent attack of unilateral visual disturbances
  4. Complicated Migraine- chronic migraine and status migraines.
  5. Ophthalmoplegic Migraine- Associated with periorbital pain, diplopia sec to cranial neuropathies.


  • Nausea
  • Lightheadedness
  • Vomiting
  • Vertigo
  • Seizure
  • Diarrhoea
  • Photophobia
  • Scalp tenderness
  • Visual disturbances
  • Syncope
  • Confusion


Diagnosis is Clinical, No investigations are mandatory.

Diagnostic Criteria for Migraine:-

Repeated attacks of Headache lasting 4-72 hours in patient with normal physical examination and no other reasonable cause for headache, and

Atleast 2 of the following features:

  • Unilateral pain
  • Throbbing pain
  • Aggravated by movements
  • Moderate to severe intensity

Plus Atleast 1 of the following features:

  • Nausea/ Vomiting
  • Photophobia or Phonophobia

Management Of Migraine Headache:-

MIDAS ( Migraine Disability Assessment Score) is a well validated tool , on the basis of which Migraine is Graded from I to IV

General Measures Against Migraine:

  1. Identify and Avoid Trigger factors
  2. Regular exercise and healthy diet
  3. Regular sleep pattern, avoid alcohol
  4. Yoga .

Medical Management:

Judicious use of 1 or more drug is the mainstay of treatment:

  • Mild cases- Oral agents
  • Sever cases- Parental therapy
  1. NSAIDS- decrease both severity + Duration. Naproxen, Ibuprofen are good enough
  2. 5 HT1 agonists- Sumatriptan, Naratriptan,
  3. Parental Inj Dihydroergotamine + Sumatriptan is FDA approved therapy
  4. Dopamine Antagonists:- Metoclopramide, Prochlorperazine are used as adjunctive therapy

Other Agents are:

  2. Oral Acetaminophen + Dichloralphenazone+ Isomethaptene
  3. Parental Meperidine ( 50-100 mg )

Prophylaxis therapy In Migraine headache:

According to the British Assocaiation for Study of Headache, Prophylaxis are required when any of:-

  1. Frequent disabling attacks > 2 per month inspite of Acute therapy
  2. Failure of acute Therapy
  3. Hemiplegic migraine, Basilar Migraine
  4. Very high attack frequency( >2/week)
  5. Progressively worsening attack.
  6. Patients Request

Calcium Channel Blocker – FLUNARIZINE  5-10 mg reduces the frequency by 50-75%. Women require lower doses.

Beta Blockers- PROPONALOL
Botulinum Toxin

Read about http://www.merckmedicus.com/pp/us/hcp/diseasemodules/migraine/pathophysiology_sub.jsp

Simplified: http://www.mayoclinic.com/health/migraine-headache/DS00120

SOURCE: Lecture notes from Harrison, Davidson and ache.org

  1. July 1, 2010
  2. July 5, 2010
  3. May 4, 2011

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