Explained: Everything you need to know about migraine 

Dr. K. Ravishankar, consultant in-charge of the headache and migraine clinic at Jaslok Hospital and Lilavati Hospital sheds light on migraine prevalence, triggers, treatment, impact on women’s health, and the impact of the pandemic 

June is observed as the National Migraine and Headache Awareness Month in the USA. According to the World Health Organization estimates, headache disorders are one of the most common disorders of the nervous system. Nearly 50 per cent of the adult population across the globe suffers from diverse forms of headaches every year making it a cause of concern for public health. Among these, migraine is a primary headache disorder which affects women disproportionately and remains to be widely under-diagnosed impacting the quality of life of millions. Recent studies also report a rise in frequency and intensity of migraines in patients amid the pandemic.

Mid-Day spoke to Dr. K. Ravishankar, consultant in-charge of the headache and migraine clinic at Jaslok Hospital and Lilavati Hospital to better understand this widely prevalent medical condition. “Worldwide, migraine affects 10 to 12 percent of the population, yet remains neglected and under-diagnosed. The prevalence of migraine is higher in women compared to men. We do not have exact numbers from India, but the prevalence is near similar,” explains Ravishankar. 

Below, the globally recognised specialist in headache medicine and former trustee of the International Headache Society (IHS) answers a few important questions on migraine. 

How can someone tell if their headaches might be migraine?

Migraine is a chronic, neurological disorder that can alter one’s quality of life, making the need to distinguish between benign headaches and migraines more urgent and necessary. 

Headaches are unpleasant pains in the head that cause pressure. With the pain ranging from mild to severe, they usually occur on both sides of the head or stretch across one’s forehead or the back of the neck. Migraine, on the other hand, results in severe throbbing pain or a pulsing sensation, usually on one side of the head. These tend to also be accompanied by other symptoms, including nausea, vomiting, and extreme sensitivity to light and sound. 

In many cases, migraine begins with one or more neurological symptoms referred to as ‘migraine with aura.’ This typically manifests in the form of visual symptoms, including the perception of seeing halos or flashing lights, wavy lines, and can even lead to temporary loss of vision. It can also produce a sensation of numbness or tingling on one side of the body, particularly in the face or hand.

What makes migraine widely under-diagnosed? What are the early signs of migraine and common symptoms that people tend to ignore?

Migraines are often neglected, overlooked, and wrongly labelled as ‘just a headache’. Misdiagnosis or neglect can also contribute to under- or mistreatment of the condition. Low awareness, both globally and in India, amplifies this trend. 

More than half of migraine patients are never diagnosed, despite the fact that nearly one in ten people worldwide reportedly suffer from migraines. The early signs of migraine, like fatigue and inability to concentrate, are often ignored or misattributed to daily stressors. 

What are the risk factors and key triggers of migraine? 

Several factors contribute to increased risk of experiencing migraines. These include a family history of migraine episodes and age, with one’s first migraine episode often occurring during adolescence, peaking during the 30s, and gradually becoming less severe and frequent in the following decades. Women are three times more likely to experience migraine especially owing to hormonal changes. The onset of menstruation might increase the frequency of headaches. 

There are also a number of triggers that aggravate migraine. These include cold drinks, stress, excessive sensory stimuli (including bright lights, sun glare, loud sounds and strong smells), uneven sleep pattern, increased and intense physical exertion, weather change, certain foods, and alcohol. Hormonal or other medications, such as oral contraceptives or hormone replacement therapy, can also worsen migraines. However, it is important to note that triggers are not the same for everyone as they differ from person to person.

Does migraine vary in intensity? If yes, how does treatment differ?

Migraine episodes vary in intensity, occurring across several stages, including prodrome, aura, headache, and postdrome. Prodrome refers to the pre-headache phase, characterised by subtle changes in one’s body and mood, which typically occur as symptoms before the onset of a migraine. The next stage, aura, manifests in the form of visual phenomena, contributing to perceptions of halos, flashing lights, vertigo as well as auditory symptoms, including temporary loss of hearing. The eventual migraine attack, with throbbing pain and nausea, can last from a few hours up to three days in severe cases. Recovery or the postdrome stage encompasses fatigue, dizziness, mood changes, and muscle aches. Individuals experiencing migraines may cycle through all of these phases, or experience only one or a few of them.

Most people with migraine experience premonitory symptoms like difficulty in concentrating, food cravings, and sensitivity to light and smell. Treatment may vary based on a number of factors, including the frequency and severity of migraine episodes, specific symptoms experienced, family history, other existing comorbidities and in the case of women, menstruation or the stage of menopause. Holistic, integrated approaches to treatment cater to the individual’s specific needs and preferences, typically combining preventive and acute treatment approaches.

What is the role of diet when it comes to migraine?

A balanced, nutritious diet plays an important role in leading a healthy lifestyle. A diet consisting of fresh foods, including fruits, vegetables, whole grains, and proteins may help prevent migraines, although further evidence-based dietary recommendations are needed.

 In addition to a healthy diet, not skipping meals and eating at regular intervals, such as at least five small meals a day, can enable a healthier lifestyle pattern and prevent migraine. Foods such as chocolate, caffeine, milk, cheese and alcoholic beverages, have been identified as common triggers of migraine attacks.

 What is the most effective treatment? Can treatment be done without medicine?

Treatment of migraine across all stages of life can vary. An integrated approach to treatment, encompassing preventive and acute migraine medication, behavioural therapy and lifestyle change recommendations can effectively support individuals in managing the disease, alleviating symptoms, and avoiding adverse outcomes, such as a rise in frequency or severity of episodes. 

Prevention-focused interventions include behavioural changes such as trigger recognition and management, while lifestyle interventions such as consumption of a nutritional diet, a healthy sleep routine, exercise, and reducing alcohol and caffeine intake.  

Given that migraine is a chronic, neurological condition, it is important to manage these with the right prescribed medications and treatment. Acute treatment options typically depend on the individual’s symptoms, headache frequency and burden, and can be helpful in facilitating symptom control and management.

Why is migraine prevalence higher in women and how does it impact them differently?

Not only does migraine impact more women globally, it also affects women more severely.  An increased risk of recurrence, greater disability, and longer duration of attack are common experiences among women.  

Changes in migraine frequency are associated with menstruation and pregnancy. During childhood, migraine is more prevalent in boys than in girls. However, post puberty, when the influence of oestrogen begins, typically peaking in one’s 30s, the prevalence of migraine rises rapidly in women. More severe and more frequent migraine attacks often result from changes in oestrogen levels. Women often experience episodic pain (often for a longer duration) and chronic pain more frequently than men. 

How has the pandemic impacted those suffering from migraine?

Patients experiencing migraines have been especially vulnerable to the drastic and negative impacts of the pandemic. Psychosocial stress, anxiety and fear, leading to depression, disturbance of sleep, and eating habits, have been major triggers for migraine attacks and led to the worsening of migraine symptoms. Moreover, social isolation, disruption of sleep and dietary habits along with several pandemic specific concerns and stressors, have acted as triggers, further aggravating episodes of migraine with increased severity. 

How have patients seeking diagnosis and access to treatment suffered?

Since the onset of the pandemic, in-person clinic consultations have reduced due to fear of infections, resulting in under-diagnosis of the disease, thereby leading to incorrect treatment and management. However, with the adoption of teleconsultation, patients have now started accessing much needed health solutions with the help of digital tools and solutions.

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