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Migraine is characterized by moderate to severe headache accompanied by other signs such as nausea, vomiting, visual disturbances and sensitivity to light and sound
Migraine is a neurological phenomenon involving a wave of unusual nerve activity and altered blood flow in the brain
Pathophysiology
Definition
Genetic factors
• Almost 90% of patients have a positive family
history of migraine
Age
• Migraine may begin at any age as early as
adolescence
Gender
• Females are more likely to have migraine
than males after puberty
A number of Factors may trigger a Migraine attack
Hormonal changes
Some women experience migraine just before or during menstruation. Migraine generally improve after menopause. Although migraines may improve or aggravate variably during pregnancy
Food & Drinks
Cheese, salty , processed foods, chocolates. Skipping meals or fasting may also trigger attacks.
Alcohol, wine , caffeinated drinks may trigger attacks.
Stress Physical exertion or mental stress may also be triggers
Sleep deprivation
Sleep deprivation or any change in sleep pattern, oversleeping
MedicationsOral contraceptives , vasodilators are known to aggravate symptoms of migraine
Other FactorsExposure to bright flickering light, bright sunlightStrong odors, perfumes
typically described as throbbing /pulsating in character
moderate to severe in severity
often but not always confined to one side/part of the head
recurrent
self limiting
known to last for hours to days
associated with autonomic signs
preceded by “aura” in about 30% of patients
Headache which is..
Prodrome
•Some patients experience premonitory symptoms before the onset of aura or pain. These include depression ,
hyperactivity, constipation, irritability, neck stiffness, excessive yawning, sleepiness, excessive thirst, frequent
urination, craving for certain foods
Aura
•A spectrum of transient neurological phenomena that occur before or during headache. Visual changes such as flickering
lights, bright spots, jagged lights, visual loss. Sensory aurae such as sensation of pins and needles on arm or leg ,
numbness, spreading to one side of body. Speech and language difficulties and motor difficulties such as weakness of one
side of body may also occur. Auditory hallucinations or delusions may also occur. Migraine may occur without Aura
Pain•Pulsating pain usually begins over the eyes, spreading to one side of the head. Although at times the entire head
may be involved. Undue sensitivity to light, smell, and sound. physical activity, leaning forward may aggravate the
pain. Nausea and vomiting may also occur
Postdrome
•Weakness, tiredness may persist for a few days after headache though some patients may experience a sense of
euphoria
Migraine is known to progress through in four phases. Although not all the phases may necessarily be experienced by a particular patient
Migraine lasting
for 15 days or
more in a month
Migraine attack
lasting for more
than 72 hours
Persistent aura
without
infarction- Aura
lasting for more
than 7 days after
the attack has
passed
Risk of brain
infarct when
aura lasts for
more than one
hour
Chronic Migraine Status migrainosus Persistent aura Migrainous infarct
Beta blockers-dizziness, cold extremities, decreased libido, asthma aggravation
Tricyclic antidepressants-drowsiness, dry eyes, dry mouth
Serotonin antagonists-drowsiness, weight gain
Anti seizure drugs-nausea , tremor, weight gain, dizziness
NSAIDs-Gastrointestinal bleeding, ulcers
Triptans-nausea, dizziness, drowsiness, muscle weakness. contraindicated for people at risk for stroke and heart attacks
Opioids- habit forming
Preventive drugs and side effects
Pain relieving medication and side effects
Biofeedback-Patient is trained to gain awareness and
control over the body’s reaction to stress using
instruments to measure changes in muscle activity,
heart rate, temperature, sweat gland activity
accompanying changes in thoughts, emotions and
behaviour
Neurofeedback/EEG feedback- using sophisticated
equipment to measure brain electrical activity and re-
training it to practice healthier patterns of mood
regulation
Remedy Indications
GLONOINE Throbbing pain, from exposure to sun, heat., during menopausehead feels large, sensation as if skull is too small for brain
BELLADONNA Throbbing, pulsating headache worse from light, noise, jar, lying down, in afternoon
IRIS VERSICOLOR Headache accompanied by nausea, vomiting, heartburn. Nausea not relieved by vomiting .headache begins with blurring of vision,with visual disturbances. Headache in frontal area and right temple ,comes on after patient relaxes from a mental strain
EPIPHEGUS Affinity for left side of the head, headache settles over left eye, headache comes on due to mental exertion, exposure to sun, undue exertion, overwork, unaccustomed activity, profuse viscid salivation, pain better by sleep
NUX VOMICA gastric migraine, constipation, , bloating, flatulence, headache after eating rich fatty food, drinking alcohol
CIMICIFUGA Throbbing headache, associated with menstrual period, stiffness of neck, feeling of gloom, and despair, depression, ears sensitive to noise.
1Homoeopathic Management of Migraine
Remedy Indications
COCCULUS INDICUS Headache from loss of sleep, travelling, pain nape of neck, vertigo, nausea, visions, colors, shapes , black spots in front of eyes
CYCLAMEN Migraine accompanied by sparks before eyes
COFFEA Headache brought on after loss of sleep, or following excitement
PULSATILLA Headache associated with digestive upsets, after eating warm, rich, or fatty foods or ice cream. Nausea and vomiting frequently accompany headache. headaches with menstrual periods (before, during, or especially when the period ends) or those that result from a frightening experience. The pain is most often felt in the forehead or on one side of the head and may change location frequently. Throbbing accompanies the headache. Although walking briskly may make the pain worse, generally there is relief from gentle motion, especially walking about slowly in the open air
GELSEMIUM headaches begin at the back of the head, often extending to the rest of the head or to the forehead. The person may feel as though a band or hood were bound tightly around their head. But Gelsemium is also one of the fairly few homeopathic medicines that clearly suit headaches preceded by dimness of vision or other visual disturbances, symptoms of migraines. Localized pain on the right side of the head is also covered by this remedy. The Gelsemium headache is not much affected by changes of temperature, but other environmental factors (light, noise, motion, jarring) aggravate it. Napping or, curiously, urinating relieves the pain. The person feels dull, tired, heavy, and apathetic. exhausted. wants to be left alone.
2Homoeopathic Management of Migraine
Remedy Indications
SANGUINARIA headaches begins in the back of the head but extend to and soon settle over the right eye or in the right side of the head. . The pain is sharp, splitting, knifelike, and sometimes throbbing. Nausea and vomiting occur at the height of the pain, but unlike Iris headaches, those of Sanguinaria are relieved after vomiting. Motion aggravates the pain, whereas sleep and firm pressure relieve it., Sanguinaria suits headaches that recur with periodicity
SPIGELIA Headache in frontal or left side of the head increased by shaking and jarring ,movement, stooping, temporary relief by washing with cold water
NATRUM MUR. Headache semi-lateral, chiefly on left side, sensation as if hammers are knocking on brain, from grief, fright, anger , from sunrise to sunset, noise, warm room, mental exertion, relieved by sleep, open air, cold application. Patient is depressed, irritable, wants to be alone.
ONOSMODIUM headache with pain in eyeballs, vision affected , blurred objects seem distorted
3Homoeopathic Management of Migraine
1. Scutellaria Laterifolora Q Migraine, worse over right eye; aching in eyeballs.
Explosive headache of school teachers with
frequent urination.
2. Usnea Barbata Q Congestive headache. Bursting feeling, as if
temples would burst, or the eyes burst out of
sockets.
3. Epiphegus Q, 6C Migraine, pressing pain in temples from without
inwards; worse left side.
Viscid salivation, constant inclination to spit. Sick
headache when deviating from ordinary pursuits.
Headache preceeded by hunger.
4. Chionanthus Q Dull frontal headache, over root of nose, over eyes,
through temples, worse stooping, motion, jar.
5. Iris Versicolor Q, 6C Frontal headache, with nausea.
Right temples especially affected.
Sick headache worse rest; begins with a blur before
eyes, after relaxing from a mental strain.
Few Mother Tinctures which are very useful during Acute Migraine attacks
Regular sleep
Regular meals
Regular exercise
Avoidance of triggers such as dietary, caffeine, alcohol
Stress management with relaxation techniques