What is Migraine?
Genetic Migraine is the commonest disease of the brain and is usually a recurring headache caused by abnormal genes. It affects a significant proportion of the world’s population. However, migraine is also a symptom of many diseases of the brain. It may present as heaviness in the head, giddiness, fatigue, problems in vision, hearing and balance, tingling in body parts and even paralysis. Many people also have symptoms such as nausea and vomiting and prefer to rest in a dim lit and noise free environment. Migraines can begin in childhood with abdominal pain, vomiting and no headache at all. It may start in adulthood as well. It may occur during fasting and stress. There are many types of migraine, but common types include:
- Migraine with and without aura: Aura can be seeing lights, dark spots, blurred vision and double vision, tingling sensations and weakness.
- Migraine aura without headache: Sometimes they present with pure aura and no headache.
- Hemiplegic migraine: Sometimes present with paralysis.
- Vestibular migraine: Present with dizziness, vertigo, imbalance, fullness or buzzing in the ear. Vertigo will make you feel as if your surroundings are spinning. These types of migraines might also have ear and hearing problems.
- Migrainous stroke: Some migraines lead to stroke
- Migalepsy: Some migraines present as epilepsy
- Cognitive migraine: Present with problems with concentration, memory, speech and thought.
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Excluding Migraine Mimics
We assess and ascertain which type of migraine you have and also rule out diseases which appears to be migraine, but is not. Migraine mimics are headache disorders with features/symptoms similar to a migraine which may lead to a false diagnosis of migraine-positive. Individuals with new or recurrent headaches require proper evaluation. The diagnosis of migraine mimics begins at the time of the first consultation. Some of the migraine mimics can be:
- Strokes
- Infections
- Hormonal disease
- Heart disease
- Temporomandibular dysfunction
- Aneurysm and AV Malformation
- Pituitary disease
- Vasculitis
- Tumours
- High and low pressures in the brain
- Reduced oxygenation to the brain
- Traumatic headaches
If migraine mimics are not diagnosed early, it may sometimes be fatal. Possibility of migraine mimics should be considered:
- During the first consultation
- No responses to regular treatment
- Overuse of painkillers
- If headache features change over time
Newer Treatments for Migraine
With current advancements in headache science and neurological research, migraine and its mimics can now be effectively diagnosed and treated by a headache specialist. Newer acute treatments methods available are
Newer migraine painkillers
Such as gepants and ditans, triptan triple therapy.
Intranasal injections
Such as sphenopalatine ganglion block for reduction of severe headaches.
Newer migraine preventive Injections and infusions
Such as Monoclonal antibodies designed to bind to or block CGRP given as a monthly or 3 monthly injections
Non-invasive Neuromodulation devices
Using principles of electricity and magnetism to change the way nerves send information to the brain
Multiple cranial nerve blocks
Depending on the pain generators, targeted injections of local anesthetic or steroid is given to reduce nerve hyperexcitability and thereby severity and frequency of headaches
Onabotulinumtoxin A
Injections under the scalp, administered 3 monthly.