Migraine

Migraine is a neurological condition with recurring episodes of moderate-to-severe headache — often one-sided, throbbing, with nausea and sensitivity to light, sound, or smell. Episodes last 4-72 hours and can be disabling. Migraine affects around 1 in 10 Indians, more often women. Effective treatment exists — many people are under-treated.

Phases and features

• Prodrome (hours-days before) — mood change, food cravings, yawning.
• Aura (30%) — visual zigzags, spots, numbness, speech change — lasts 5-60 minutes before headache.
• Headache — pulsating, often one-sided, nausea, light/sound sensitivity, worse with activity.
• Postdrome — exhaustion, brain fog.

Red flags — not typical migraine

• First ever severe headache; sudden "worst-ever".
• Headache after 50 with new pattern.
• Headache with fever, stiff neck, drowsiness.
• Persistent neurological signs (weakness, slurred speech).
• Progressive worsening over weeks.

Common triggers

• Skipped meals, dehydration, poor sleep.
• Stress — and stress relief (weekend migraines).
• Hormonal (periods).
• Bright lights, loud noise, strong smells.
• Food — for some: aged cheese, chocolate, MSG, red wine, aspartame.
• Weather changes; high humidity.

Treatment

• Acute attack — simple pain relievers or NSAIDs early; triptan-class for moderate/severe; anti-nausea medicine. Rest in a quiet dark room; hydrate.
• Preventive medicines — for 4+ attacks/month or disabling: several classes including beta-blockers, anti-epileptics, tricyclics, newer CGRP-pathway medicines. A neurologist can match to you.
• Avoid medication-overuse — painkillers more than 10-15 days a month worsen headache long-term.
• Lifestyle — regular sleep, meals, hydration, exercise; treat associated anxiety/depression; stress management.
• Headache diary — identifies triggers and guides treatment.
• Botox, nerve blocks, CGRP monoclonal antibodies — for refractory chronic migraine; available at Indian headache centres.