Migraine Headache Treatment in Bangalore

What is aura?

Aura are alarming symptoms which typically occurs in all patients but not are not compulsory. Symptoms like intolerance to lights, sounds, nausea, vomiting, tingling sensations in arms and legs, blurred vision, confusion, dizziness, irritability. These symptoms are alarming sign for acute attack of headache. Typically are present for 20-70 minutes and then goes off.

Can there be migraine without aura?

Yes migraine without aura are present in few percentage of patients.

What causes migraine headache?

The exact cause of migraine headache is yet to be discovered. Environmental conditions and Genetics play important role in causing migraine headaches. Imbalances in the chemical mediators of brain like serotonin have said to play important role.

What can trigger a migraine attack?

• Stress, depression, anxiety, excitement, and shock can trigger a migraine.
• Tiredness and insufficient sleep, shoulder or neck tension, poor posture, and physical overexertion have all been linked to migraines.
• Alcohol and caffeine , chocolate, cheese, citrus fruits,
• Some sleeping pills, hormone replacement therapy (HRT) medications, Hormonal changes
• Triggers in the environment: Flickering screens, strong smells, second-hand smoke, and loud noises can set off a migraine.
• Stuffy rooms, temperature changes, and bright lights .

Measures to avoid an attack of migraine

• Maintain a migraine diary
• Try to identify your own triggering agent and avoid them
• Maintain regular routine
• Eat regularly, avoid skipping meals
• Avoid all the triggering factors
• Regular exercise
• Meditation
• Avoid involving in stressful activities
• Establish regular sleeping hours
• To see your physician regularly

How to diagnose migraine headache:

The patient’s history is the essential diagnostic tool. Different patients present with different types of symptoms. Your physician may also ask yo for various tests like CT Scan, MRI, blood tests depending on the associated features.

Treatment

Treatment options includes.

Avoiding the triggering factors , understanding the aura and taking the medicine before migraine sets in.

Drugs as prescribed by the physician is to be taken to abort the acute attack of migraine- NSAIDs, triptan group of drugs, ergotamines.

Drugs to prevent the attack of this headaches are given to the following candidates;

• Attack lasting for more than 12 hours
• More than 4  debilitating attack in a month
• When the drugs to abort the acute attack takes long time to act.

What is the role of Botox injection for migraine?

Botox injection is the new the technique which provides relief from migraine headache.

The FDA approves the use of Botox to treat chronic migraine in adults who are age 18 or over.

Usually it gives relive for 6-8 months after which it has to be repeated. Few people may be allergic to Botox therapy and may express some reactions.

When should patient not miss to see a doctor

Intense, exploding headache
New-onset headache in patients
Persistent morning headache with nausea
New onset of headache in a patient with history of cancer

Progressive headache, worsening over weeks .
Headaches associated with postural changes
Aura symptoms that last longer than an hour
Occur for the first time on using oral contraceptive pill

Cluster headache:

What are cluster headaches?

Cluster headaches are headaches involving one side along with pain near the eyeball and are usually associated with lacrimation, nasal congestion, running nose . They usually occurs in clusters at a same particular time period for weeks and months followed by headache free period. Cluster headaches are more common in young men between 30-40 years.

How can I identify my condition?

The attacks last between 15 minutes and 3 hours, occurring from once every other day to up to eight per day.

The patient is extremely restless and agitated and often sweats profusely.

There can be periorbital and orbital swelling

Attacks occurring daily for a few weeks to a few months, followed by a gap of a few months to a few years.

What are the triggering factors?

Usually this headache is triggered by use of alcohol, caffeine, exercise, strong odors.

What are the other conditions similar to this?

Few other conditions which can resemble this is migraine headaches, trigeminal neuralgia and temporal arteritis.

What investigation I need to do for the diagnosis?

The diagnosis is usually done on the basis of clinical history and examination some investigations like few blood tests and ophthalmic examination has to be done to rule out other causes . sometimes MRI brain or CT scan is to be done if other complications are identified but usually it is not required.

What are the treatments available?

Acute attack of cluster headaches can be aborted by Inhaling 100 percent oxygen for 15 minutes There are few medicines like sumatriptan and dihydroergotamines in form of nasal spray which can relieve pain immediately but has to be taken under the supervision of a doctor.

There are many drug options available which has to be taken regularly under the supervision of a doctor to prevent further episodes.

In refractory cases not responding to treatment , few nerve blocks has proven to be effective.

Is this condition completely curable?

This condition has a good prognosis if the diagnosis has been established early. Most patients will respond to the treatment if the therapy is initiated early. Taking medicines regularly as prescribed and avoiding all the triggering factors remains the keystone for management.

Tension type headache:

What is tension type headaches?

Tension type headaches is the most common type of headache. It is commonly seen as a taut band like in whole head from back to front. The pain will last from 30 minutes to 7 days. It is usually present on both the sides but sometimes may be unilateral also.

What are the symptoms of tension type headaches?

The headaches is mild to moderate and very rarely it is severe. Muscles around the neck and forehead may be tender and neck pain are often present. Sometimes patient cannot tolerate light or sound .

It affects both the gender with equal preponderance

It can be episodic with less than 15 episodes per month or can be chronic with more than 15 episodes per month.

Usually associated with anxiety and depression and some other medical illness like cervical spondylosis and TM joint disorders.

What are the triggering factors?

Triggering factors for tension headaches, such as

• stress,
• impaired sleep, or
• skipping meals.
• vision problems
• eye strain,
• overexertion, muscle strains

What are the other conditions it can mimic?

It can mimic conditions like migraine, fibromyalgia, nasal sinusitis.

How to make the diagnosis of tension type headaches?

Regenerative Therapy, PRP Therapy, Plasma Therapy

The diagnosis of tension type headaches make by clinical history and examination of the patient. The classical symptoms makes the diagnosis easy but sometimes it becomes to differentiate from migraine headaches. Unlike migraine , the tension headache do not increase with physical activity and the patients are bale to do routine daily work with the headache. Also nausea vomiting are not associated with tension type headache.

In case of classical symptoms no other investigations are required but sometimes secondary causes of headaches is to be identified if the pain is increasing in intensity or if the pain is not relieved by analgesics. Few of the times overuse of medicines can also lead to progression of headaches severity.

What are the treatment modalities available?

For mil to moderate episodes of headaches over the counter analgesics like aspirin and paracetamol will be sufficient. . Other pain killers and caffeine will also help in aborting the acute attack. In case of severe form combination of drugs can be used along with opiods.

opioid drugs are to be avoided in mild to moderate cases as these will not help in aborting the attack and also the side effects will be evident.

Preventive treatment is to be taken bt those in which the disability is increasing. There are certain medications to be taken as a prophylaxis like antipdepressants in low dose which acts as analgesics like amitirptiline and few other drugs like gabapentin.

Other options like relaxation therapy, acupuncture, exercises are also helpful in preventing further episodes.