Headache Medicine

Migraine
Dr. Mit Ankur Raval

Migraine is a neurological disorder characterised by recurrent attacks of headache and associated symptoms. Some patients experience aura; others have prominent nausea or light/sound sensitivity.

Recognising migraine

Typical features.

Headache

Moderate or severe headache may be unilateral or pulsating and often worsens with routine activity.

Associated symptoms

Nausea, vomiting and sensitivity to light or sound are common.

Aura

Some patients experience fully reversible visual, sensory, speech or other aura symptoms.

Diagnosis

Migraine is usually diagnosed clinically from the history and examination.

Prevention

Preventive treatment is considered when attacks are frequent, disabling or otherwise warrant reducing headache burden.

Lifestyle

Regular sleep, meals, hydration and exercise can complement medical treatment.

Treatment strategy

Acute treatment + prevention + review.

Acute treatment

Treatment of an individual attack may include analgesic or migraine-specific medicines depending on the patient.

Preventive treatment

Current options include conventional preventive therapies and CGRP-targeting therapies.

Medication overuse

Frequent acute medication use can contribute to persistent headache in susceptible patients.

Botulinum toxin

OnabotulinumtoxinA is an established preventive option for appropriately diagnosed chronic migraine.

Patient questions

Patient questions

Do all headaches need an MRI?
No. Imaging is guided by the history and neurological examination.
When is headache an emergency?
Sudden severe headache, new focal neurological deficits, seizure, loss of consciousness or severe confusion requires urgent assessment.
Can migraine be prevented?
Yes. Preventive treatment is available when indicated and is individualised.
Selected references: ICHD-3 and American Headache Society clinical guidance. ICHD-3 • AHS
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Important: This website provides general information and is not a substitute for an in-person medical consultation. In an emergency, seek immediate medical care.
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