Migraine

Overview

Migraine is a complex neurological disorder characterized by recurrent episodes of moderate-to-severe headache, typically unilateral and pulsating, often accompanied by nausea, vomiting, and sensitivity to light and sound.

Types

Migraine Without Aura (75%)

• Unilateral pulsating headache
• Duration: 4-72 hours
• Aggravated by physical activity

Migraine With Aura (25%)

• Visual disturbances (zigzag lines, scotomas)
• Sensory symptoms (tingling, numbness)
• Aura duration: 5-60 minutes

Phases of a Migraine Attack

Treatment

Acute

• Triptans — Sumatriptan, rizatriptan (first-line)
• NSAIDs — Ibuprofen, naproxen
• Anti-emetics — Metoclopramide

Preventive (≥4 attacks/month)

• Beta-blockers — Propranolol
• Anticonvulsants — Topiramate, valproate
• CGRP inhibitors — Erenumab, fremanezumab (newer)
• Botox — For chronic migraine

CGRP monoclonal antibodies represent the first migraine-specific preventive therapy, offering significant reduction in monthly migraine days with minimal side effects.