Migraine

Migraine is a type of headache that causes an intense throbbing or pulsing sensation in one area of the head. It is a neurological disorder (that is, a disorder related to the brain). Migraines can be classified as with aura, or without aura. Aura refers to feelings and symptoms you notice shortly before the headache begins. These early symptoms are also called a prodrome. 

Migraine with aura is a type of migraine where there are warning signs before the migraine begins. This includes: ​

  • ​Confusing thoughts or experiences

  • The perception of strange sparkling or flashing lights

  • Zigzag lines in the visual field

  • Blind spots or blank patches in the vision

  • Pins and needles in your arm or leg

  • Difficulty speaking

  • Stiffness in the shoulders, neck or limbs

  • Unpleasant smells

Migraine without aura occurs without any warning signs.

At times you may experience migraine aura without headache, also known as silent migraine. This is where an aura or other migraine symptoms are experienced, but a headache does not follow the aura.

The exact cause of migraines is unknown, although they are thought to be the result of abnormal brain activity temporarily affecting nerve signals, chemicals and blood vessels in the brain. It's not clear what causes this change in brain activity, but it is possible that your genes make you more likely to experience migraines as a result of a specific trigger. Many possible migraine triggers have been suggested, including:

  • Hormonal: for instance, menstrual or menopausal

  • Emotional: due to stress, anxiety, tension, depression etc.

  • Physical: due to low blood sugar, fatigue, strenuous exercise etc.

  • Dietary: due to dehydration, malnutrition etc.

  • Environmental: due to bright lights, strong smells, smoke, loud noises etc.

  • Medicinal: due to sleeping pills, hormone replacement therapy etc.​

Migraine headaches begin from childhood up until early adulthood. There are four stages of a migraine, which are described below:

  • Prodrome: A few days before a migraine attack, you may notice subtle changes that signify an imminent migraine. These include:​

  • Aura: Auras are nervous system symptoms that are usually visual disturbances, such as flashes of light. Most people experience migraine headaches without aura. These symptoms start gradually and then build up over several minutes. They commonly last between twenty to sixty minutes. Examples of aura include:

    • ​Visual phenomena, such as seeing various shapes, bright spots or flashes of light

    • Loss of vision

    • Pins and needles sensations in your arm or leg

    • Speech or language problems (known as aphasia)

    • Limb weakness (this is a less common symptom)​

  • Attack: A migraine attack usually lasts from four to seventy two hours, but the frequency with which headaches occur varies from person to person. Following are the common symptoms experienced during a migraine attack:

    • ​Pain on one side or both sides of your head

    • Pain that has a pulsating, throbbing quality

    • Sensitivity to light, sounds and sometimes smells​

    • Nausea and vomiting

    • Blurred vision

    • Light-headedness, sometimes followed by fainting

  • Postdrome: This is the final phase, known as postdrome, which occurs after a migraine attack. After the attack you may feel drained and exhausted.​​

If you or a loved one is experiencing sudden, intense headaches or any of the symptoms mentioned above, it is recommended that you consult with a doctor at the Mind and Brain Service Line​ at The Aga Khan University Hospital.​ ​​
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.​

In order to diagnose migraines, your doctor will first obtain a complete medical history. He/she may also recommend other tests, including:

  • Blood tests: these will be done to test for blood vessel problems, infections in your spinal cord or brain, and toxins in your system.

  • Magnetic Resonance Imaging (MRI) scan: this is a type of brain scan which uses strong magnetic fields and radio waves to produce detailed images of the inside of your body. It can be used to detect possible causes of the condition. An MRI scanner is a large tube that contains powerful magnets. You will have to lie inside the tube during the scan and it will produce a picture of your brain.

  • Computerized Tomography (CT) scan: this is an imaging method that creates a two-dimensional image of the brain using X-ray technology.

  • Spinal tap (lumbar puncture): this will be conducted only if your doctor suspects an underlying condition, such as infections or bleeding in your brain. In this procedure, a thin needle is inserted in your lower back to extract a sample of fluid (known as cerebrospinal fluid) for further laboratory analysis.​​

There's no perfect cure for migraines but your symptoms can be managed with medication and care.

Your doctor may ask you to follow some tips to relieve pain. These may include:

  • Staying in a quiet, dark room.

  • Placing cold compresses or use pressure on the painful areas.

  • Taking pain-relieving medications

  • Using NSAIDs (Non-steroidal Anti-inflammatory Medication) to ease 

  • Taking prescription medications to tighten blood vessels.

  • Taking prescription medications to relieve pain and encourage sleep.

  • Using medication to treat related symptoms such as nausea and vomiting.​

Your doctor may also prescribe medications to prevent migraines. These may include:

  • Beta-blockers (cardiovascular drugs, usually used to treat high blood pressure)

  • Antidepressants

  • Ergotamine (this may cause worsened nausea and vomiting) 

  • Antihistamines 

  • Anti-seizure medications​​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.​

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage​

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The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.​