The headache that cancels plans, darkens rooms and derails careers has a name most sufferers never hear from a doctor: migraine. Affecting an estimated 10 to 15 per cent of Indians, migraine is among the commonest neurological conditions and a leading cause of disability worldwide, yet studies show the majority of Indian migraineurs have never received a diagnosis, treating attacks with over-the-counter painkillers or simply enduring them. Migraine is not just a bad headache; it is a complex brain disorder with effective treatments, and the gap between suffering and care is largely an awareness problem.

What migraine is

Migraine is a disorder of brain excitability, involving waves of altered brain activity, trigeminal nerve activation and inflammatory changes in the meninges. The classic attack unfolds in phases: prodrome, subtle mood, energy or appetite changes hours before; aura, visual disturbances like shimmering zigzags or blind spots, in about a third of patients; the headache phase, typically throbbing, one-sided, moderate to severe, worsened by activity and accompanied by nausea, vomiting and sensitivity to light and sound, lasting 4 to 72 hours; and postdrome, the drained hangover day after. Attacks vary enormously; some people have aura without headache, others have chronic migraine, 15 or more headache days monthly.

Triggers: personal and manageable

• Common triggers: missed meals and dehydration, irregular sleep, stress and the let-down after stress, strong smells, bright or flickering light, weather changes.
• Hormonal: menstrual migraine, timed to the oestrogen drop before periods, affects a large share of women sufferers.
• Dietary: aged cheese, processed meats, alcohol, particularly red wine, and excessive caffeine; but trigger lists are individual, and blanket food bans are discouraged.
• The Indian context: harsh sun exposure, fasting during religious observances, strong perfumes and incense, and erratic meal timings feature prominently in patient histories.
• Trigger management: keep a headache diary for a month; patterns emerge that generic lists miss. Regularity, of sleep, meals and hydration, prevents more attacks than avoidance.

The treatment ladder

Acute treatment aims to abort attacks: simple analgesics and NSAIDs work for mild attacks if taken early; triptans, migraine-specific drugs that constrict the dilated vessels and calm trigeminal activation, are the mainstay for moderate to severe attacks and work best at onset; anti-nausea medicines help when vomiting prevents oral drugs. Preventive treatment is for frequent or disabling migraine: beta-blockers, certain anti-epileptics, tricyclics and calcium-channel blockers are established options, and the newer CGRP-targeting antibodies and gepants, now available in India though expensive, represent a genuine advance with fewer side effects. Non-drug approaches with evidence include biofeedback, regular aerobic exercise, and cognitive behavioural strategies for stress-related attacks.

Medication-overuse headache: the trap

The commonest iatrogenic complication is one patients create innocently: using acute painkillers more than 10 to 15 days a month can transform episodic migraine into chronic daily headache, a condition caused by the treatment itself. Sufferers escalate doses as attacks multiply, not realising the pills drive the cycle. Breaking it requires supervised withdrawal and preventive therapy. Any headache pattern worsening despite increasing painkiller use should prompt medical review, not stronger self-medication.

When to see a neurologist

Seek prompt evaluation for: the worst headache of your life or thunderclap onset; headache with fever, rash or neck stiffness; new headache after 50; headache with weakness, vision loss, confusion or seizure; headache after head injury; or pattern changes in established migraine. See a neurologist routinely if attacks are frequent, disabling, unresponsive to standard treatment, or if you need preventive therapy. Migraine is a clinical diagnosis; scans are for atypical features or red flags, not routine confirmation.

FAQs

Is migraine curable? Not curable, but highly manageable; many patients achieve dramatic reduction in frequency and severity with proper treatment, and attacks often ease with age.

Are migraines dangerous? Migraine itself is rarely dangerous, but migraine with aura carries a small increased stroke risk, relevant to smoking and combined oral contraceptive decisions, worth discussing with your doctor.

Can children get migraine? Yes, often presenting as recurrent abdominal pain or vomiting with headache; paediatric migraine is under-recognised and treatable.

Migraine’s tragedy in India is not lack of treatment but lack of diagnosis: crores endure a treatable neurological disorder as if it were fate or weakness. The diary, the timely triptan, the preventive that halves attack frequency, these are not exotic interventions. They are standard care, awaiting the sufferers who have never been told their headaches have a name.

Compiled by the Khabar 24h Editorial Desk from publicly available sources.