Migraine: Understanding and Managing Attacks

A migraine is a recurring neurovascular disorder characterized by moderate to severe pulsating pain, usually unilateral, lasting 4 to 72 hours. Nausea, vomiting, and sensitivity to light or sound often accompany the pain.

Common triggers

• Hormonal fluctuations (menstrual migraine)
• Sleep deprivation or oversleep
• Skipped meals, dehydration
• Stress and post-stress relaxation
• Specific foods: aged cheese, processed meats, alcohol
• Bright lights or strong smells

Acute treatment

Triptans remain the most effective specific class for moderate to severe attacks when taken early. NSAIDs or paracetamol can suffice for milder crises. Avoid analgesic overuse: more than 10 days per month causes medication-overuse headache.

Prevention

Beta-blockers, topiramate, amitriptyline and the newer anti-CGRP monoclonal antibodies (erenumab, fremanezumab) significantly reduce attack frequency in chronic migraine.

A headache diary for 4 weeks identifies most triggers and dramatically improves treatment.