Overview

A migraine is a neurological condition that causes intense, throbbing headaches—often on one side of the head—along with nausea, sensitivity to light, sound, or smell, and sometimes visual disturbances called Auras.

It’s more than just a headache — migraines can last from a few hours to several days and affect daily life significantly

Phases of a Migraine

1. Prodrome (early warning signs): Fatigue, mood changes, food cravings, neck stiffness.
2. Aura (in some cases): Visual disturbances (flashing lights, blind spots), speech or sensory changes.
3. Headache: Severe pain, often with nausea, vomiting, sensitivity to light/sound/smell.
4. Postdrome: Feeling drained or confused, like a "migraine hangover’’

Symptoms

• Pulsating or throbbing headache (usually one-sided)
• Nausea or vomiting
• Blurred vision or visual aura (flashing lights, zigzag lines)
• Sensitivity to light (photophobia) and sound (phonophobia)
• Dizziness, fatigue, irritability

Causes

Migraines are believed to be caused by a combination of genetic, hormonal, dietary, lifestyle, environmental, physical causes and environmental factors. If a parent has migraines, there's about a 50% chance their child may develop them 

Migraine can be triggered by a variety of factors, which can be categorized into

Hormonal changes such as menstruation, menopause, and the use of birth control pills are common triggers, especially in women.

Dietary factors like consuming aged cheese, chocolate, caffeine, red wine, and foods containing MSG can also provoke migraine episodes.

Lifestyle habits such as skipping meals, dehydration, and lack of sleep often contribute to the onset of migraines.

Environmental factors including bright lights, loud noises, and sudden weather changes can also act as triggers.

Physical strain such as neck tension or overexertion can lead to migraine in sensitive individuals. Identifying and managing these triggers is an important step in preventing migraine attacks.

Psychosomatic Causes of Migraine

Psychosomatic causes of migraine refer to how mental and emotional stressors trigger or worsen migraine attacks. The mind and body are deeply connected, especially through the nervous system and hormones. Migraines are not "just in the head" emotionally—they are very real, physical responses to emotional overload or unresolved psychological patterns.

Chronic Stress

• One of the most common psychosomatic triggers of migraines.
• Stress causes muscle tension, hormone imbalances, and nervous system overload.
• Often leads to "stress hangovers" where migraines occur after tension releases.

Anxiety & Overthinking

• Mental tension and constant worry can overstimulate the brain.
• This creates pressure in the head, sensitivity to stimuli, and poor sleep—all of which can set off migraines.

Suppressed Emotions

• Holding in anger, grief, or frustration can manifest as head pressure or recurring pain.
• Psychologically, migraines may act as a "release valve" for repressed emotions.

Perfectionism or Over-Control

• People who are overly self-critical or driven often experience migraines when they feel they are "failing" or not in control.
• This personality pattern can result in internal tension that affects the nervous system.

Emotional Burnout or Exhaustion

• Long-term emotional fatigue from caregiving, work pressure, or relationship strain can lower brain resilience and trigger migraines.

 Psychosomatic Patterns in the Body

• Tension in the neck, shoulders, jaw, or scalp often relates to unexpressed emotional load.
• Migraines often begin with tightness in these areas before spreading to the head.

Diagnoses and management

Diagnosing migraine is mainly clinical, meaning it's based on your symptoms, personal history and family history, and how often the headaches occur. There’s no single lab test or scan that can confirm a migraine, but doctors use structured criteria and rule out other causes to arrive at a diagnosis.

 Medical History (Key Step)

Your doctor will ask detailed questions about:

• Headache pattern (location, type of pain, duration)
• Associated symptoms (nausea, vomiting, aura, light/sound sensitivity)
• Triggers (foods, stress, hormones, sleep issues)
• Family history of migraine
• Impact on daily life and how often it happens

Clinical Criteria (Based on ICHD-3)

To diagnose migraine without aura, most neurologists follow guidelines from the International Classification of Headache Disorders (ICHD). A migraine is likely if you’ve had at least 5 attacks, each lasting 4–72 hours, with two or more of the following:

• One-sided (unilateral) pain
• Pulsating or throbbing pain
• Moderate to severe intensity
• Worsens with physical activity

And at least one of the following:

• Nausea and/or vomiting
• Sensitivity to light and sound

Migraine with Aura (in ~25% people)

Diagnosed when:

• Reversible visual symptoms (flashing lights, zigzag lines, blind spots) occur before the headache
• Aura lasts 5–60 minutes
• Headache follows the aura within 60 minute

Physical and Neurological Exam

Doctors perform a basic exam to check:

• Reflexes, coordination, vision, and muscle strength
• To rule out other neurological conditions like tumors, stroke, or brain infections.

 Investigations (Only If Needed)

If symptoms are unusual or severe, tests may be done to rule out other causes:

• MRI or CT scan – if there's sudden onset, weakness, confusion, or change in usual headache pattern
• EEG – if seizures are suspected
• Blood tests – to rule out infection, inflammation, or anemia

Migraine is diagnosed by recognizing specific symptoms, patterns, and ruling out other conditions. A good doctor or practitioner will look at both physical and emotional factors.

Diagnosis in AYUSH Systems

🔹 Ayurveda:

Migraine is often diagnosed as Ardhavabhedaka, caused by Vata-Pitta imbalance. Diagnosis includes:

• Nadi Pariksha (pulse diagnosis)
• Darshana (observation) – skin, eyes, behavior
• Prashna (questioning) – diet, stress, sleep, dosha triggers

🔹 Yoga/Naturopathy:

Diagnosis involves evaluating lifestyle, posture, stress levels, breath quality, and emotional state (mind-body imbalance).

🔹 Homeopathy:

Takes a detailed mind-body symptom history, including:

• Triggers, personality traits, emotional stress
• Modalities (what worsens/improves the condition)
• Family history

Cure and management

While there is no permanent “one-size-fits-all” cure for migraine, the condition can be effectively managed, reduced, and sometimes completely controlled through a combination of medications, lifestyle changes, and natural therapies. The goal of treatment is to reduce the frequency, intensity, and duration of migraine attacks and to improve quality of life.

There is no universal permanent cure, but many people do become migraine-free with proper care. Some outgrow migraines (especially women post-menopause), while others manage them successfully for life with a multi-system approach.

Migraine can be controlled and sometimes reversed through a combination of modern medicine, AYUSH therapies, stress relief, and personalized lifestyle changes. Early diagnosis and consistent management are key.

Modern treatment

Acute Relief (During an Attack)

• Pain relievers
• Triptans
• Anti-nausea medications
• Caffeine-based combination medicines: Sometimes used for faster relief
• CGRP Inhibitors (Newer Targeted Therapy)

Preventive (Long-term) Treatment

Prescribed if migraines are frequent/severe:

• Beta-blockers
• Anti-seizure drugs
• Antidepressants

These help reduce the number and severity of attacks over time.

 AYUSH-Based Cure and Management

 Ayurveda

Migraine is considered Ardhavabhedaka, linked to Pitta + Vata imbalance.

• Nasya therapy: Nasal drops with Anu taila or Shadbindu taila
• Shirodhara: Warm oil stream on the forehead to calm the nervous system
• Herbs:
• Brahmi (calming, memory enhancer)
• Shankhpushpi (mental clarity)
• Ashwagandha (stress relief)
• Godanti bhasma (traditionally used for migraines)

Side effects

Long-term use of painkillers such as paracetamol, ibuprofen, and other NSAIDs can lead to several complications. One of the most common issues is rebound headaches or medication overuse headaches, where the very medicine intended to relieve pain starts causing more frequent attacks. These medications can also irritate the stomach lining, leading to gastric problems, ulcers, or nausea. Over time, they may harm the kidneys and strain the liver, especially when taken in high doses.

Triptans, which are migraine-specific drugs like sumatriptan and rizatriptan, may cause tightness in the chest or neck, drowsiness, or dizziness with regular use. They are not suitable for individuals with heart disease or high blood pressure, and excessive use can also contribute to medication overuse headaches.

When it comes to preventive medications, each class comes with its own risks. Beta-blockers like propranolol may cause fatigue, cold hands and feet, and sometimes low mood or depression, particularly in those sensitive to emotional changes.

Antidepressants such as amitriptyline can lead to weight gain, dry mouth, constipation, and drowsiness.

Meanwhile, anti-seizure medications like topiramate and valproate are linked to brain fog, tingling sensations, weight changes, and in some cases, more serious concerns like liver toxicity or kidney stones.

Newer medications like CGRP inhibitors (e.g., erenumab) are generally well-tolerated but may cause constipation, muscle pain, and rarely, allergic reactions. Their long-term safety is still being studied, and they are often expensive.

It is important to know that relying heavily on migraine medications over a long period can result in drug dependency, reduced effectiveness, and withdrawal symptoms if stopped abruptly. It may also mask the underlying triggers or root causes of migraine. To reduce these risks, it is helpful to combine medication with natural therapies such as Ayurvedic herbs, yoga, pranayama, and nasya treatments, Past life regression therapy along with a healthy lifestyle focused on diet, hydration, sleep, and stress management.

Top 5 Modalities to Treat Migraine

Modern Medicine (Allopathy – Acute + Preventive)

Best for: Quick pain relief, severe attacks, and reducing frequency
How it helps:

• Acute phase: Painkillers, Triptans , and anti-nausea medications
• Preventive treatment: Beta-blockers, antidepressants, anticonvulsants, or CGRP inhibitors for frequent migraines
  Ideal when: Attacks are frequent or disabling and need quick, targeted relief

Ayurveda (Dosha Balancing + Detox Therapies)

Best for: Long-term root cause healing (Pitta-Vata imbalance)
How it helps:

• Nasya therapy (medicated nasal oil drops like Anu Taila)
• Shirodhara (medicated oil poured over forehead to calm the mind)
• Herbs: Brahmi, Shankhpushpi, Ashwagandha, Godanti Bhasma
  Ideal when: Migraine is linked to stress, poor digestion, or hormonal imbalances

 Yoga & Pranayama (Mind-Body Balancing)

Best for: Nervous system relaxation, stress relief, and prevention
How it helps:

• Poses: Balasana, Shavasana, Viparita Karani
• Breathing: Anulom-Vilom, Bhramari, Nadi Shodhana
• Helps reduce attack frequency by calming the brain and stabilizing energy flow
  Ideal when: Stress, anxiety, or irregular lifestyle is a trigger.

 Homeopathy (Individualized Remedy Matching)

Best for: Gentle, long-term constitutional correction
How it helps:

• Based on symptom patterns, personality, and emotional triggers
• Common remedies: Belladonna (sudden, throbbing pain), Iris versicolor (migraine with vomiting), Sanguinaria (right-sided pain)
  Ideal when: Conventional medicines don’t work or have side effects

Lifestyle & Diet Therapy (Foundational Support)

Best for: Preventing recurrence and enhancing all other treatments
How it helps:

• Identifying and avoiding triggers (like chocolate, wine, sleep loss, or dehydration)
• Following a Pitta- and Vata-balancing diet
• Creating a balanced daily routine with fixed meals and sleep schedule
  Ideal when: You want to reduce dependency on medications and prevent long-term flare-ups.

Prevention

The most effective approach to migraine combines symptom relief (modern medicine) with root-cause healing and prevention (AYUSH, lifestyle, and mind-body practices). A multi-modality treatment plan is often the most successful.

Most Effective Treatment:

Integrative Lifestyle Management

 Why?
Migraine is a lifestyle-sensitive neurological condition. The most effective long-term strategy is a combination of proper sleep, diet, hydration, stress management, and trigger avoidance. This approach:

• Prevents attacks before they begin
• Enhances the success of any other modality (Ayurveda, Allopathy, etc.)
• Has no side effects, improves overall health, and targets the root cause

What it includes:

• Regular meals and sleep schedule
• Hydration and a Pitta-Vata calming diet
• Avoidance of trigger foods (e.g., caffeine, aged cheese, chocolate)
• Daily practices like yoga, pranayama, or meditation

 Difference between Migraine and Trigeminal Neuralgia

Here's a clear comparison between Migraine and Trigeminal Neuralgia, focusing on symptoms, triggers, causes, duration, and treatment approaches:

Migraine is a neurological condition characterized by recurrent, throbbing headaches, typically affecting one side of the head, such as the forehead, temple, or area around the eyes. The pain can last from 4 to 72 hours and is often accompanied by nausea, vomiting, and sensitivity to light and sound. Some people may experience an aura—visual disturbances or sensory symptoms—before the headache begins. Migraine usually develops gradually, following phases like prodrome (early warning signs), aura, the main headache, and postdrome (recovery phase). It is more common in women, especially those with hormonal fluctuations. Triggers often include stress, lack of sleep, specific foods, hormonal changes, or environmental factors. The cause is thought to be related to neurovascular dysfunction, inflammation, and genetic predisposition. Diagnosis is primarily clinical, sometimes supported by MRI if symptoms are unusual. Treatment includes painkillers, triptans, and preventive medications, along with lifestyle modifications, Ayurveda, Yoga, and other AYUSH approaches. With consistent management, migraines can be significantly controlled, and in some cases, people may even outgrow them.

In contrast, Trigeminal Neuralgia is a chronic pain condition that affects the trigeminal nerve, which supplies sensation to the face. It is marked by sudden, sharp, stabbing, or electric-shock-like pain on one side of the face, typically around the jaw, cheek, lips, gums, or eyes. These episodes are usually very brief—lasting seconds to a few minutes—but can occur repeatedly throughout the day. The pain often starts abruptly and can be triggered by everyday activities such as brushing the teeth, talking, chewing, or exposure to cold air. Trigeminal neuralgia is more common in women over the age of 50 and is typically caused by compression of the nerve by a blood vessel or occasionally due to a tumor or multiple sclerosis. Diagnosis is clinical but usually confirmed with MRI to rule out structural causes. Treatment primarily involves anticonvulsant medications like carbamazepine, and in severe or unresponsive cases, surgical options may be considered. While AYUSH systems may offer some supportive relief, especially in managing stress and improving nerve health, their role is more limited compared to their effectiveness in migraine management.

In summary, while both conditions involve pain in the head or face, migraine is a brain-based vascular condition with systemic symptoms, whereas trigeminal neuralgia is a nerve-based disorder causing brief but extremely intense facial pain. Understanding the distinction is crucial for proper diagnosis and treatment.

What is CGRP in Migraine?

CGRP stands for Calcitonin Gene-Related Peptide — a naturally occurring protein in the brain and nervous system that plays a central role in causing migraine headaches.

 How CGRP Works in Migraine

CGRP is a key chemical that causes migraine pain. Modern science now uses CGRP blockers as advanced treatments to prevent and relieve migraine attacks, especially for chronic sufferers.

CGRP stands for Calcitonin Gene-Related Peptide, a neuropeptide that plays a central role in the cause and progression of migraine. It is found in nerve endings within the brain and blood vessels, and is involved in pain transmission, inflammation, and dilation of blood vessels—all key factors in a migraine attack.

 What CGRP Does in Migraine

When a migraine is triggered:

• CGRP is released from the trigeminal nerve.
• It causes widening of blood vessels (vasodilation) in the brain.
• Leads to neurogenic inflammation, which intensifies pain.
• Activates and sensitizes pain pathways, worsening the migraine.

So, excessive release or heightened sensitivity to CGRP is believed to be a major mechanism behind migraine headaches.

CGRP-Based Migraine Treatments (Modern Medicine)

In recent years, CGRP inhibitors have been developed as targeted treatments for both acute relief and prevention of migraine. These are either monoclonal antibodies or small molecule antagonists.

 Types of CGRP Medications:

1. CGRP Receptor Antagonists ("gepants") – used during migraine attacks
• Examples: Ubrogepant, Rimegepant, Atogepant
2. CGRP Monoclonal Antibodies – used for prevention
• Target the CGRP ligand or receptor
• Examples:
• Erenumab (targets the receptor)
• Fremanezumab, Galcanezumab, Eptinezumab (target CGRP molecule)

 Benefits of CGRP-Targeted Therapy

• Specifically designed for migraine mechanism
• Suitable for chronic and treatment-resistant cases
• Fewer systemic side effects compared to older drugs
• Long-acting — some injections are once a month or even quarterly

Possible Side Effects

• Constipation
• Injection site pain
• Fatigue or nausea
• Rare: hypersensitivity reactions

In Summary:

CGRP is a key molecule in the migraine pathway, and blocking it helps reduce both the intensity and frequency of migraine attacks. CGRP-inhibitor therapy is one of the most advanced modern treatments for people with moderate to severe or frequent migraines who don’t respond well to conventional options.

Would you like a comparison between CGRP drugs and AYUSH options in terms of safety and effectiveness?